DRUGS ACTING ON THE 10.

Class IA antiarrhythmic agents

CARDIOVASCULAR SYSTEM
have little effect on:

- B. SA node
1.Which of the following clients is at
greatest risk for digitalis toxicity? 11. Which of the following drugs can
cause severe hematologic disorders?
- D. An 80-year-old client with CHF
- D. Procainamide (Pronestyl)
2. Which of the following is a
contraindication for digoxin 12. Which of the following ECG
administration? findings alerts the nurse that the
client needs an antiarrhythmic?
- C. Heart rate below 60
- D. Frequent ventricular ectopy
3. The action of medication is
inotropic when it: 13. When administering an
antiarrhythmic agent, which of the
- C. Increases the force of contraction
following assessment parameters is
4. Which is the most appropriate the most important for the nurse to
action for the nurse to take before evaluate?
administering digoxin?
- A. ECG
- A. Monitor potassium level
14. Which of the following blood
5. The therapeutic drug level for tests will tell the nurse that an
digoxin is: adequate amount of drug is present
in the blood to prevent arrhythmias?
- D. 0.5-2.0 ng/mg
- C. Drug levels
6. Blurred vision or halos are signs of:
15. Which of the following drugs
- B. Digoxin toxicity
should be used only in situations in
7. Amrinone (Inocor) is used for short which the client can be very closely
term therapy for CHF and acts by monitored, such as a critical care
which of the following mechanisms? unit?
- A. Increasing stroke volume and - A. Bretylium (Bretylol)
heart rate
16. The A. digoxin (Lanoxin). toxic
8. Before giving milrinone (Primacor) antiarrhythmic agent is:
by an IV infusion to a client with
- C. Amiodarone (Cordarone)
symptoms of CHF, which of the
following nursing actions is 17. Epinephrine is used to treat
necessary? cardiac arrest and status asthmaticus
because of which of the following
- D. Review medication regimen to
actions?
identify if the client is on IV
furosemide (lasix) - B. Bronchodilation and increased
heart rate, contractility, and
9. Johanna has ventricular ectopy,
conduction.
which of the following drugs is the
first line used to treat her condition? 18. Following A. Electrolyte status.
Norepinephrine (Levophed)
- D. Lidocaine (Xylocaine)
administration, it is essential to the 26. Which of the following effects of
nurse to assess: calcium channel blockers causes a
reduction in blood pressure?
- B. Color and temperature of toes
and fingers - B. Decreased peripheral vascular
resistance
19. Norepinephrine (Levophed) is
contraindicated in which of the 27. Jason James is taking ß blockers,
following conditions? all of the following should be
included in his assessment except:
- A. Hypovolemic shock
- A. Pulmonary function tests
20. When administering dopamine
(Intropin), it is most important for the 28. Routine laboratory monitoring in
nurse to know that: clients taking ß blockers should
include:
- C. The drug cannot be directly
mixed in solutions containing - B. Glucose
bicarbonate or aminophylline
29. Competitive antagonism of which
21. Dobutamine (Dobutrex) improves of the following occurs at ß receptor
cardiac output and is indicated for sites?
use in all of the following
- A. Catecholamines
conditions except:
30. ß blockers should be avoided in
- C. Arrhythmias
which of the following conditions?
22. Conduction defects will most
- A. Bronchoconstriction
likely be an adverse associated with
the use of: 31. As a knowledgeable nurse, you
know that the action of nitrates is:
- A. Verapamil (Isoptin)
- C. Smooth muscle relaxation
23. Which of the following calcium
channel blockers has 32. A 50-year-old client is prescribed
the most potent peripheral smooth to take nitrate each day for his
muscle dilator effect? condition. As a competent nurse, you
know the result of nitrate
- B. Nifedipine (Adalat CC)
administration is
24. Which of the following adverse
- A. Decreased myocardial oxygen
reactions is found more often in
demand
volume-depleted elderly clients?
33. A student nurse is asked to give
- D. Hypotension
an example of a long-acting nitrate.
25. Which of the following calcium He is correct by saying:
channel blockers is used to
- C. Isosorbide PO
counteract or prevent cerebral
vasospasm? 34. When nitrates are administered
early to the acute MI client, the effect
- B. Nimodipine
is:

- C. Reduced mortality
35. When teaching about nitrate 41. Raymund is reviewing
administration, the nurse should cardiovascular drugs for his
instruct the client to: upcoming exam. For a well-prepared
student, he should know that
- A. Change position slowly
vasodilators are agents that:
36. ACEs participate in the renin-
- A. Relax smooth muscles
angiotensin-aldosterone system to
have which of the following 42. As a competent nurse, you are
physiologic effects? aware that vasodilators are used
mainly to treat:
- C. Promote sodium and water
retention. - B. Hypertension

37. Nurse Margie just administered 43. The drug/drugs

an ACE inhibitor to her client. Before used most commonly to treat
ambulating the client for the first peripheral or cerebral vascular
time after administration, the nurse obstructive disease is/are:
should monitor for:
- D. All of the above (pentoxifylline,
- D. Hypotension cyclandelate, isoxsuprine)

38. Mira is managing her 44. In a 50-year-old widower who

hypertension with an ACE inhibitor. had a transient ischemic attack, what
Which of the following statements is the most common vasodilator
stated by her indicates a need for used for his treatment?
further instruction?
- D. Nitroprusside (Nitropress)
- B. “I need to increase my intake or
45 For a client taking drugs to treat
orange juice, bananas, and green
peripheral vascular disease, it is
vegetables”
important to provide health
39. Pepito is a hypertensive client education about:
who has been placed on captopril - D. All of the above (Smoking cessation,
(Capoten). He states, “Dr. del Mundo developing a proper balance between rest
and activity, proper foot care)
keeps changing my pills and none
are working. I feel like a guinea pig.” 46. A clinical instructor asks a nursing
Which of the following responses by student about an aldosterone
the nurse would antagonist. The student is correct by
be most appropriate? saying that aldosterone antagonists:

- D. “This drug is used when other - B. Inhibit the exchange of sodium

drugs have failed” for potassium

40. The action of an ACE inhibitor 47. Which of the following is a

interrupts the renin-angiotensin- potential side effect of IV furosemide
aldosterone mechanism, thereby (Lasix)?
producing which of the following?
- D. Hearing loss
- D. Increased sodium excretion and
48. A 68-year-old client with a history
potassium reabsorption
of mild CHF and glaucoma is
receiving IV mannitol (Osmitrol) to
decrease intraocular pressure. The - B. Abdominal fat
nurse would monitor the client for
58. The half-life of heparin is:
signs and symptoms of:
- B. 1 to 1.5 hours
- A. Fluid volume excess
59. Which drug is used to stop
49. All potassium-sparing diuretics:
bleeding associated with heparin
- D. Are weak diuretics overdose?

50. Which of the following clients - C. Protamine sulfate (Protamine)

is most likely to experience adverse
60. During the warfarin (Coumadin)
effects from treatment with diuretics?
administration, the nurse can expect
- D. A 75-year-old man that the initial extension of PT occurs
within how many hours after therapy
51. Kylie is reviewing drugs related to
begins?
cardiovascular therapies. She should
be aware that the desired action of - C. 8 to 12
lipid-lowering agents is to:
61. A nurse is providing instructions
- D. Increase high-density lipoprotein to a client who is receiving warfarin
(HDL) sodium (Coumadin). Which
statement made by the client
52. For lipid-lowering agents to be
indicates the need for further
successful, drug therapy must lower:
instruction?
- B. LDL
- B. “I will take Ecotrin for my
53. As a competent nurse, you know headaches”
that the most significant
62. A nurse is caring for a client
contraindication for therapy with
receiving a heparin intravenous (IV)
lipid-lowering agent is:
infusion. The nurse expects that
- C. Liver disease which of the following laboratory will
54. Which of the following vitamins be prescribed to monitor the
may not be absorbed properly when therapeutic effect of heparin?
giving bile acid sequestrants? - B. Activated partial thromboplastin
- D. Vitamin K time (aPTT)

55. Which of the following lipid- 63. A client with atrial fibrillation is
lowering agents has the common receiving a continuous heparin
side effect of constipation? infusion at 1,000 units/hr. The nurse
observes that the client is receiving
- A. Lovastatin (Mevacor) the therapeutic effect based on which
56. Parenteral anticoagulants work by of the following results?
disrupting: - B. Activated partial thromboplastin
- B. Conversion of prothrombin to time of 60 seconds
thrombin 64. A client is receiving intravenous
57. SC heparin should be heparin therapy. The nurse ensures
administered in the:
the availability of which of the activator, alteplase (Activase, tPA).
following medication? While on the therapy, the nurse plans
to prioritize which of the following?
- D. Protamine sulfate
- D. Observe for signs of bleeding
65. A client is receiving a continuous
infusion of streptokinase (Streptase). 71. A nurse is caring for a client who
The client suddenly complains of a is taking digoxin (Lanoxin) 0.25mcg
difficulty of breathing, itchiness, and tab once a day. The client suddenly
nausea. Which of the following complaints of anorexia, nausea,
should be the priority action of the vomiting, and diarrhea. The physician
nurse? is ruling a digoxin toxicity. As a nurse,
you know the therapeutic digoxin
- A. Stop the infusion and notify the
rate is?
physician.
- B. 0.5-2 ng/ml
66. A client with deep vein
thrombosis is receiving Streptokinase 72. A nurse is monitoring a client who
(Streptase). The nurse would notify is taking carvedilol (Coreg CR). Which
the physician if which of the of the following assessment made by
following assessments is noted? the nurse would warrant a possible
complication with the use of this
- D. A blood pressure of 185/110
medication?
mmHg
- D. Complaints of dyspnea
67. A client who is receiving
streptokinase therapy suddenly had a 73. A nurse is interviewing a client
nosebleed. The nurse ensures the who is about to receive metoprolol.
availability of which of the following Upon the history taking, the client is
medication? also taking insulin. Which of the
following statements made by the
- C. Aminocaproic acid (Amicar)
nurse will correctly explain the
68. A nurse is providing health possible interaction of these
teachings regarding antiplatelet medications?
medications. Which of the following
- C. “This medication may mask some
is not true regarding the use of this
of the symptoms of hypoglycemia
medication?
such as tremor, palpitation, and rapid
- B. Antiplatelet medications cannot heartbeat”
be used with anticoagulants
74. A client is about to receive
69. A client is receiving procainamide metolazone (Zaroxolyn). The nurse in
(Procanbid) for the treatment of charge understands which of the
ventricular arrhythmia. The client following laboratory results are
suddenly complains of nausea and related to the administration of the
drowsiness. Which of the intervention medication?
should the nurse do first?
- D. Hypokalemia and hyperglycemia
- A. Check BP and HR
75. A client with congestive heart
70. A client with myocardial infarction failure is being treated with
is receiving tissue plasminogen torsemide (Demadex). The nurse
obtains the following vital signs: made by the nurse indicates a
Blood pressure of 100/65 mm hg; further immediate action?
pulse rate of 91 beats per minute;
- C. The client still complains of chest
and respiration of 25 breaths per
pain with a pain scale of 2/10.
minute? Which of the following will
be the priority assessment of the
nurse after the initiation of the dose? DRUGS ACTING ON THE
- C. Blood pressure GASTROINTESTINAL SYSTEM

76. A nurse is giving instruction to a 1. The nurse is giving instructions to a

client who is receiving client receiving cholestyramine
cholestyramine (Questran) for the (Prevalite). Which statement made by
treatment of hyperlipidemia. Which the client indicates a need for further
of the following statements made by teachings?
the client indicates the need for - C. “I will sip the cholestyramine
further instructions? powder for a long time for faster
- C. “I will take my Vitamin A 30 absorption”
minutes after cholestyramine” 2. Which of the following conditions
77. A nurse is providing instructions can you safely administer
to a client who is on nicotinic acid for metoclopramide (Reglan)?
the treatment of hyperlipidemia. - C. Patient undergoing radiation
Which statement made by the nurse
indicates a comprehension of the 3. A client has been taking Ibuprofen
instructions? for a while and was given
misoprostol (Cytotec). Which of the
- A. “I should take aspirin 30 minutes following is exhibiting the
before nicotinic acid” therapeutic effect of Cytotec?
78. A nurse is monitoring a client who - D. Relief of gastric ulcer
is taking digoxin (Lanoxin). All of
which are the side effects associated 4. A geriatric patient is prescribed
with the medication, except? with cimetidine (Tagamet) for the
treatment of heartburn. Which of the
- D. Tremors following is the most frequent CNS
79. A nurse is interviewing a patient side effect of the medication?
who is about to receive bumetanide - A. Agitation
(Bumex). Which of the following is a
concern related to the administration 5. A nurse is administering an IV
of the medication? bolus of cimetidine (Tagamet). Which
of the following should the nurse
- B. Sulfa allergy monitor closely follow the
80. A client arrives in the emergency administration?
with complaints of chest pain and is - C. Blood pressure
diagnosed with acute MI. A morphine
4mg IV was given 5 minutes ago. 6. A client has been given loperamide
Which of the following assessments hydrochloride (Imodium). Which of
the following conditions is the - C. “It will decrease your diarrhea
medication indicated for? and your bowel can rest”

- B. Patients with an ileostomy 12. A client is receiving sulfasalazine

(Azulfidine) for the treatment of
7. A client has been given
ulcerative colitis. Which of the
ondansetron (Zofran). For which of
following assessment findings will
the following post-operative
concern the nurse most?
condition should the nurse
administer this medication? - B. Decreased urine output

- D. Vomiting 13. A client has been prescribed

sucralfate (Carafate) for the treatment
8. A client with a duodenal ulcer is
of gastric ulcers. The nurse instructs
diagnosed with H. pylori infection.
the client that this medication is
The physician prescribed amoxicillin
taken?
(Wymox), pantoprazole (Prevacid),
and clarithromycin (Biaxin). Which - A. 1 hour before meals
statement made by the nurse
14. Tincture of opium is given to a
correctly explains the purpose of
patient who is having diarrheal
these medications?
episodes. Which of the following is
- B. “These medicines will stop the true regarding this medication?
acid production and will kill the
- C. Has an unpleasant taste and it
bacteria”
can be diluted with 15-30 ml water
9. A patient with Crohn’s disease is
15. A nurse is giving medicine
receiving an infusion therapy of
instructions to a client with
infliximab (Remicade). Which of the
hemorrhoids who is receiving a
following should the nurse do while
Mineral oil. Which of the following
the patient is on this medication?
statements made by the client
- C. Monitoring the frequency and indicates further teaching?
consistency of bowel movements
- D. “I can use mineral oil liquid for an
10. A client has been prescribed with extended period to prevent further
pancrelipase (Pancrease). Which of damage”
the following symptoms would
16. A nurse is giving discharge
prompt the nurse that the medication
instructions to a client who is
is having its therapeutic effect if
receiving a bulk-forming laxative as
which of the following is noted?
part of the home medications. All of
- D. Reduction of excess fat in feces which are examples of bulk-forming
laxative, except?
11. A nurse is giving nothing per
orem instructions to a malnourished - A. Docusate sodium (Colace
client with diarrhea and frequent
17. A client with a history of chest
abdominal pain episodes who is
pain is admitted to irritable bowel
about to receive a Total Parenteral
syndrome. As a nurse, which of the
Nutrition. Which statement made by
following medicines will
the nurse is the most appropriate?
you least expect to be a part of the 25. Hydrochloric acid secretion is
medical management? blocked by which of the following
categories of drugs?
- B. Tegaserod (Zelnorm)
- C. Histamine-2-antagonists
18. What is the priority nursing
intervention for a client receiving 26. Which category of drugs
antiemetic? prevents/treats constipation by the
osmotic drawing of water from
- D. Keep bed in low position with
extravascular space to intestinal
side rails up.
lumen?
19. An osmotic laxative will be
- C. Hyperosmotic agents
prescribed for a client. The nurse
understands which medications are 27. Which of the following is a bulk-
osmotic laxative? Select all that forming agent?
apply
- B. FiberCon
- C. Polyethylene glycol and
28. A client needs rapid cleansing of
electrolytes; D. Sodium Phosphate
the bowel, which category
20. Which of the following is best used?
statements best describes the action
- D. Saline laxatives with magnesium
of antacids?
29. Which of the following categories
- A. Antacids neutralize gastric acid
is used for diarrhea and constipation?
21. Jam is under chemotherapy in
- A. Bulk-forming agents
which nausea is an expected side
effect. Which of the following drugs 30. Which of the following may be
is indicated to prevent such side used for bowel preparation and is not
effects? recommended for the treatment of
constipation?
- A. metoclopramide
- Castor oil
22. Which of the following drugs will
reduce the effectiveness of
sucralfate?

- A. Ranitidine

23. Extrapyramidal symptoms are a

side effect of which of the following
drugs?

- D. Metoclopramide

24. Which histamine-2 antagonist is

associated with the most drug
interactions?

- B. Cimetidine
 NCLEX Questions: GI
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A 74-year-old female patient with gastroesophageal reflux dis-
ease (GERD) takes over-the-counter medications. For which c. Omeprazole (Prilosec)
medication, if taken long-term, should the nurse teach about an
increased risk of fractures? There is a potential link between proton pump inhibitors (PPIs)
(e.g., omeprazole) use and bone metabolism. Long-term use or
a. Sucralfate (Carafate) high doses of PPIs may increase the risk of fractures of the hip,
b. Cimetidine (Tagamet) wrist, and spine. Lower doses or shorter duration of therapy should
c. Omeprazole (Prilosec) be considered.
d. Metoclopramide (Reglan)
Following administration of a dose of metoclopramide (Reglan) to
the patient, the nurse determines that the medication has been c. Relief of nausea and vomiting
effective when what is noted?
Metoclopramide is classified as a prokinetic and antiemetic med-
a. Decreased blood pressure ication. If it is effective, the patient's nausea and vomiting should
b. Absence of muscle tremors resolve. Metoclopramide does not affect blood pressure, muscle
c. Relief of nausea and vomiting tremors, or diarrhea.
d. No further episodes of diarrhea
The patient receiving chemotherapy rings the call bell and reports c. Ondansetron (Zofran)*
the onset of nausea. The nurse should prepare an as-needed
dose of which medication? Ondansetron is a 5-HT3 receptor antagonist antiemetic that is
especially effective in reducing cancer chemotherapy-induced
a. Morphine sulfate nausea and vomiting. Morphine sulfate may cause nausea and
b. Zolpidem (Ambien) vomiting. Zolpidem does not relieve nausea and vomiting. Dex-
c. Ondansetron (Zofran) amethasone is usually used in combination with ondansetron for
d. Dexamethasone (Decadron) acute and chemotherapy-induced emesis.
The patient who is admitted with a diagnosis of diverticulitis and
a history of irritable bowel disease and gastroesophageal reflux
b. Heartburn
disease (GERD) has received a dose of Mylanta 30 mL PO. The
nurse should evaluate its effectiveness by questioning the patient
Mylanta is an antacid that contains both aluminum and magne-
as to whether which symptom has been resolved?
sium. It is indicated for the relief of GI discomfort, such as heart-
burn associated with GERD. Mylanta can cause both diarrhea
a. Diarrhea
and constipation as a side effect. Mylanta does not affect lower
b. Heartburn
abdominal pain.
c. Constipation
d. Lower abdominal pain
A patient complains of nausea. When administering a dose of
metoclopramide (Reglan), the nurse should teach the patient to a. Tremors
report which potential adverse effect?
Extrapyramidal side effects, including tremors and tardive dysk-
a. Tremors inesias, may occur as a result of metoclopramide (Reglan) ad-
b. Constipation ministration. Constipation, double vision, and numbness in fingers
c. Double vision and toes are not adverse effects of metoclopramide.
d. Numbness in fingers and toes
The nurse determines that a patient has experienced the ben-
eficial effects of therapy with famotidine (Pepcid) when which c. Epigastric pain
symptom is relieved?
Famotidine is an H2-receptor antagonist that inhibits parietal cell
a. Nausea output of HCl acid and minimizes damage to gastric mucosa
b. Belching related to hyperacidity, thus relieving epigastric pain. Famotidine
c. Epigastric pain is not indicated for nausea, belching, and dysphagia.
d. Difficulty swallowing
A patient with a history of peptic ulcer disease has presented to
the emergency department reporting severe abdominal pain and
a. Providing IV fluids and inserting a nasogastric (NG) tube
has a rigid, boardlike abdomen that prompts the health care team
to suspect a perforated ulcer. What intervention should the nurse
A perforated peptic ulcer requires IV replacement of fluid losses
anticipate?
and continued gastric aspiration by NG tube. Nothing is given by
mouth, and gastric pH testing is not a priority. Calcium gluconate
a. Providing IV fluids and inserting a nasogastric (NG) tube
is not a medication directly relevant to the patient's suspected
b. Administering oral bicarbonate and testing the patient's gastric
pH level

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c. Performing a fecal occult blood test and administering IV calci-
um gluconate diagnosis, and parenteral nutrition is not a priority in the short
d. Starting parenteral nutrition and placing the patient in a term.
high-Fowler's position
The results of a patient's recent endoscopy indicate the presence
of peptic ulcer disease (PUD). Which teaching point should the
b. "It would likely be beneficial for you to eliminate drinking alco-
nurse provide to the patient based on this new diagnosis?
hol."
a. "You'll need to drink at least two to three glasses of milk daily."
Alcohol increases the amount of stomach acid produced so it
b. "It would likely be beneficial for you to eliminate drinking alco-
should be avoided. Although there is no specific recommended
hol."
dietary modification for PUD, most patients find it necessary to
c. "Many people find that a minced or pureed diet eases their
make some sort of dietary modifications to minimize symptoms.
symptoms of PUD."
Milk may exacerbate PUD.
d. "Your medications should allow you to maintain your present
diet while minimizing symptoms."
A female patient has a sliding hiatal hernia. What nursing inter-
c. Have the patient eat 4 to 6 smaller meals each day.
ventions will prevent the symptoms of heartburn and dyspepsia
that she is experiencing?
Eating smaller meals during the day will decrease the gastric
pressure and the symptoms of hiatal hernia. Keeping the patient
a. Keep the patient NPO.
NPO or in a Trendelenberg position are not safe or realistic for a
b. Put the bed in the Trendelenberg position.
long period of time for any patient. Varying antacids will only be
c. Have the patient eat 4 to 6 smaller meals each day.
done with the care provider's prescription, so this is not a nursing
d. Give various antacids to determine which one works for the
intervention.
patient.
d. Rigid abdomen and vomiting following indigestion
A 72-year-old patient was admitted with epigastric pain due to
A rigid abdomen with vomiting in a patient who has a gastric ulcer
a gastric ulcer. Which patient assessment warrants an urgent
indicates a perforation of the ulcer, especially if the manifesta-
change in the nursing plan of care?
tions of perforation appear suddenly. Midepigastric pain is relieved
by eating, drinking water, or antacids with duodenal ulcers, not
a. Chest pain relieved with eating or drinking water
gastric ulcers. Back pain 3-4 hours after a meal is more likely to
b. Back pain 3 or 4 hours after eating a meal
occur with a duodenal ulcer. Burning epigastric pain 1-2 hours
c. Burning epigastric pain 90 minutes after breakfast
after a meal is an expected manifestation of a gastric ulcer related
d. Rigid abdomen and vomiting following indigestion
to increased gastric secretions and does not cause an urgent
change in the nursing plan of care.
The patient with chronic gastritis is being put on a combination of
medications to eradicate H. pylori. Which drugs does the nurse c. Antibiotic(s), proton pump inhibitor, and bismuth
know will probably be used for this patient?
To eradicate H. pylori, a combination of antibiotics, a proton pump
a. Antibiotic(s), antacid, and corticosteroid inhibitor, and possibly bismuth (for quadruple therapy) will be
b. Antibiotic(s), aspirin, and antiulcer/protectant used. Corticosteroids, aspirin, and NSAIDs are drugs that can
c. Antibiotic(s), proton pump inhibitor, and bismuth cause gastritis and do not affect H. pylori.
d.Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
The patient is having a gastroduodenostomy (Billroth I operation) c. Dumping syndrome
for stomach cancer. What long-term complication is occurring
when the patient reports generalized weakness, sweating, pal- After a Billroth I operation, dumping syndrome may occur 15 to 30
pitations, and dizziness 15 to 30 minutes after eating? minutes after eating because of the hypertonic fluid going to the
intestine and additional fluid being drawn into the bowel. Malnu-
a. Malnutrition trition may occur but does not cause these symptoms. Bile reflux
b. Bile reflux gastritis gastritis cannot happen when the stomach has been removed.
c. Dumping syndrome Postprandial hypoglycemia occurs with similar symptoms, but 2
d. Postprandial hypoglycemia hours after eating.
d. Don gloves and gown before entering the patient's room
The nurse is admitting a 68-year-old man with severe dehydration
and frequent watery diarrhea. He just completed a 10-day out-
Clostridium difficile is an antibiotic-associated diarrhea transmit-
patient course of antibiotic therapy for bacterial pneumonia. It is
ted by contact, and the spores are extremely difficult to kill. Pa-
most important for the nurse to take which action?
tients with suspected or confirmed infection with C. difficile should
be placed in a private room and gloves and gowns should be
a. Wear a mask to prevent transmission of infection.
worn by visitors and health care providers. Alcohol-based hand
b. Wipe equipment with ammonia-based disinfectant.
cleaners and ammonia-based disinfectants are ineffective and do

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not kill all of the spores. Equipment cannot be shared with other
c. Instruct visitors to use the alcohol-based hand sanitizer. patients, and a disposable stethoscope and individual patient
d. Don gloves and gown before entering the patient's room thermometer are kept in the room. Objects should be disinfected
with a 10% solution of household bleach.
After an abdominal hysterectomy, a 45-year-old woman com-
plains of severe gas pains. Her abdomen is distended. It is most d. Metoclopramide (Reglan)
appropriate for the nurse to administer which prescribed medica-
tion? Swallowed air and reduced peristalsis after surgery can result
in abdominal distention and gas pains. Early ambulation helps
a. Morphine sulfate restore peristalsis and eliminate flatus and gas pain. Medications
b. Ondansetron (Zofran) used to reduce gas pain include metoclopramide (Reglan) or
c. Acetaminophen (Tylenol) alvimopan (Entereg) to stimulate peristalsis.
d. Metoclopramide (Reglan)
The nurse identifies that which patient is at highest risk for devel- b. A 32-year-old female with a 12-year history of ulcerative colitis
oping colon cancer?
Risk for colon cancer includes personal history of inflammatory
a. A 28-year-old male who has a body mass index of 27 kg/m2 bowel disease (especially ulcerative colitis for longer than 10
b. A 32-year-old female with a 12-year history of ulcerative colitis years); obesity (body mass index e 30 kg/m2); family (first-degree
c. A 52-year-old male who has followed a vegetarian diet for 24 relative) or personal history of colorectal cancer, adenomatous
years polyposis, hereditary nonpolyposis colorectal cancer syndrome;
d. A 58-year-old female taking prescribed estrogen replacement red meat (=7 servings/week); cigarette use; and alcohol (=4
therapy drinks/week).
A 58-year-old woman is being discharged home today after osto-
my surgery for colon cancer. The nurse should assign the patient
c. A registered nurse with 6 months of experience on the surgical
to which staff member?
unit
a. A nursing assistant on the unit who also has hospice experience
The patient needs ostomy care directions/reinforcement at dis-
b. A licensed practical nurse who has worked on the unit for 10
charge and should be assigned to a registered nurse with expe-
years
rience in providing discharge teaching for ostomy care. Teaching
c. A registered nurse with 6 months of experience on the surgical
should not be delegated to a licensed practical/vocational nurse
unit
or unlicensed assistive personnel.
d. A registered nurse who has floated to the surgical unit from
pediatrics
a. Maintain a high intake of fluid and fiber in the diet.
The nurse is conducting discharge teaching for a patient with
metastatic lung cancer who was admitted with a bowel impaction. Increased fluid intake and a high-fiber diet reduce the incidence of
Which instructions would be most helpful to prevent further constipation caused by immobility, medications, and other factors.
episodes of constipation? Fluid and fiber provide bulk that in turn increases peristalsis and
bowel motility. Analgesics taken for lung cancer probably cannot
a. Maintain a high intake of fluid and fiber in the diet. be reduced. Other medications may decrease constipation, but it
b. Reduce intake of medications causing constipation. is best to avoid laxatives. Eating several small meals per day and
c. Eat several small meals per day to maintain bowel motility. position do not facilitate bowel motility. Defecation is easiest when
d. Sit upright during meals to increase bowel motility by gravity. the person sits on the commode with the knees higher than the
hips.
The nurse should administer an as-needed dose of magnesium
b. No bowel movement for 3 days
hydroxide (MOM) after noting what information while reviewing a
patient's medical record?
MOM is an osmotic laxative that produces a soft, semisolid stool
usually within 15 minutes to 3 hours. This medication would benefit
a. Abdominal pain and bloating
the patient who has not had a bowel movement for 3 days. MOM
b. No bowel movement for 3 days
would not be given for abdominal pain and bloating, decreased
c. A decrease in appetite by 50% over 24 hours
appetite, or signs of hypomagnesemia.
d. Muscle tremors and other signs of hypomagnesemia
The nurse is preparing to administer a dose of bisacodyl (Dulco- d. Increases peristalsis by stimulating nerves in the colon wall
lax). In explaining the medication to the patient, the nurse would
explain that it acts in what way? Bisacodyl is a stimulant laxative that aids in producing a bow-
el movement by irritating the colon wall and stimulating enteric
a. Increases bulk in the stool nerves. It is available in oral and suppository forms. Fiber and
b. Lubricates the intestinal tract to soften feces bulk forming drugs increase bulk in the stool; water and stool
c. Increases fluid retention in the intestinal tract softeners soften feces, and saline and osmotic solutions cause
d. Increases peristalsis by stimulating nerves in the colon wall fluid retention in the intestinal tract.

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The nurse is caring for a 68-year-old patient admitted with abdom-
inal pain, nausea, and vomiting. The patient has an abdominal d. High-pitched and hyperactive above the area of obstruction
mass, and a bowel obstruction is suspected. The nurse auscul-
tating the abdomen listens for which type of bowel sounds that Early in intestinal obstruction, the patient's bowel sounds are
are consistent with the patient's clinical picture? hyperactive and high-pitched, sometimes referred to as "tinkling"
above the level of the obstruction. This occurs because peristaltic
a. Low-pitched and rumbling above the area of obstruction action increases to "push past" the area of obstruction. As the ob-
b. High-pitched and hypoactive below the area of obstruction struction becomes complete, bowel sounds decrease and finally
c. Low-pitched and hyperactive below the area of obstruction become absent.
d. High-pitched and hyperactive above the area of obstruction
The nurse is planning care for a 68-year-old patient with an
abdominal mass and suspected bowel obstruction. Which factor
b. History of colorectal polyps
in the patient's history increases the patient's risk for colorectal
cancer?
A history of colorectal polyps places this patient at risk for colorec-
tal cancer. This tissue can degenerate over time and become ma-
a. Osteoarthritis
lignant. Osteoarthritis, lactose intolerance, and the use of herbs
b. History of colorectal polyps
do not pose additional risk to the patient.
c. History of lactose intolerance
d. Use of herbs as dietary supplements
The nurse is preparing to insert a nasogastric (NG) tube into a
68-year-old female patient who is nauseated and vomiting. She
has an abdominal mass and suspected small intestinal obstruc-
a. "The tube will help to drain the stomach contents and prevent
tion. The patient asks the nurse why this procedure is necessary.
further vomiting."
What response by the nurse is most appropriate?
The NG tube is used to decompress the stomach by draining
a. "The tube will help to drain the stomach contents and prevent
stomach contents and thereby prevent further vomiting. The NG
further vomiting."
tube will not push past the blocked area. Potential surgery is not
b. "The tube will push past the area that is blocked and thus help
currently indicated. The location of the obstruction will determine
to stop the vomiting."
the type of fluid to use, not measure the amount of stomach
c. "The tube is just a standard procedure before many types of
contents.
surgery to the abdomen."
d. "The tube will let us measure your stomach contents so that we
can plan what type of IV fluid replacement would be best."
b. How to deep breathe and cough

What information would have the highest priority to be included Because anesthesia, an abdominal incision, and pain can impair
in preoperative teaching for a 68-year-old patient scheduled for a the patient's respiratory status in the postoperative period, it is
colectomy? of high priority to teach the patient to cough and deep breathe.
Otherwise, the patient could develop atelectasis and pneumonia,
a. How to care for the wound which would delay early recovery from surgery and hospital dis-
b. How to deep breathe and cough charge. Care for the wound and location and care of the drains
c. The location and care of drains after surgery will be briefly discussed preoperatively, but done again with higher
d. Which medications will be used during surgery priority after surgery. Knowing which drugs will be used during
surgery may not be meaningful to the patient and should be
reviewed with the patient by the anesthesiologist.
The nurse asks a 68-year-old patient scheduled for colectomy to
sign the operative permit as directed in the physician's preoper-
ative orders. The patient states that the physician has not really
explained very well what is involved in the surgical procedure.
d. Delay the patient's signature on the consent and notify the
What is the most appropriate action by the nurse?
physician about the conversation with the patient.
a. Ask family members whether they have discussed the surgical
The patient should not be asked to sign a consent form unless the
procedure with the physician.
procedure has been explained to the satisfaction of the patient.
b. Have the patient sign the form and state the physician will visit
The nurse should notify the physician, who has the responsibility
to explain the procedure before surgery.
for obtaining consent.
c. Explain the planned surgical procedure as well as possible and
have the patient sign the consent form.
d. Delay the patient's signature on the consent and notify the
physician about the conversation with the patient.
Two days following a colectomy for an abdominal mass, a patient
reports gas pains and abdominal distention. The nurse plans care
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for the patient based on the knowledge that the symptoms are a. impaired peristalsis.
occurring as a result of
Until peristalsis returns to normal following anesthesia, the patient
a. impaired peristalsis. may experience slowed gastrointestinal motility leading to gas
b. irritation of the bowel. pains and abdominal distention. Irritation of the bowel, nasogastric
c. nasogastric suctioning. suctioning, and inflammation of the surgical site do not cause gas
d. inflammation of the incision site. pains or abdominal distention.
The nurse is caring for a postoperative patient with a colostomy.
The nurse is preparing to administer a dose of famotidine (Pepcid)
when the patient asks why the medication was ordered since the
patient does not have a history of heartburn or gastroesophageal d. "This will reduce the amount of HCl in the stomach until the
reflux disease (GERD). What response by the nurse would be the nasogastric tube is removed and you can eat a regular diet again."
most appropriate?
Famotidine is an H2-receptor antagonist that inhibits gastric HCl
a. "This will prevent air from accumulating in the stomach, causing secretion and thus minimizes damage to gastric mucosa while
gas pains." the patient is not eating a regular diet after surgery. Famotidine
b. "This will prevent the heartburn that occurs as a side effect of does not prevent air from accumulating in the stomach or stop the
general anesthesia." stomach from bleeding. Heartburn is not a side effect of general
c. "The stress of surgery is likely to cause stomach bleeding if you anesthesia.
do not receive it."
d. "This will reduce the amount of HCl in the stomach until the
nasogastric tube is removed and you can eat a regular diet again."
Which clinical manifestations of inflammatory bowel disease are
c. Bloody, diarrhea stools
common to both patients with ulcerative colitis (UC) and Crohn's
d. Cramping abdominal pain
disease (select all that apply)?
Clinical manifestations of UC and Crohn's disease include bloody
a. Restricted to rectum
diarrhea, cramping abdominal pain, and nutritional disorders. In-
b. Strictures are common.
testinal lesions associated with UC are usually restricted to the
c. Bloody, diarrhea stools
rectum before moving into the colon. Lesions that penetrate the
d. Cramping abdominal pain
intestine or cause strictures are characteristic of Crohn's disease.
e. Lesions penetrate intestine.
a. "I will be able to regulate when I have stools."
When evaluating the patient's understanding about the care of
The ileostomy is in the ileum and drains liquid stool frequently,
the ileostomy, what statement by the patient indicates the patient
unlike the colostomy which has more formed stool the further
needs more teaching?
distal the ostomy is in the colon. The ileostomy pouch is usually
worn 4-7 days or until it leaks. It must be changed immediately
a. "I will be able to regulate when I have stools."
if it leaks because the drainage is very irritating to the skin.
b. "I will be able to wear the pouch until it leaks."
To avoid obstruction, popcorn, dried fruit, coconut, mushrooms,
c. "Dried fruit and popcorn must be chewed very well."
olives, stringy vegetables, food with skin, and meats with casings
d. "The drainage from my stoma can damage my skin."
must be chewed extremely well before swallowing because of the
narrow diameter of the ileostomy lumen.
When teaching the patient about the diet for diverticular disease,
which foods should the nurse recommend?

a. White bread, cheese, and green beans d. Dried beans, All Bran (100%) cereal, and raspberries
b. Fresh tomatoes, pears, and corn flakes
c. Oranges, baked potatoes, and raw carrots
d. Dried beans, All Bran (100%) cereal, and raspberries

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Before meals and at bedtime. Timed so it can form protective
A client with a gastric ulcer has a prescription for sucralfate 1 g
coating before food intake stimulates gastric acid production and
PO QID. When should the nurse time her administration?
mechanical irritation.
The nurse determines the client needs further instruction on
cimetidine if which statements were made? Select all that apply.
A. "I will take the cimetidine with my meals."
B. "I'll know the medication is working if my diarrhea stops."
C. "My episodes of heartburn will decrease if the medication is
effective."
A, B, D
D. "Taking the cimetidine with an antacid will increase its effec-
tiveness."
E. "I will notify my health care provider if I become depressed or
anxious."
F. "Some of my blood levels will need to be monitored closely since
I also take warfarin for atrial fibrillation."
Dicyclomine hydrochloride has been prescribed for a client with
irritable bowel syndrome, and the nurse provides instructions to
the client about how to take this medication. Which statement, if
made by the client, indicates an understanding of how to take this
Dicyclomine hydrochloride is an anticholinergic, antispasmodic
medication?
agent often used to treat irritable bowel syndrome that is unre-
sponsive to diet therapy. To be effective in decreasing bowel motil-
A. "I should take the pill with food and at mealtimes."
ity, antispasmodic medication should be administered 30 minutes
B. "I should take the pill 30 minutes before each meal."
before meals. The other options are incorrect.
C. "I should take the pill after I have finished eating my meal."
D.
"I should take the pill when I first wake up in the morning and right
before I go to bed."
What medication is used to treat hepatic encephalopathy? lactulose
Mix the medication with a full glass of water or juice. Psyllium
is a bulk-forming laxative that should be taken with a full glass
A client who has had a myocardial infarction has a prescription
of water or juice (not applesauce), followed by another glass of
to take a powdered form of psyllium after discharge. The nurse
liquid. This will help prevent impaction of the medication in the
should plan to include which information when teaching the client
stomach or small intestine. Fiber in the diet and fluid intake should
about this medication?
not be decreased unless specifically prescribed by the health care
provider.
30 minutes before meals and at bedtime
A client admitted to the medical nursing unit has a diagnosis of
Metoclopramide is a gastrointestinal stimulant. Administration
gastroesophageal reflux disease (GERD). Metoclopramide has
should be scheduled 30 minutes before meals and at bedtime to
been prescribed 4 times a day. When should the nurse schedule
allow the medication time to begin working before food intake and
administration of the medication?
digestion.
A client has been given lansoprazole for the chronic management
of Zollinger-Ellison syndrome. The nurse instructs the client to Lansoprazole is a proton pump inhibitor. Zollinger-Ellison syn-
take which product for pain while taking this medication? drome is a hypersecretory condition of the stomach, associated
Ibuprofen with increased risk of problems from irritation of the stomach
lining. The client should take acetaminophen for pain relief. Nons-
A. Ibuprofen teroidal antiinflammatory drugs (NSAIDs), such as ibuprofen and
B. Acetaminophen naproxen sodium, should be avoided, as should aspirin, because
C. Naproxen sodium they are potential stomach irritants.
D. Acetylsalicylic acid
At bedtime.
A health care provider has written a prescription for ranitidine 300
Ranitidine is a histamine H2-receptor antagonist and should be
mg once daily. The client indicates understanding of use of this
taken at bedtime, when it is given as a single daily dose. This
medication by stating that the prescribed dose is best taken at
allows for prolonged effect and provides the greatest protection
what time?
of the gastric mucosa both during sleep and around the clock.
A client has begun taking a stimulant laxative. In monitoring the
client for medication side and adverse effects, the nurse is likely abdominal cramps
to note which finding?
A client with constipation has been directed to take oral bisacodyl.
The nurse instructs the client on how to receive the most rapid ef-
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fect from the medication. The client demonstrates understanding
of use of this medication by stating that which method will produce
C
the most rapid effect?
The most rapid results from bisacodyl occur when it is taken on
an empty stomach. If it is taken at bedtime, the client will have a
A. "I should take it at bedtime."
bowel movement in the morning. It will not have a rapid effect if
B. "I will take it with a large meal."
taken with a large meal or with 2 glasses of milk.
C. "I will take it on an empty stomach."
D. "I will drink 2 glasses of milk when I take it."

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A physician has written an order for ranitidine (Zantac) once daily.
The nurse schedules the medications for which of the following
times?
A. at bed time, ranitidine (Zantac) is an H2 blocker
A. At bed time
B. After lunch
C. With supper
D. Before breakfast
A client has been taking omeprazole (Prilosec) for 4 weeks. The
nurse determines that the client is receiving the optimal intended
effect of the medication if the client reports absence of which of
the following symptoms?
B. Heartburn ,omeprazole (Prilosec) is used for GERD
A. Diarrhea
B. Heartburn
C. Flatulence
D. Constipation
A physician prescribes bisacodyl (Dulcolax) for a client in prepa-
ration for a diagnostic test and wants the client to achieve a rapid
effect from the medication. The nurse then tells the client to take
the medication:
B. on an empty stomach, bisacodyl (Dulcolax) is a stool softner
A. With a large meal
B. On an empty stomach
C. At bedtime with a snack
D. With two glasses of juice
A client has a PRN order for loperamide (Imodium). The nurse
should plan to administer this medication if the client has:

A. constipation C. episode of diarrhea, loperamide (Imodium) is an antidiarrheal

B. abdominal pain
C. episode of diarrhea
D. Hematest-positive nasogastric tube drainage
A client is taking docusate sodium (Colace). The nurse monitors
which of the following to determine whether the client is having a
therapeutic effect from this medication?
D. Regular bowel movements
A. Abdominal pain
B. Reduction in steatorrhea
C. Hematest-negative stools
D. Regular bowel movements
A nurse teaches a client taking metoclopramide (Reglan) to dis-
continue the medication immediately and call the physician if
which side effect occurs with long- term use?
A. Excessive excitability C. Uncontrolled rhythmic movements of the face or limbs
B. Anxiety or irritability
C. Uncontrolled rhythmic movements of the face or limbs
D. Dry mouth not helped by the use of sugar-free hard candy
A client has just taken a dose of trimethobenzamide (Tigan). The
nurse plans to monitor this client for relief of:
D. Nausea and vomiting, trimethobenzamide (Tigan) is an
A. Heartburn
antiemetic
B. Constipation
C. Abdominal Pain
D. Nausea and vomiting
A client has a PRN order for ondansetron (Zofran). The nurse
would administer this medication to the postoperative client for
relief of: D. Nausea and vomiting, ondansetron (Zofran) is an antiemetic

A. paralytic ileus
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B. incisional pain
C. urinary retention
D. Nausea and vomiting
A client has an order to take magnesium citrate to prevent consti-
pation following a barium study of the upper gastrointestinal (GI)
tract. The nurse plans to administer this medication:
A. chilled
A. chilled
B. with fruit juice only
C. room temp
D. with a full glass of water
A client has begun medication therapy with pancrelipase (Pan-
crease). The nurse determines that the medication is having the
optimal intended benefit if which effect is observed?
A. Weight loss C. Reduction of steatorrhea
B. Relief of heartburn
C. Reduction of steatorrhea
D. Absence of abdominal pain
A histamine (H2) - receptor antagonist will be prescribed for a
client. The nurse understands that which medications are H2-
receptor antagonists, one of which could be prescribed. Select all
that apply.
answer: 1,2,3,4
1. Nizatidine (Axid)
- 5 and 6 are PPI's (proton pump inhibitors)
2. Ranitidine (Zantac)
3. Famotidine (Pepcid)
4. Cimetidine (Tagamet)
5. Esomeprazole (Nexium)
6. Lansoprazole (Prevacid)
A client with a gastric ulcer has an order for sucralfate (Carafate),
1 g orally four times a day. The nurse schedules the medications
for which of the following times?
D. one hour before meals and at bedtime
A. With meals and at bedtime
B. Every 6 hours around the clock
C. One hour after meals and at bedtime
D. One hour before meals and at bedtime
A client with a history of duodenal ulcer is taking calcium car-
bonate chewable tablets. The nurse determines that the client is
experiencing optimal effects of the medication if:
A. Heart burn is relieved A. Heart burn is relieved
B. Muscle twitching stops
C. Serum calcium levels rise
D. Serum phosphrous levels decrease
The patient asks how stool softeners relieve constipation. Which
of the following would be the best response by the nurse? Stool
softeners relieve constipation by:
a. stimulating the walls of the intestine c. promoting the retention of water in the fecal mass
b. promoting the retention of sodium in the fecal mass
c. promoting the retention of water in the fecal mass
d. lubricating the intestinal walls
the nurse administers antidiarrheal drugs...
a. after each loose bowel movement
b. hourly until diarrhea ceases a. after each loose bowel movement
c. with food
d. BID, in the AM and at bedtime
the pregnancy category for the antiflatulent drug simethicone is:
a. category A c. category unknown
b. category C

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 NCLEX style questions ( G.I. Drugs)
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c. category unknown
d. category X
When recording the administration of diphenoxylate for multiple
loose stools:
a. document the daily number of drugs given
d. document each dose on the MAR
b. record all stools once each shift
c. indicate all stools on the MAR next to the drug
d. document each dose on the MAR
A hospitalized client asks the nurse for sodium bicarbonate to
relieve heartburn following a meal. The nurse reviews the client's
medical record, knowing that the medication is contraindicated in
which of the following conditions?
3. Respiratory acidosis
1. urinary calculi
2. chronic bronchitis
3. metabolic alkalosis
4. respiratory acidosis
An 80- year-old client has recently been started on cimetidine
(Tagamet). The nurse monitors the client for which most frequent
central nervous system (CNS) side effect of this medication?
1. Tremors 3. confusion
2. Dizziness
3. Confusion
4. Hallucination
A client is relying on OTC laxatives for regular elimination. Which
of the following pieces of information is most important for the
B. Excessive laxative use may cause decreased sodium levels
nurse to provide to the client?
Rationale: Excessive laxative use causes G.I. system to become
A. daily bowel movements are not necessary for good intestinal
dependent on external methods to achieve elimination
health
- Laxative dependence weakens peristalsis and musculature of
B. Excessive laxative use may cause decreased sodium levels
colon
C. Chronic use of laxatives can lead to dependency of elimination
D. The client should increase intake of high-fiber diet
A nurse is caring for a client with cirrhosis who has a new prescrip-
tion for cephulac (Lactulose). Following administration, the nurse B. Diarrhea
will monitor the client for which adverse effect of this medication?
Rationale: The nurse will monitor for diarrhea, Lactulose is a
A. Dry mouth synthetic disaccharide that the small intestine cannot utilize. It
B. Diarrhea causes diarrhea by lowering the ph so that the bacterial flora are
C. Headache changed in the bowel
D. Peripheral edema
A charge nurse and a newly licensed nurse are providing care
for a client who reports nausea and has a presciption for meto-
clopramide (Reglan) as an antiemetic. Which of the following
D. promotes gastric emptying
statements by the newly licensed nurse indicates a correct un-
Rationale: Metoclopramide is a gastrointestinal stimulant used to
derstanding of the actions of the medication. "Metoclopramide":
relieve nausea, vomiting, heartburn, stomach pain, bloating, and
persistent feeling of fullness after meals.
A. depresses vagal nerve activity
- Metoclopramide works by promoting gastric emptying
B. decreases gastric acid secretions
C. slows peristalsis
D. promotes gastric emptying
C. "I don't have pain in my stomach"
A nurse is caring for a caring for a client who is receiving es-
omeprazole (Nexium) to manage GERD. Which of the following
rationale: esomeprazole (Nexium) is proton pump inhibitor (PPI)
best indicates the desired therapeutic effect?
and works in the parietal cells of the stomach by inhibiting the
A. " I don't pass gas a often"
proton pump enzyme that generates gastric acid secretion.
B. "my abdomen is no longer firm"
- Treatment is for gastric ulcers, duodenal ulcers and GERD.
C. "I don't have pain in my stomach"
- an expected finding if medication is effective will be a decrease
D. " I have regular BM's"
in the client's symptoms of an ulcer or GERD. Heartburns are a

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common sign of GERD, so absence of pain means the medication
is working
A nurse is talking with a client who has peptic ulcer disease and
is starting therapy with sucralfate (Carafate). The nurse should B. 1 hr before meals
instruct the client to take this medication:
A. with antacid rationale: Sucralfate is a mucosal protectant, the client should
B. 1 hr before meals take it on an empty stomach, 1 hr before meals, for maximum
C. with food or milk effectiveness
D. immediatly after meals
A nurse is reviewing medications for a client who has a diagnosis
of small bowel obstruction. The nurse should withhold Senna
(Senoket) prescribed orally based on an understanding of which
A. laxatives are contraindicated in clients who have small bowel
of the following?
obstruction
A. laxatives are contraindicated in clients who have small bowel
Rationale: Laxatives are contraindicated in clients who have fecal
obstruction
impactation, bowel obstruction, and acute abdominal surgery to
B. Only bulk-forming laxatives such as psyllium (Metamucil)
prevent perforation. Laxatives will cause increased abdominal
should be prescribed
cramping and discomfort
C. Medication should be administered via NG tube than oral route
D. Opioid analgesics, rather than laxative should be prescribed to
alleviate discomfort
A client has been taking omeprazole (Prilosec) for the past 4
weeks. The nurse determines that the medication is effective
D. acid indigestion
when the client reports?
Rationale: Omeprazole, a proton pump inhibitor, reduces gastric
A. nausea
acid secretion and treats duodenal and gastric ulcers, prolonged
B. diarrhea
dyspepsia, gastrointestinal reflux disease and erosive esophagitis
C.headache
D. acid indigestion
A physician orders a colonoscopy b/c of the client's persistent
diarrhea. The nurse instructs the client to drink 250 mL of an C. the client's stools become clear liquid
electrolyte solution called GOLYTELY every 15 minutes over a 2
hour period. Which observation by the nurse provides the best Rationale: GOLYTELY is given as a colonic lavage. Within 30
evidence that the solution has achieved its primary purpose? minutes of ingesting the 1st volume of the solution, the client
should experience the 1st of many bowel movements. The bowel
A. the client's serum electrolyte levels are normal must be clear of feces for the colonoscopy to be effective! The
B. the client's intake approximates the output solution is preferable to other forms of bowel clensing its less likely
C. the client's stools become clear liquid to deplete electrolytes or cause water intoxification
D. the client's bladder fills with urine
1,2,3
After drinking the prescribed dose of GOLYTELY and have nu- rationale: sodium is the most abundant cation in the blood and
merous stools, the client reports feeling chest palpitations to the functions in the body to maintain osmotic pressure and acid-base
nurse. The nurse suspects an electrolyte imbalance and requests balance to transmit nerve impulses, very low values can result in
a physician order for Lab work. Which ones concern you? seizures and neurologic symptoms, normal adult range between
135 adn 146 mEq/L
1. sodium 126 mEq/ L - Potassium is essential for maintaining fluid balance, nerve im-
2. potassium 2.8 mEq/L pulse function, muscle function, and cardiac (heart muscle) func-
3. chloride 90 mEq/L tion. Very low values can cause cardiac arrhythmias, normal range
4. calcium 9.4 mEq/dL in an adult is 3.5 and 5.5 mEq
5. phosphrous 3.5 mEq/dL - Chloride is influenced by the extracellular fluid balance and
6. Blood Urea nitrogen (BUN) 16 mg/dL acid-base balance. Choloride passively follows water and sodium.
Normal adult range is 95 to 112 mEq/L
The physician prescribes docusate sodium (Colace) fo the client.
The client asks the nurse to explain why the medication is needed. A. To ease bowel evacuation and its related discomfort
Which explanation given by the nurse correctly states the purpose
of medication? Rationale: Docusate sodium (Colace) is a stool softner, retaining
water in the stool, softens the mass and makes stool easier and
A. To ease bowel evacuation and its related discomfort less painful to pass.
B. To irriatate the bowel and promote stool elimination

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C. To stimulate peristalsis to remove wastes after the digestion
D. To reduce intestinal activity and decrease stool size
Your client is dx with end stage liver failure and receiving lactu-
lose/granulote. which lab test tells you it is effective?
A. serum ammonia
A. serum ammonia
B. BUN
C. sodium
D. serum Creatinine
Your elderly pt is being administered Lomotil, what kind of drug?
A. Antiflatulent
B. Laxative C. Antidiarrheal, its a narcotic
C. Antidiarrheal
D. Emetic
The Patient has GERD and they are prescribed( Prilosec)
Omeprazole What kind of a drug is it?
A. Antacid
D. Proton Pump inhibitor
B. Histamine H2 Antagonist
C. Anticholinergic
D. Proton Pump Inhibitor
How should the patient be taking (Prilosec) Omeprazole? B. Take 1 hour before meals and swallow tablet as whole
A. take drugs 2 hours after a meal
B. take 1 hour before meals and swallow tablets as whole rationale: Proton Pump inhibitors, decreases gastric juices and
C. take it with juice and crush tablets reduces pain, they are taken 1 hour before meals, not after and
D. all of the above we don't take it crushed, take it whole
what do you tell patients to do with tablets (antacid)?
A. take drugs 30 minutes before meals
B. crush it and mix with orange juice D. chew thoroughly and take with a full glass of water
C. take 1 hour after meal
D. chew thoroughly and take with full glass of water

5/5
 Renal urinary drugs NCLEX questions
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A client who has a cold is seen in the emergency department
with an inability to void. Because the client has a history of benign
Decongestants
prostatic hyperplasia, the nurse determines that the client should
be questioned about the use of which medication?
Nitrofurantoin is prescribed for a client with a urinary tract infec-
The client is experiencing a pulmonary reaction requiring cessa- tion. The client contacts the nurse and reports a cough, chills,
tion of the medication. fever, and difficulty breathing. The nurse should make which in-
terpretation about the client's complaints?
The nurse is providing discharge instructions to a client receiv-
Drink 8 to 10 glasses of water per day. ing trimethoprim-sulfamethoxazole. Which instruction should be
included in the list?
Trimethoprim-sulfamethoxazole is prescribed for a client. The
Sore throat nurse should instruct the client to report which symptom if it
develops during the course of this medication therapy?
Phenazopyridine is prescribed for a client with a urinary tract
Urination is not painful. infection. The nurse evaluates that the medication is effective
based on which observation?
Bethanechol chloride is prescribed for a client with urinary reten-
Urinary strictures tion. Which disorder would be a contraindication to the adminis-
tration of this medication?
The nurse, who is administering bethanechol chloride, is monitor-
Bradycardia ing for cholinergic overdose associated with the medication. The
nurse should check the client for which sign of overdose?
Oxybutynin chloride is prescribed for a client with urge inconti-
Restlessness nence. Which sign would indicate a possible toxic effect related to
this medication?
Following kidney transplantation, cyclosporine is prescribed for a
Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L) client. Which laboratory result would indicate an adverse effect
from the use of this medication?
The nurse is providing dietary instructions to a client who has
Grapefruit juice been prescribed cyclosporine. Which food item should the nurse
instruct the client to exclude from the diet?
Tacrolimus is prescribed for a client who underwent a kidney
Take the oral medication every 12 hours at the same times every
transplant. Which instruction should the nurse include when
day.
teaching the client about this medication?
The nurse is reviewing the laboratory results for a client receiving
Fasting blood glucose of 200 mg/dL (11.1 mmol/L) tacrolimus. Which laboratory result would indicate to the nurse that
the client is experiencing an adverse effect of the medication?
The nurse receives a call from a client concerned about elim-
"Continue taking the medication; the brown urine occurs and is inating brown-colored urine after taking nitrofurantoin for a uri-
not harmful." nary tract infection. The nurse should make which appropriate
response?
A client with chronic kidney disease is receiving epoetin alfa.
Hematocrit of 33% (0.33) Which laboratory result would indicate a therapeutic effect of the
medication?
A client with a urinary tract infection is receiving ciprofloxacin by
Infusing slowly over 60 minutes the intravenous (IV) route. The nurse appropriately administers
the medication by performing which action?
Nitrofurantoin is prescribed for the client. The nurse checks the
Renal disease client's record, knowing that this medication is contraindicated in
which disorder?
Oral bethanechol chloride is prescribed for the client. The nurse
Two hours after meals
should instruct the client to take this medication at which time?
"It is used to treat anemia."

1/3
 Renal urinary drugs NCLEX questions
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Epoetin alfa is prescribed for a client diagnosed with chronic
kidney disease. The client asks the nurse about the purpose of the
medication. Which response by the nurse is most appropriate?
Tamsulosin hydrochloride is prescribed for a client. The nurse
Urinary obstruction should suspect that this medication is prescribed to relieve which
condition?
Tamsulosin hydrochloride has been prescribed for a client with
Thirty minutes after a meal benign prostatic hypertrophy (BPH). How should the nurse instruct
the client to take the medication?
A client who has had a prostatectomy is complaining of pain from
bladder spasms. The nurse checks the health care provider's pre-
Oxybutynin
scription sheet and expects to see which medication prescribed
to treat the problem?
A client with chronic kidney disease has a medication prescription
Subcutaneously for epoetin alfa. The nurse should plan to administer this medica-
tion by which method?
A client with chronic kidney disease (CKD) who is receiving an
antihypertensive medication is experiencing frequent hypotensive
Methyldopa episodes. The nurse reviews the client's medication record, know-
ing that which medication would have the greatest tendency to
cause hypotension?
Ciprofloxacin is prescribed for a client with a Pseudomonas
aeruginosa infection of the urinary tract. The health care provider
Myasthenia gravis
(HCP) should be questioned by the nurse about the prescription
if which underlying condition is noted in the client's record?
Nitrofurantoin is prescribed for an adult client to treat acute urinary
50 mg every 6 hours tract infection (UTI). Based on the normal adult dose, how should
the nurse instruct the client to take this medication?
The nurse is providing teaching for a client prescribed
"If I develop any tendon pain while taking ciprofloxacin, exercise
ciprofloxacin for a urinary tract infection. Which statement made
should help to decrease the pain."
by the client indicates that there is a need for further teaching?
A client is receiving levofloxacin for treatment of urinary tract
Prolonged QT interval on electrocardiogram infection. Which finding warrants an immediate call to the health
care provider (HCP)?
Bethanechol chloride is prescribed for an adult client with post-
10 to 50 mg 3 to 4 times a day operative bladder spasms. Based on the normal adult dose, how
should the nurse plan to administer this medication?
Parenteral bethanechol chloride is prescribed for a client with
Subcutaneously urinary retention. The nurse should plan to administer this med-
ication by which route?
Aluminum hydroxide is prescribed for a client with chronic kidney
With meals disease (CKD). The nurse should instruct the client to take this
medication at what time?
A client taking metronidazole telephones the home health nurse
Tell the client that this is a harmless medication side effect. to report dark discoloration to the urine. The nurse interprets that
the client's complaint warrants which nursing action at this time?
A client being admitted to the nursing unit has been taking
bethanechol chloride at home. During the admission assessment,
Bradycardia
the nurse gives special attention to assessing the client for which
side and adverse effect of this medication?
The nurse has a prescription to administer bethanechol chloride
Asthma subcutaneously. Before giving this medication, the nurse checks
to ensure that which condition is not noted in the client's history?
A client with acute pyelonephritis who was started on antibiotic
Phenazopyridine
therapy 24 hours earlier is still complaining of burning with urina-

2/3
 Renal urinary drugs NCLEX questions
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tion. The nurse should anticipate that the health care provider will
prescribe which medication?
The home health nurse is caring for a client who is taking
probenecid. The client has been instructed to restrict the diet to
Scallops
low-purine foods. Which food item should the nurse instruct the
client to avoid?
The nurse is planning to administer furosemide 40 mg by intra-
Pinch the IV tubing above the injection port, and inject slowly over venous push (IVP) through an existing intravenous (IV) line. To
1 to 2 minutes. deliver this medication safely, the nurse should perform which
action?
A client is prescribed sulfamethoxazole for treatment of urinary
tract infection. Identification of which other medication noted on
Phenytoin
the client's medical record requires further collaboration with the
health care provider (HCP)?
Laboratory analysis of a urine sample for culture and sensitivity
reveals a bacterial infection, and the client is diagnosed with
Checking lung sounds
cystitis. Nitrofurantoin is prescribed for the client. Which is the
prioritynursing assessment before administering this medication?
The nurse provides instructions regarding the administration of
"I will purchase a dropper from the pharmacy to calibrate the
liquid oral cyclosporine solution to a client. Which statement, if
amount of medication that I need."
made by the client, would indicate the need for further teaching?
Nitrofurantoin is prescribed for a client with urinary tract infection.
The nurse is instructing the client regarding the administration of
With meals
the medication. Which information about the besttime to take this
medication should be included in the client's education?
Trimethoprim-sulfamethoxazole is prescribed to be administered
Over 60 to 90 minutes by intravenous infusion to a client with a recurrent urinary tract
infection. How should the nurse administer this medication?
Propantheline bromide is prescribed for a client with bladder
Glaucoma spasms. Which disorder, if noted in the client's record, should alert
the nurse to question the prescription for this medication?
A client is receiving oxybutynin. The nurse should suspect that this
Overactive bladder
medication is prescribed to relieve which condition?
The nurse is taking care of a client receiving oxybutynin. Which
Dry mouth finding should the nurse expect to note if the client develops side
or adverse effects of this medication?
A client is prescribed dutasteride. Which outcome indicates that
Decreased obstruction to outflow of urine through the urethra
the medication is effective?
The ambulatory care nurse is providing instructions to a client with
If taken with meals, it will help decrease the risk for gastrointestinal
a urinary tract infection (UTI) being started on nitrofurantoin. The
(GI) upset.
nurse should provide the client with which information?
A client is prescribed trimethoprim-sulfamethoxazole for a recur-
Take each dose with 8 oz (235 mL) of water, and drink extra water
rent urinary tract infection (UTI). The nurse should give the client
each day
which instruction regarding this medication?
A client with a urinary tract infection (UTI) is given a prescription
"Pain in the back of the leg should be reported." for levofloxacin. The nurse should provide the client with which
information about this medication?
The nurse is preparing a subcutaneous dose of bethanechol
prescribed for a client with urinary retention. Before giving the
Atropine sulfate
dose, the nurse checks to see that which medication is available
on the emergency cart for use if needed?
The nurse is administering a dose of a prescribed diuretic to
an assigned client. The nurse should monitor the client for hy-
Bumetanide
pokalemia as a side effect of therapy if the client has been re-
ceiving which medication?

3/3
 NCLEX-Pharmacology - Renal and Urinary
Study online at https://quizlet.com/_89zwby
A client who has a cold is seen in the emergency department with
an inability to void. Because the client has a history of benign
Decongestants
prostatic hyperplasia, the nurse determines that the client should
be questioned about the use of which medication?
Nitrofurantoin is prescribed for a client with a urinary tract infec-
tion. The client contacts the nurse and reports a cough, chills, The client is experiencing a pulmonary reaction requiring cessa-
fever, and difficulty breathing. The nurse should make which in- tion of the medication.
terpretation about the client's complaints?
The nurse is providing discharge instructions to a client receiving
trimethoprim-sulfamethoxazole. Which instruction should be in- Drink 8 to 10 glasses of water per day.
cluded in the list?
Trimethoprim-sulfamethoxazole is prescribed for a client. The
nurse should instruct the client to report which symptom if it Sore throat
develops during the course of this medication therapy?
Phenazopyridine is prescribed for a client with a urinary tract
infection. The nurse evaluates that the medication is effective Urination is not painful.
based on which observation?
Bethanechol chloride is prescribed for a client with urinary reten-
tion. Which disorder would be a contraindication to the adminis- Urinary strictures
tration of this medication?
The nurse, who is administering bethanechol chloride, is monitor-
ing for cholinergic overdose associated with the medication. The Bradycardia
nurse should check the client for which sign of overdose?
Oxybutynin chloride is prescribed for a client with urge inconti-
nence. Which sign would indicate a possible toxic effect related to Restlessness
this medication?
Following kidney transplantation, cyclosporine is prescribed for a
client. Which laboratory result would indicate an adverse effect Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L)
from the use of this medication?
The nurse is providing dietary instructions to a client who has
been prescribed cyclosporine. Which food item should the nurse Grapefruit juice
instruct the client to exclude from the diet?
Tacrolimus is prescribed for a client who underwent a kidney
Take the oral medication every 12 hours at the same times every
transplant. Which instruction should the nurse include when
day.
teaching the client about this medication?
The nurse is reviewing the laboratory results for a client receiving
tacrolimus. Which laboratory result would indicate to the nurse Fasting blood glucose of 200 mg/dL (11.1 mmol/L)
that the client is experiencing an adverse effect of the medication?
The nurse receives a call from a client concerned about elim-
inating brown-colored urine after taking nitrofurantoin for a uri- "Continue taking the medication; the brown urine occurs and is not
nary tract infection. The nurse should make which appropriate harmful."
response?
A client with chronic kidney disease is receiving epoetin alfa.
Which laboratory result would indicate a therapeutic effect of the Hematocrit of 33% (0.33)
medication?
A client with a urinary tract infection is receiving ciprofloxacin by
the intravenous (IV) route. The nurse appropriately administers Infusing slowly over 60 minutes
the medication by performing which action?
Nitrofurantoin is prescribed for the client. The nurse checks the
client's record, knowing that this medication is contraindicated in Renal disease
which disorder?
Oral bethanechol chloride is prescribed for the client. The nurse
Two hours after meals
should instruct the client to take this medication at which time?
"It is used to treat anemia."

1/3
 NCLEX-Pharmacology - Renal and Urinary
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Epoetin alfa is prescribed for a client diagnosed with chronic
kidney disease. The client asks the nurse about the purpose of the
medication. Which response by the nurse is most appropriate?
Tamsulosin hydrochloride is prescribed for a client. The nurse
should suspect that this medication is prescribed to relieve which Urinary obstruction
condition?
Tamsulosin hydrochloride has been prescribed for a client with
benign prostatic hypertrophy (BPH). How should the nurse in- Thirty minutes after a meal
struct the client to take the medication?
A client who has had a prostatectomy is complaining of pain from
bladder spasms. The nurse checks the health care provider's pre-
Oxybutynin
scription sheet and expects to see which medication prescribed
to treat the problem?
A client with chronic kidney disease has a medication prescription
for epoetin alfa. The nurse should plan to administer this medica- Subcutaneously
tion by which method?
A client with chronic kidney disease (CKD) who is receiving an
antihypertensive medication is experiencing frequent hypotensive
episodes. The nurse reviews the client's medication record, know- Methyldopa
ing that which medication would have the greatest tendency to
cause hypotension?
Ciprofloxacin is prescribed for a client with a Pseudomonas
aeruginosa infection of the urinary tract. The health care provider
Myasthenia gravis
(HCP) should be questioned by the nurse about the prescription
if which underlying condition is noted in the client's record?
Nitrofurantoin is prescribed for an adult client to treat acute urinary
tract infection (UTI). Based on the normal adult dose, how should 50 mg every 6 hours
the nurse instruct the client to take this medication?
The nurse is providing teaching for a client prescribed
"If I develop any tendon pain while taking ciprofloxacin, exercise
ciprofloxacin for a urinary tract infection. Which statement made
should help to decrease the pain."
by the client indicates that there is a need for further teaching?
A client is receiving levofloxacin for treatment of urinary tract
infection. Which finding warrants an immediate call to the health Prolonged QT interval on electrocardiogram
care provider (HCP)?
Bethanechol chloride is prescribed for an adult client with post-
operative bladder spasms. Based on the normal adult dose, how 10 to 50 mg 3 to 4 times a day
should the nurse plan to administer this medication?
Parenteral bethanechol chloride is prescribed for a client with
urinary retention. The nurse should plan to administer this med- Subcutaneously
ication by which route?
Aluminum hydroxide is prescribed for a client with chronic kidney
disease (CKD). The nurse should instruct the client to take this With meals
medication at what time?
A client taking metronidazole telephones the home health nurse
to report dark discoloration to the urine. The nurse interprets that Tell the client that this is a harmless medication side effect.
the client's complaint warrants which nursing action at this time?
A client being admitted to the nursing unit has been taking
bethanechol chloride at home. During the admission assessment,
Bradycardia
the nurse gives special attention to assessing the client for which
side and adverse effect of this medication?
The nurse has a prescription to administer bethanechol chloride
subcutaneously. Before giving this medication, the nurse checks Asthma
to ensure that which condition is not noted in the client's history?
A client with acute pyelonephritis who was started on antibiotic
Phenazopyridine
therapy 24 hours earlier is still complaining of burning with urina-

2/3
 NCLEX-Pharmacology - Renal and Urinary
Study online at https://quizlet.com/_89zwby
tion. The nurse should anticipate that the health care provider will
prescribe which medication?
The home health nurse is caring for a client who is taking
probenecid. The client has been instructed to restrict the diet to
scallops
low-purine foods. Which food item should the nurse instruct the
client to avoid?
The nurse is planning to administer furosemide 40 mg by intra-
venous push (IVP) through an existing intravenous (IV) line. To Pinch the IV tubing above the injection port, and inject slowly over
deliver this medication safely, the nurse should perform which 1 to 2 minutes.
action?
A client is prescribed sulfamethoxazole for treatment of urinary
tract infection. Identification of which other medication noted on
Phenytoin
the client's medical record requires further collaboration with the
health care provider (HCP)?
Laboratory analysis of a urine sample for culture and sensitivity
reveals a bacterial infection, and the client is diagnosed with cys-
Checking lung sounds
titis. Nitrofurantoin is prescribed for the client. Which is the priority
nursing assessment before administering this medication?
The nurse provides instructions regarding the administration of
"I will purchase a dropper from the pharmacy to calibrate the
liquid oral cyclosporine solution to a client. Which statement, if
amount of medication that I need."
made by the client, would indicate the need for further teaching?
Nitrofurantoin is prescribed for a client with urinary tract infection.
The nurse is instructing the client regarding the administration of
With meals
the medication. Which information about the best time to take this
medication should be included in the client's education?
Trimethoprim-sulfamethoxazole is prescribed to be administered
by intravenous infusion to a client with a recurrent urinary tract Over 60 to 90 minutes
infection. How should the nurse administer this medication?
Propantheline bromide is prescribed for a client with bladder
spasms. Which disorder, if noted in the client's record, should alert Glaucoma
the nurse to question the prescription for this medication?
A client is receiving oxybutynin. The nurse should suspect that this
Overactive bladder
medication is prescribed to relieve which condition?
The nurse is taking care of a client receiving oxybutynin. Which
finding should the nurse expect to note if the client develops side Dry mouth
or adverse effects of this medication?
A client is prescribed dutasteride. Which outcome indicates that
Decreased obstruction to outflow of urine through the urethra
the medication is effective?
The ambulatory care nurse is providing instructions to a client with
If taken with meals, it will help decrease the risk for gastrointestinal
a urinary tract infection (UTI) being started on nitrofurantoin. The
(GI) upset.
nurse should provide the client with which information?
If taken with meals, it will help decrease the risk for gastrointestinal If taken with meals, it will help decrease the risk for gastrointestinal
(GI) upset. (GI) upset.
A client with a urinary tract infection (UTI) is given a prescription
for levofloxacin. The nurse should provide the client with which "Pain in the back of the leg should be reported."
information about this medication?
The nurse is preparing a subcutaneous dose of bethanechol
prescribed for a client with urinary retention. Before giving the
Atropine sulfate
dose, the nurse checks to see that which medication is available
on the emergency cart for use if needed?
The nurse is administering a dose of a prescribed diuretic to
an assigned client. The nurse should monitor the client for hy-
Bumetanide
pokalemia as a side effect of therapy if the client has been re-
ceiving which medication?

3/3
 Renal and Urinary Medications NCLEX Questions
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Decongestants
A client who has a cold is seen in the emergency department with
an inability to void. Because the client has a history of benign
Rationale: in the client with benign prostatic hyperplasia, episodes
prostatic hyperplasia, the nurse determines that the client should
of urinary retention can be triggered by certain medications, such
be questioned about the use of which medication?
as decongestants, anticholinergics, and antidepressants. These
1. diuretics
medications lessen the voluntary ability to contract the bladder.
2. antibiotics
The client should be questioned about the use of these medica-
3. antilipemics
tions if he has urinary retention. Diuretics increase urine output.
4. decongestants
Antibiotics and antlipemics do not affect ability to urinate.
The client is experiencing a pulmonary reaction requiring cessa-
tion of the medication.
Nitrofurantoin is prescribed for a client with a urinary tract infec-
Rationale: Nitrofurantoin can induce 2 kinds of pulmonary re-
tion. The client contacts the nurse and reports a cough, chills,
actions: acute and subacute. Acute reactions, which are most
fever, and difficulty breathing. The nurse should make which in-
common, manifest with dyspnea, chest pain, chills, fever, cough,
terpretation about the client's complaints?
and alveolar infiltrates. These symptoms resolve 2 to 4 days after
1. The client may have contracted the flu
discontinuing the med. Acute pulmonary responses are thought
2. The client is experiencing anaphylaxis
to be hypersensitivity reactions. Subacute reactions are rare and
3. The client is experiencing expected effects of the medications
occur during prolonged treatment. Symptoms (e.g., dyspnea,
4. The client is experiencing a pulmonary reaction requiring ces-
cough, malaise) usually regress over weeks to months following
sation of the medication.
nitrofurantoin withdrawal. However, in some clients, permanent
lung damage may occur. The remaining options are incorrect
interpretations
2. Drink 8 to 10 glasses of water per day.
The nurse is providing discharge instructions to a client receiving
trimethoprim-sulfamethoxazole. Which instruction should be in- Rationale: each dose of trimethoprim-sulfamethoxazole should
cluded in the list? be administered with a full glass of water, and the client should
1. Advise that sunscreen is not needed maintain a high fluid intake to avoid crystalluria. The med is more
2. Drink 8 to 10 glasses of water per day. soluble in alkaline urine. The client should not be instructed to
3. Decrease the dosage when symptoms are improving to prevent taper or discontinue the dose. Clients should be advised to use
an allergic response sunscreen since the skin becomes sensitive to the sun. Some
4. If the urine turns dark brown, call the provider immediately forms of trimethoprim-sulfamethoxazole cause urine to turn dark
brown or red. This does not indicate the need to notify the HCP
4. sore throat
Trimethoprim-sulfamethoxazole is prescribed for a client. The
nurse should instruct the client to report which symptom if it
Rationale: clients taking trimethoprim-sulfamethoxazole should
develops during the course of this medication therapy?
be informed about early signs and symptoms of blood disorders
1. Nausea
that can occur from this medication. These include sore throat,
2. Diarrhea
fever, and pallor, and the client should be instructed to notify
3. Headache
the HCP if these occur. The other options do not require HCP
4. Sore throat
notification
2. Urination is not painful
Phenazopyridine is prescribed for a client with a urinary tract
infection. The nurse evaluates that the medication is effective
Rationale: phenazopyridine is a urinary analgesic. It is effective
based on which observation?
when it eliminates pain and burning with urination. It does not
1. Urine is clear amber
eliminate the bacteria causing the infection, so it would not make
2. Urination is not painful.
the urine clear amber. It does not treat urge incontinence. It will
3. Urge incontinence is not present
cause the client to have reddish-orange discoloration of urine but
4. A reddish orange discoloration of the urine is present
this is a side effect of the medication, not the desired effect
Urinary strictures
Bethanechol chloride is prescribed for a client with urinary reten-
tion. Which disorder would be a contraindication to the adminis-
Rationale: bethanechol chloride can be hazardous to clients with
tration of this medication?
urinary tract obstruction or weakness of the bladder wall. The
1. Gastric atony
medication has the ability to contract the bladder and thereby
2. Urinary strictures
increase pressure within the urinary tract. Elevation of pressure
3. Neurogenic atony
within the urinary tract could damage or rupture the bladder in
4. Gastroesophageal reflux
clients with these conditions
3. Bradycardia
The nurse, who is administering bethanechol chloride, is monitor-
ing for cholinergic overdose associated with the medication. The
Rationale: cholinergic overdose of bethanechol chloride produces

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 Renal and Urinary Medications NCLEX Questions
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manifestations of excessive muscarinic stimulation such as sali-
nurse should check the client for which sign of overdose? vation, sweating, involuntary urination and defecation, bradycar-
1. Dry skin dia, and severe hypotension. Remember that the sympathet-
2. Dry mouth ic nervous system speeds the heart rate and the cholinergic
3. Bradycardia (parasympathetic) nervous system slows the heart rate. Treatment
4. Signs of dehydration includes supportive measures and the administration of atropine
sulfate (anticholinergic) subcutaneously or intravenously
4. Restlessness
Oxybutynin chloride is prescribed for a client with urge inconti-
nence. Which sign would indicate a possible toxic effect related to Rationale: toxicity (overdosage) of oxybutynin produces central
this medication? nervous system excitation, such as nervousness, restlessness,
1. Pallor hallucinations, and irritability. Other signs of toxicity include hy-
2. Drowsiness potension or hypertension, confusion, tachycardia, flushed or red
3. Bradycardia face, and signs of respiratory depression. Drowsiness is a fre-
4. Restlessness quent side effect of the medication but does not indicate over-
dosage
The nurse receives a call from a client concerned about elim-
inating brown-colored urine after taking nitrofurantoin for a uri-
nary tract infection. The nurse should make which appropriate "Continue taking the medication; the brown urine occurs and is not
response? harmful."
1. "Continue taking the medication; the brown urine occurs and is
not harmful." Rationale: nitrofurantoin imparts a harmless brown color to the
2. "Take magnesium hydroxide with your medication to lighten the urine and the medication should not be discontinued until the
urine color" prescribed dose is completed. Magnesium hydroxide will not affect
3. "Discontinue taking the medication and make an appointment urine color. In addition, antacids should be avoided because they
for a urine culture." interfere with medication effectiveness
4. " Decrease your medication to half the dose, because your urine
is too concentrated"
1. Infusing slowly over 60 minutes
A client with a urinary tract infection is receiving ciprofloxacin by
the intravenous (IV) route. The nurse appropriately administers
Rationale: ciprofloxacin is prescribed for treatment of mild, moder-
the medication by performing which action?
ate, severe, and complicated infections of the urinary tract, lower
1. Infusing slowly over 60 minutes
respiratory tract, and skin structure. A single dose is administered
2. Infusing in a light-protective bag
slowly over 60 min to minimize discomfort and vein irritation.
3. Infusing through a central line
Ciprofloxacin is not light sensitive, may be infused thru a periph-
4. Infusing rapidly as a direct IV push medication
eral IV, an is not given by IV push method
Blood urea nitrogen level of 25 mg/dL (8.8 mmol/L)

Following kidney transplantation, cyclosporine is prescribed for a Rationale: cyclosporine is an immunosuppressant. Nephrotoxicity
client. Which laboratory result would indicate an adverse effect can occur from the use of cyclosporine. Nephrotoxicity is evaluat-
from the use of this medication? ed by monitoring for elevated blood urea nitrogen and serum crea-
1. hemoglobin level of 14 g/dL tinine levels. The normal BUN level is 10-20. The normal creatinine
2. creatinine level of 0.6 mg/dL level for male is 0.6-1.2 and for female is 0.5-1.1. Cyclosporine
3. blood urea nitrogen level of 25 mg/dL can lower complete blood cell count levels. A normal hemoglobin
4. fasting blood glucose level of 99 mg/dL is 14-18 (male) and 12-16 (female). A normal hemoglobin is not
an adverse effect. Cyclosporine does affect the glucose level. The
normal fasting glucose is 70-110
Grapefruit juice
The nurse is providing dietary instructions to a client who has
been prescribed cyclosporine. Which food item should the nurse
Rationale: a compound present in grapefuit juice inhibits metab-
instruct the client to exclude from the diet?
olism of cyclosporine through the cytochrome P450 system. As
1. red meats
a result, consumption of grapefruit juice can raise cyclosporine
2. orange juice
levels by 50-100%, thereby greatly increasing the risk of toxicity.
3. grapefruit juice
Red meats, orange juice, and green leafy vegetables do not
4. green leafy vegetables
interact with the cytochrome P450 system

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The nurse reinforces discharge instructions to a postoperative
client who is taking warfarin sodium (Coumadin). Which statement D. "I will take Ecotrin (enteric-coated aspirin) for my headaches
made by the client reflects the need for further teaching? because it is coated."

A. "I will take my pills every day at the same time." Ecotrin is an aspirin-containing product and should be avoided.
B. "I will be certain to avoid alcohol consumption." Alcohol consumption should be avoided by a client taking warfarin
C. "I have already called my family to pick up a Medic-Alert sodium. Taking prescribed medication at the same time each day
bracelet." increases client compliance. The Medic-Alert bracelet provides
D. "I will take Ecotrin (enteric-coated aspirin) for my headaches health care personnel emergency information.
because it is coated."
A client is receiving digoxin (Lanoxin) daily. The nurse suspects A. Visual disturbances
digoxin toxicity after collecting data noting which signs and symp- B. Nausea and vomiting
toms? Select all that apply. C. Serum digoxin level of 2.3 ng/mL

A. Visual disturbances Signs and symptoms of digoxin toxicity include gastrointestinal

B. Nausea and vomiting signs, bradycardia, visual disturbances, and hypokalemia. A ther-
C. Serum digoxin level of 2.3 ng/mL apeutic serum digoxin level ranges from 0.5 to 2 ng/mL. The serum
D. Serum potassium level of 3.9 mEq/L potassium level should be 3.5 mEq/L or higher. The apical pulse
E. Apical pulse rate of 63 beats per minute must be 60 or higher beats per minute.
Heparin sodium is prescribed for the client. Which laboratory
result indicates that the heparin is prescribed at a therapeutic D. Activated partial thromboplastin time (aPTT) of 55 seconds
level?
The aPTT will assess the therapeutic effect of Heparin sodium.
A. Prothrombin time (PT) of 21 seconds The PT and INR will assess for the therapeutic effect of warfarin
B. Thrombocyte count of 100,000 cells/mm3 sodium (Coumadin). A decreased thrombocyte count can cause
C. International normalized ratio (INR) of 2.3 bleeding.
D. Activated partial thromboplastin time (aPTT) of 55 seconds
The nurse is monitoring a client who is taking propranolol (Inderal
LA). Which data collection finding would indicate a potential seri-
ous complication associated with propranolol? B. The development of audible expiratory wheezes

A. The development of complaints of insomnia Audible expiratory wheezes may indicate a serious adverse re-
B. The development of audible expiratory wheezes action: bronchospasm. ²-Blockers may induce this reaction, par-
C. A baseline blood pressure of 150/80 mm Hg, followed by a ticularly in clients with chronic obstructive pulmonary disease or
blood pressure of 138/72 mm Hg after two doses of the medica- asthma. Normal decreases in blood pressure and heart rate are
tion expected. Insomnia is a frequent mild side effect and should be
D. A baseline resting heart rate of 88 beats/min, followed by a monitored.
resting heart rate of 72 beats/min after two doses of the medica-
tion
Isosorbide mononitrate (Imdur) is prescribed for a client with C. Take the medication with food.
angina pectoris. The client tells the nurse that the medication
is causing a chronic headache. Which action should the nurse Isosorbide mononitrate is an antianginal medication. Headache
suggest to the client? is a frequent side effect of isosorbide mononitrate and usually
disappears during continued therapy. If a headache occurs during
A. Cut the dose in half. therapy, the client should be instructed to take the medication with
B. Discontinue the medication. food or meals. It is not necessary to contact the HCP unless the
C. Take the medication with food. headaches persist with therapy. It is not appropriate to instruct the
D. Contact the health care provider (HCP). client to discontinue therapy or adjust the dosages.
A client is diagnosed with an acute myocardial infarction and is C. Monitor for signs of bleeding.
receiving tissue plasminogen activator, alteplase (Activase, tPA).
Which action is a priority nursing intervention? Tissue plasminogen activator is a thrombolytic. Hemorrhage is a
complication of any type of thrombolytic medication. The client is
A. Monitor for renal kidney failure. monitored for bleeding. Monitoring for renal failure and monitoring
B. Monitor psychosocial status. the client's psychosocial status are important but are not the most
C. Monitor for signs of bleeding. critical interventions. Heparin is given after thrombolytic therapy,
D. Have heparin sodium available. but the question is not asking about follow-up medications.
B. Contact the registered nurse.
A client with coronary artery disease complains of substernal D. Collect more data on the client's pain level.
chest pain. After checking the client's heart rate and blood pres- E. Check the client's blood pressure.
F. Administer a second nitroglycerin, 0.4 mg, sublingually.

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 NCLEX Cardiovascular Medication Questions (Saunders)
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sure, the nurse administers nitroglycerin, 0.4 mg, sublingually. The usual guideline for administering nitroglycerin tablets for a
After 5 minutes, the client states, "My chest still hurts." Which hospitalized client with chest pain is to administer one tablet every
appropriate actions should the nurse should take? Select all that 5 minutes PRN for chest pain, for a total dose of three tablets.
apply. The registered nurse should be notified of the client's condition,
who will then notify the health care provider immediately. In this
A. Call a code blue. situation, because the client is still complaining of chest pain, the
B. Contact the registered nurse. nurse would administer a second nitroglycerin tablet. The nurse
C. Contact the client's family. would assess the client's pain level and check the client's blood
D. Collect more data on the client's pain level. pressure before administering each nitroglycerin dose. There are
E. Check the client's blood pressure. no data in the question that indicate the need to call a code blue.
F. Administer a second nitroglycerin, 0.4 mg, sublingually. In addition, it is not necessary to contact the client's family unless
the client has requested this.
The home health care nurse is visiting a client with elevated D. "I'll continue my nicotinic acid from the health food store."
triglyceride levels and a serum cholesterol level of 398 mg/dL.
The client is taking cholestyramine (Questran). Which statement Nicotinic acid, even an over-the-counter form, should be avoided
made by the client indicates the need for further teaching? because it may lead to liver abnormalities. All lipid-lowering med-
ications also can cause liver abnormalities, so a combination of
A. "Constipation and bloating might be a problem." nicotinic acid and cholestyramine resin is to be avoided. Constipa-
B. "I'll continue to watch my diet and reduce my fats." tion and bloating are the two most common side effects. Walking
C. "Walking a mile each day will help the whole process." and the reduction of fats in the diet are therapeutic measures to
D. "I'll continue my nicotinic acid from the health food store." reduce cholesterol and triglyceride levels.
A client is on nicotinic acid (niacin) for hyperlipidemia, and the D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid
nurse reinforces instructions to the client about the medication. should decrease the flushing."
Which statement by the client indicates an understanding of the
instructions? Flushing is a side effect of this medication. Aspirin or a nons-
teroidal anti-inflammatory drug can be taken 30 minutes before
A. "It is not necessary to avoid the use of alcohol." taking the medication to decrease flushing. Alcohol consumption
B. "The medication should be taken with meals to decrease flush- needs to be avoided because it will enhance this side effect.
ing." The medication should be taken with meals; this will decrease
C. "Clay-colored stools are a common side effect and should not gastrointestinal upset. Taking the medication with meals has no
be of concern." effect on the flushing. Clay-colored stools are a sign of hepatic
D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid dysfunction and should be immediately reported to the health care
should decrease the flushing." provider (HCP).
The nurse is planning to administer hydrochlorothiazide (Hy-
droDIURIL) to a client. Which are concerns related to the admin- C. Hypokalemia, hyperglycemia, sulfa allergy
istration of this medication?
Thiazide diuretics such as hydrochlorothiazide are sulfa-based
A. Hypouricemia, hyperkalemia medications, and a client with a sulfa allergy is at risk for an allergic
B. Increased risk of osteoporosis reaction. Also, clients are at risk for hypokalemia, hyperglycemia,
C. Hypokalemia, hyperglycemia, sulfa allergy hypercalcemia, hyperlipidemia, and hyperuricemia.
D. Hyperkalemia, hypoglycemia, penicillin allergy
A client with diabetes mellitus who has been controlled with daily
insulin has been placed on atenolol (Tenormin) for the control D. Low blood glucose level
of angina pectoris. Because of the effects of atenolol, the nurse
determines that which is the most reliable indicator of hypo- ²-Adrenergic blocking agents, such as atenolol, inhibit the appear-
glycemia? ance of signs and symptoms of acute hypoglycemia, which would
include nervousness, increased heart rate, and sweating. There-
A. Sweating fore, the client receiving this medication should adhere to the
B. Tachycardia therapeutic regimen and monitor blood glucose levels carefully.
C. Nervousness Option 4 is the most reliable indicator of hypoglycemia.
D. Low blood glucose level
A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) D. Triamterene is a potassium-retaining diuretic, whereas hy-
has been started on triamterene (Dyrenium) as well. The client drochlorothiazide is a potassium-excreting diuretic.
asks the nurse why both medications are required. Which re-
sponse is the most accurate to give to the client? Potassium-retaining diuretics include amiloride (Midamor),
spironolactone (Aldactone), and triamterene (Dyrenium). They are
A. Both are weak potassium-excreting diuretics. weak diuretics that are used in combination with potassium-ex-
B. The combination of these medications prevents renal toxicity. creting diuretics. This combination is useful when medication and
C. Hydrochlorothiazide is an expensive medication, so using a dietary supplement of potassium is not appropriate. The use of two
combination of diuretics is cost-effective. different diuretics does not prevent renal toxicity. Hydrochloroth-
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 NCLEX Cardiovascular Medication Questions (Saunders)
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D. Triamterene is a potassium-retaining diuretic, whereas hy- iazide is an effective and inexpensive generic form of the thiazide
drochlorothiazide is a potassium-excreting diuretic. classification of diuretics.
A client who has begun taking fosinopril (Monopril) is very dis-
C. Inform the client that impaired taste is expected and generally
tressed, telling the nurse that he cannot taste food normally since
disappears in 2 to 3 months.
beginning the medication 2 weeks ago. Which suggestion would
provide the best support for the client?
ACE inhibitors, such as fosinopril, cause temporary impairment
of taste (dysgeusia). The nurse can tell the client that this effect
A. Tell the client not to take the medication with food.
usually disappears in 2 to 3 months, even with continued therapy,
B. Suggest that the client taper the dose until taste returns to
and provide nutritional counseling if appropriate to avoid weight
normal.
loss. Options 1, 2, and 4 are inappropriate actions. Taking this
C. Inform the client that impaired taste is expected and generally
medication with or without food does not affect absorption and ac-
disappears in 2 to 3 months.
tion. The dosage should never be tapered without HCP approval,
D. Tell the client that a request will be made to the health care
and the medication should never be stopped abruptly.
provider (HCP) to change the prescription.
B. Blood pressure and heart rate
The nurse is planning to administer amlodipine (Norvasc) to a
client. The nurse should plan to check which before giving the
Amlodipine is a calcium channel blocker. This medication de-
medication?
creases the rate and force of cardiac contraction. Before adminis-
tering a calcium channel blocking agent, the nurse should check
A. Respiratory rate
the blood pressure and heart rate, which could both decrease in
B. Blood pressure and heart rate
response to the action of this medication. This action will help to
C. Heart rate and respiratory rate
prevent or identify early problems related to decreased cardiac
D. Level of consciousness and blood pressure
contractility, heart rate, and conduction.
A. Heart rate
The nurse is preparing to administer digoxin (Lanoxin), 0.125 mg
orally, to a client with heart failure. Which vital sign is most impor- Digoxin is a cardiac glycoside that is used to treat heart failure and
tant for the nurse to check before administering the medication? acts by increasing the force of myocardial contraction. Because
bradycardia may be a clinical sign of toxicity, the nurse counts
A. Heart rate the apical heart rate for 1 full minute before administering the
B. Temperature medication. If the pulse rate is less than 60 beats/minute in an
C. Respirations adult client, the nurse would withhold the medication and report
D. Blood pressure the pulse rate to the registered nurse, who would then contact the
health care provider.
The nurse is caring for a client who has been prescribed
furosemide (Lasix) and is monitoring for adverse effects associ- B. Tinnitus
ated with this medication. Which should the nurse recognize as C. Hypotension
potential adverse effects? Select all that apply. D. Hypokalemia

A. Nausea Furosemide is a loop diuretic; therefore, an expected effect is

B. Tinnitus increased urinary frequency. Nausea is a frequent side effect, not
C. Hypotension an adverse effect. Photosensitivity is an occasional side effect.
D. Hypokalemia Adverse effects include tinnitus (ototoxicity), hypotension, and
E. Photosensitivity hypokalemia and occur as a result of sudden volume depletion.
F. Increased urinary frequency
The nurse provides medication instructions to an older hyperten- A. "I can skip a dose once a week."
sive client who is taking 20 mg of lisinopril (Prinivil) orally daily.
The nurse evaluates the need for further teaching when the client Lisinopril is an antihypertensive angiotensin-converting enzyme
makes which statement? inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse
effects include headache, dizziness, fatigue, orthostatic hypoten-
A. "I can skip a dose once a week." sion, tachycardia, and angioedema. Specific client teaching points
B. "I need to change my position slowly." include taking one pill a day, not stopping the medication without
C. "I take the pill after breakfast each day." consulting the health care provider (HCP), and monitoring for side
D. "If I get a bad headache, I should call my health care provider effects and adverse reactions. The client should notify the HCP if
immediately." side effects occur.
A client complaining of not feeling well is seen in a clinic. The client
C. Double vision, loss of appetite, and nausea
is taking several medications for the control of heart disease and
hypertension. These medications include a beta blocker, digoxin
Double vision, loss of appetite, and nausea are signs of digoxin
(Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity
toxicity. Additional signs of digoxin toxicity include bradycardia,
is made. Which assessment data supports this diagnosis?
difficulty reading, visual alterations such as green and yellow

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 NCLEX Cardiovascular Medication Questions (Saunders)
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A. Dyspnea, edema, and palpitations
B. Chest pain, hypotension, and paresthesia vision or seeing spots or halos, confusion, vomiting, diarrhea,
C. Double vision, loss of appetite, and nausea decreased libido, and impotence.
D. Constipation, dry mouth, and sleep disorder
A client is being treated for acute heart failure with intravenously
administered bumetanide. The vital signs are as follows: blood
pressure, 100/60 mm Hg; pulse, 96 beats per minute; and respi-
C. Monitoring blood pressure
rations, 24 breaths per minute. After the initial dose, which is the
priority assessment?
Bumetanide is a loop diuretic. Hypotension is a common side
effect associated with the use of this medication. The other options
A. Monitoring weight loss
also require assessment but are not the priority.
B. Monitoring temperature
C. Monitoring blood pressure
D. Monitoring potassium level
C. Blood pressure of 198/110 mm Hg
A client is diagnosed with pulmonary embolism and is to be
treated with thrombolytic therapy. The nurse should report which
Thrombolytic therapy is contraindicated in a number of preexisting
priority data collection finding to the registered nurse before initi-
conditions in which there is a risk of uncontrolled bleeding, similar
ating this therapy?
to the case in anticoagulant therapy. Thrombolytic therapy also
is contraindicated in severe uncontrolled hypertension because
A. Adventitious breath sounds
of the risk of cerebral hemorrhage. Therefore, the nurse should
B. Temperature of 99.4° F orally
report the results of the blood pressure to the registered nurse
C. Blood pressure of 198/110 mm Hg
before initiating therapy. The findings in the remaining options may
D. Respiratory rate of 28 breaths per minute
be present in the client with pulmonary embolism.
B. Check the client's blood pressure.

Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized Atenolol hydrochloride is a beta blocker used to treat hyperten-
client. The nurse should perform which as a priority action before sion. Therefore, the priority nursing action before administration of
administering the medication? the medication is to check the client's blood pressure. The nurse
also checks the client's apical heart rate. If the systolic blood
A. Listen to the client's lung sounds. pressure is below 90 mm Hg or the apical pulse is 60 beats per
B. Check the client's blood pressure. minute or lower, the medication is withheld and the registered
C. Check the recent electrolyte levels. nurse and/or health care provider is notified. The nurse should
D. Assess the client for muscle weakness. check baseline renal and liver function tests. The medication may
cause weakness, and the nurse should assist the client with
activities if weakness occurs.
The nurse is preparing to administer furosemide (Lasix) to a client
A. Potassium level
with a diagnosis of heart failure. Which is the most important
laboratory test result for the nurse to review before administering
Furosemide is a loop diuretic. The medication causes a decrease
this medication?
in the client's electrolytes, especially potassium, sodium, and
chloride. Administering furosemide to a client with a low potassium
A. Potassium level
level could precipitate ventricular dysrhythmias. The options of
B. Creatinine level
BUN and creatinine reflect renal function. The cholesterol level is
C. Cholesterol level
unrelated to the administration of this medication.
D. Blood urea nitrogen (BUN)
The nurse reinforces dietary instructions to a client who will be
B. Spinach
taking warfarin sodium (Coumadin). The nurse tells the client to
avoid which food item?
Warfarin sodium is an anticoagulant. Anticoagulant medications
act by antagonizing the action of vitamin K, which is needed for
A. Grapes
clotting. When a client is taking an anticoagulant, foods high in
B. Spinach
vitamin K often are omitted from the diet. Vitamin K-rich foods
C. Watermelon
include green, leafy vegetables; fish; liver; coffee; and tea.
D. Cottage cheese
A health care provider (HCP) writes a prescription for digoxin D. Withhold the medication and call the HCP if the pulse is less
(Lanoxin), 0.25 mg daily. The nurse teaches the client about the than 60 beats per minute.
medication and tells the client that it is important to do which?
An important component of taking this medication is monitoring
A. Count the radial and carotid pulses every morning. the pulse rate; however, it is not necessary for the client to take
B. Check the blood pressure every morning and evening. both the radial and carotid pulses. It is not necessary for the
C. Stop taking the medication if the pulse is higher than 100 beats client to check the blood pressure every morning and evening

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 NCLEX Cardiovascular Medication Questions (Saunders)
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because the medication does not directly affect blood pressure.
per minute.
It is most important for the client to know the guidelines related to
D. Withhold the medication and call the HCP if the pulse is less
withholding the medication and calling the HCP. The client should
than 60 beats per minute.
not stop taking a medication.
D. Acetylsalicylic acid (aspirin)
A client is taking ticlopidine hydrochloride. The nurse tells the
client to avoid which substance while taking this medication?
Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is
used to decrease the risk of thrombotic strokes in clients with
A. Vitamin C
precursor symptoms. Because it is an antiplatelet agent, oth-
B. Vitamin D
er medications that precipitate or aggravate bleeding should be
C. Acetaminophen (Tylenol)
avoided during its use. Therefore, aspirin or any aspirin-containing
D. Acetylsalicylic acid (aspirin)
product should be avoided.
A client with angina pectoris is experiencing chest pain that
radiates down the left arm. The nurse administers a sublingual C. Blood pressure
nitroglycerin tablet to the client. The client's pain is unrelieved, and
the nurse determines that the client needs another nitroglycerin Nitroglycerin acts directly on the smooth muscle of the blood
tablet. Which vital sign is most important for the nurse to check vessels, causing relaxation and dilation. As a result, hypotension
before administering a second dose of the medication? can occur. The nurse should check the client's blood pressure
before administering the second nitroglycerin tablet. Although the
A. Temperature respirations, apical pulse and temperature may be checked, these
B. Respirations vital signs are not the most important assessments related to
C. Blood pressure administration of this medication.
D. Radial pulse rate
A. Withhold the medication.

The nurse is caring for a client who is taking metoprolol (Lopres- Metoprolol (Lopressor) is classified as a beta-adrenergic blocker
sor). The nurse measures the client's blood pressure (BP) and and is used in the treatment of hypertension, angina, and myocar-
apical pulse immediately before administration. The client's BP is dial infarction. Baseline nursing assessments include measure-
122/78 mm/Hg and the apical pulse is 58 beats per minute. Based ment of BP and apical pulse immediately before administration. If
on this data, which is the appropriate action? the systolic BP is below 90 mm/Hg and the apical pulse is below
60 beats per minute, the nurse should withhold the medication
A. Withhold the medication. and document this action. Although the registered nurse should
B. Notify the registered nurse immediately. be informed of the client's vital signs, it is not necessary to do so
C. Administer the medication as prescribed. immediately. The medication should not be administered because
D. Administer half of the prescribed medication. the data are outside of the prescribed parameters for this med-
ication. The nurse should not administer half of the medication or
alter any dosages at any point in time.
The nurse prepares to administer digoxin (Lanoxin) to a 3-year-old
with a diagnosis of heart failure and notes that the apical heart
B. Administer the digoxin.
rate is 120 beats per minute. Which nursing action is appropriate?
The normal apical heart rate for a 3-year-old is 80 to 125 beats
A. Hold the medication.
per minute. Because the apical heart rate is within normal range,
B. Administer the digoxin.
options 1, 3, and 4 are inappropriate.
C. Notify the registered nurse.
D. Recheck the apical heart rate in 15 minutes.
The nurse notes that a client in a long-term care facility is receiving A. Weight
a daily dose of furosemide (Lasix). The nurse writes in the care
plan to monitor which parameter on a daily basis? Daily weight should be monitored because this reflects the fluid
status of the client who is receiving a diuretic. Option 2 is a general
A. Weight assessment and does not relate directly to fluid balance. Options
B. Radial pulse 3 and 4 are laboratory measurements that are not prescribed
C. Hemoglobin routinely by the nurse and would not be done on a daily basis in
D. Serum creatinine clearance a long-term care facility.
A client with chronic atrial fibrillation is being started on amio-
D. "I will stop taking the prescribed anticoagulant after starting this
darone (Cordarone) as maintenance therapy for dysrhythmia
new medication."
suppression. The nurse reinforces instructions to the client about
the medication. Which statement by the client indicates a need for
Amiodarone is used for the dysrhythmia, atrial fibrillation. The
further teaching?
medication will have no effect in preventing thrombus formation
within the atria, so anticoagulants need to be continued. The
A. "I will need to have routine follow-up with my ophthalmologist."

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 NCLEX Cardiovascular Medication Questions (Saunders)
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B. "I will need to use sunscreen and protective clothing when
medication increases sun sensitivity, so protective measures are
outside."
essential. Thyroid function studies should be monitored because
C. "I will periodically have blood drawn to monitor my thyroid
the medication can affect thyroid function. Because the medication
function."
can cause corneal microdeposits, follow-up with the ophthalmol-
D. "I will stop taking the prescribed anticoagulant after starting this
ogist is important.
new medication."
A client has been given a prescription for gemfibrozil (Lopid). The
B. Beef
nurse plans to instruct the client to limit intake of which food while
taking this medication?
Gemfibrozil is a lipid-lowering agent. It is given as part of a thera-
peutic regimen that also includes dietary counseling, specifically,
A. Fish
the limitation of saturated and other fats in the diet. Therefore, the
B. Beef
intake of red meats is limited. Fish, foods that are spicy, and citrus
C. Spicy foods
products do not affect the cholesterol level.
D. Citrus products
A potassium-retaining diuretic is prescribed for a client with heart B. Bananas
failure. Which foods should the nurse instruct the client to avoid?
When the client is taking a potassium-retaining diuretic, the client
A. Plums should avoid foods high in potassium. A banana contains 451
B. Bananas mg of potassium. Cranberry juice (1 cup) contains 61 mg of
C. Cranberry juice potassium. A plum contains 48 mg of potassium, and 1 ounce of
D. Cheddar cheese cheddar cheese contains 28 mg of potassium
A client is receiving a continuous intravenous (IV) infusion of
heparin in the treatment of deep vein thrombosis. The nurse is told
that the client's activated partial thromboplastin time (aPTT) level D. Within the therapeutic range
is 65 seconds and that the client's baseline before the initiation
of therapy was 30 seconds. The nurse identifies these results as The normal aPTT varies between 20 and 36 seconds, depending
characteristic of which description? on the type of activator used in testing. The therapeutic dose of
heparin for treatment of deep vein thrombosis is to keep the aPTT
A. Low between 1.5 and 2.5 times normal. Thus, the client's aPTT is within
B. Elevated the therapeutic range, and the dose should remain unchanged.
C. Abnormal
D. Within the therapeutic range
The nurse is caring for a client who has been taking diuretics
on a long-term basis. The nurse reviews the medication record,
A. Bumetanide
knowing that which medications, if prescribed for this client, would
place the client at risk for hypokalemia?
Bumetanide is a potassium-losing loop diuretic. The client on
this medication would be at risk for hypokalemia. Spironolactone,
A. Bumetanide
triamterene, and amiloride hydrochloride are potassium-retaining
B. Triamterene (Dyrenium)
diuretics.
C. Spironolactone (Aldactone)
D. Amiloride hydrochloride (Midamor)
The nurse is caring for a client with chronic heart failure who is
C. Administer the dose of the medication as scheduled.
taking digoxin (Lanoxin) 0.125 mg daily. Before administering the
medication, the nurse reviews the serum digoxin level that was
The normal therapeutic range for digoxin is 0.5 to 2 ng/mL. A value
drawn earlier in the day. The result is 1 ng/mL. Which action should
of 1 is within therapeutic range, and the nurse should administer
the nurse take based on this laboratory result?
the next dose as scheduled. Options 1 and 4 are unnecessary.
An apical pulse must be obtained before each dose of digoxin is
A. Notify the health care provider.
administered. It is incorrect to administer the digoxin based on the
B. Check the client's last pulse rate.
client's last pulse rate, although a comparison of pulse rates may
C. Administer the dose of the medication as scheduled.
be appropriate.
D. Obtain another serum digoxin level to verify the results.
D. Check the result of the potassium level drawn 3 hours ago.
A client with heart failure who is taking furosemide (Lasix) and
Anorexia and nausea are two of the common symptoms associ-
digoxin (Lanoxin) calls the nurse and complains of anorexia and
ated with digoxin toxicity, which is compounded by hypokalemia.
nausea. The nurse should take which action?
The nurse should first check the results of the potassium level.
This would provide additional data to report to the health care
A. Administer an antiemetic.
provider, which is a key follow-up nursing action. The nurse would
B. Hold the morning dose of furosemide.
not hold the furosemide without a prescription to do so, given
the information provided. The nurse would withhold the digoxin

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 NCLEX Cardiovascular Medication Questions (Saunders)
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and notify the registered nurse, who would contact the health
care provider because digoxin toxicity is suspected. The nurse
C. Administer the daily dose of digoxin.
would not administer an antiemetic without further investigat-
D. Check the result of the potassium level drawn 3 hours ago.
ing the client's problem. The digoxin blood level should also be
checked.
D. A blood pressure of 128/80 mm Hg

The nurse is monitoring a client receiving furosemide (Lasix) Furosemide is a loop diuretic used primarily in the treatment of
40 mg orally daily. Which should indicate to the nurse that a hypertension. It may be used alone or in combination with other
therapeutic effect has occurred? antihypertensives. It also may be used in the treatment of edema
associated with heart failure (HF), renal disease, or hepatic cir-
A. A sodium level of 130 mEq/L rhosis. Overdose of the medication produces acute, profound wa-
B. A potassium level of 3.1 mEq/L ter loss; volume and electrolyte depletion; dehydration; decreased
C. The presence of dependent edema blood volume; and circulatory collapse. The presence of edema
D. A blood pressure of 128/80 mm Hg would not indicate a therapeutic effect. The normal sodium level
is 135 to 145 mEq/L, and the normal potassium level is 3.5 to 5.0
mEq/L. Options 1 and 2 indicate abnormal electrolyte values.
C. A potassium level of 5.2 mEq/L

The nurse is monitoring a client receiving spironolactone (Aldac- Spironolactone is a potassium-retaining diuretic. Side effects in-
tone) by mouth daily. Which data would indicate to the nurse that clude hyperkalemia, dehydration, hyponatremia, and lethargy. Al-
the client is experiencing a side effect related to the medication? though the concern with most diuretics is hypokalemia, this med-
ication is potassium-retaining, which means that the concern with
A. Client complaints of dry skin the administration of this medication is hyperkalemia. The normal
B. A sodium level of 140 mEq/L sodium level is 135 to 145 mEq/L, and the normal potassium
C. A potassium level of 5.2 mEq/L level is 3.5 to 5.0 mEq/L. Additional side effects include nausea,
D. Client complaints of constipation vomiting, cramping, diarrhea, headache, ataxia, drowsiness, con-
fusion, and fever. Dry skin is unrelated to the administration of this
medication.
A client is being treated with atenolol (Tenormin) for hypertension.
A. Common side effect
The client tells the nurse, "I am very tired and weak since I began
taking the medication." Based on the client's statement, the nurse
Atenolol is a beta blocker that causes a decreased heart rate and
determines that the client is experiencing which problem?
blood pressure and a decrease in cardiac output; this results in
fatigue and weakness as common side effects. If this interferes
A. Common side effect
with the client's activity level, the dosage can be adjusted to
B. Signs and symptoms of the flu
eliminate these side effects. There are no data in the question that
C. Difficulty with clearing the airway
indicate that the remaining options are correct.
D. Lack of support services for assistance at home
A client who takes a diuretic every evening expresses frustration
with the medication and wants to stop therapy. When the nurse
explores the reasoning, the client says, "It keeps me up all night. I
feel as though I should bring my pillow into the bathroom!" Which C. Switching to a morning administration of the medication
action can the nurse suggest to assist the client in successfully
adapting to this therapy? Diuretic therapy should be administered in the morning to cause
the least disruption as possible in the client's sleep cycle. Options
A. Limiting oral fluids before bedtime 1, 2, and 4 are incorrect suggestions.
B. Taking a sleep aid with the medication
C. Switching to a morning administration of the medication
D. Asking the health care provider for a new brand of medication
The nurse is scheduled to administer a dose of digoxin (Lanoxin)
B. The dose should be administered as prescribed.
to a client with atrial fibrillation. The client has a potassium level
of 4.6 mEq/L. Which would be the nurse's next action?
Hypokalemia can make the client more susceptible to digoxin tox-
icity. The nurse monitors the results of potassium levels drawn on
A. The dose should be omitted for that day.
the client. The normal reference range of potassium for an adult is
B. The dose should be administered as prescribed.
3.5 to 5.0 mEq/L. If the potassium level is low, the dose is withheld
C. The client needs a dose of potassium before receiving the
and the health care provider is notified. In this situation, the dose
digoxin.
should be administered as prescribed because the potassium
D. The dose should be withheld and the health care provider
level is within the normal range.
notified.

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 NCLEX Cardiovascular Medication Questions (Saunders)
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C. "I will weigh myself every day."
A client with heart failure is being discharged to home and will
be taking furosemide (Lasix). The nurse determines that teaching
A client taking furosemide must be able to monitor fluid status
has been effective if the client makes which statement?
throughout therapy. Monitoring daily weight is the easiest and
most accurate way to accomplish this. Options 2 and 4 are incor-
A. "I will take my pulse every day."
rect because of the difficulty of assessing fluid status accurately
B. "I will measure my urine output."
in this way. Additionally, in order for option 2 to be correct, fluid
C. "I will weigh myself every day."
intake would also need to be measured. Option 1 is incorrect and
D. "I will check my ankles every day for swelling."
unrelated to the administration of furosemide.
A client is being treated for heart failure and is receiving digoxin
(Lanoxin). The client's vital signs are blood pressure 85/50 mm
Hg, pulse 96 beats per minute, respirations 26 breaths per minute. B. Blood pressure 98/60 mm Hg, pulse 80 beats per minute,
To evaluate therapeutic effectiveness of this medication, the nurse respirations 24 breaths per minute
should expect which change in the client's vital signs?
The main function of digoxin is inotropic. The increased my-
A. Blood pressure 85/50 mm Hg, pulse 60 beats per minute, ocardial contractility is associated with increased cardiac output
respirations 26 breaths per minute causing a rise in the blood pressure in a client with heart failure.
B. Blood pressure 98/60 mm Hg, pulse 80 beats per minute, Digoxin also has a negative chronotropic effect (decreases heart
respirations 24 breaths per minute rate) and will therefore cause a slowing of heart rate. As cardiac
C. Blood pressure 130/70 mm Hg, pulse 104 beats per minute, output improves, there should be an improvement in respirations
respirations 20 breaths per minute as well. Therefore, the remaining options are incorrect.
D. Blood pressure 110/40 mm Hg, pulse 110 beats per minute,
respirations 20 breaths per minute
C. "I should decrease my intake of foods high in potassium, such
A client is being discharged following treatment for left-sided as bananas."
heart failure. The nurse is reinforcing teaching the client the
purpose, actions, adverse effects, and use of digoxin (Lanoxin) Digoxin is a cardiac glycoside and hydrochlorothiazide is a diuret-
and hydrochlorothiazide (HCTZ) prescribed for daily use. Which ic. Clients on digoxin have an increased risk of digoxin toxicity from
statement by the client indicates that a need for further teaching the potassium-depleting effect of hydrochlorothiazide. Therefore,
is needed? the diet should be high in potassium. The client should take the
pulse before taking cardiac glycosides. A combined therapeutic
A. "These medications will cause an increase in urine output." effect of these medications is to increase urine output. The in-
B. "I should take my radial pulse before taking these medications." creased blood flow to the kidneys from enhanced cardiac contrac-
C. "I should decrease my intake of foods high in potassium, such tility from the digoxin will promote urinary output. Hydrochloroth-
as bananas." iazide increases urine excretion of sodium and water by inhibiting
D. "These medications should be taken in the morning rather than sodium reabsorption in the nephron. For the best therapeutic
in the evening." effects, these medications should be taken at the same time in
the morning to avoid sleep disturbances from the need to urinate.
The nurse in the preoperative holding unit administers a dose of
scopolamine to a client. The nurse monitors the client for which A. Dry mouth
common side effect of the medication?
Scopolamine is an anticholinergic medication that causes the
A. Dry mouth frequent side effects of dry mouth, urinary retention, decreased
B. Diaphoresis sweating, and pupil dilation. Each of the incorrect options is the
C. Excessive urination opposite of a side effect of this medication.
D. Pupillary constriction
A client is being discharged to home following recovery from an
anterior myocardial infarction with recurrent angina. The client will D. "I should notify my doctor immediately if I experience
be taking diltiazem (Cardizem), isosorbide dinitrate (Isordil), and headaches with any of these medications."
nitroglycerin (Nitrostat) sublingually as needed, and the nurse
reinforces information to the client about the medications. Which Because of the vasodilating effects of nitrates, headache is a
statement by the client indicates a need for further teaching about common side effect. Medical attention is not needed unless the
the medications? headaches increase in severity or frequency. All three medica-
tions are nitrates, which improve myocardial circulation by dilating
A. "I will store these medications in a cool place, away from light." coronary arteries and collateral vessels, thus increasing blood
B. "All three of these medications will increase blood flow to my flow to the heart. These medications are used to help prevent
heart." the frequency, intensity, and duration of anginal attacks. Nitrates
C. "All three of these medications will help decrease the intensity should be stored in a cool place and in a dark container. Heat
of my chest pain." and light cause these medications to break down and lose their
D. "I should notify my doctor immediately if I experience potency.
headaches with any of these medications."

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 NCLEX Cardiovascular Medication Questions (Saunders)
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The nurse is assisting in monitoring a client who received hy-
dralazine hydrochloride (Apresoline) to treat autonomic dysre- B. Blood pressure declines.
flexia. Which finding accurately indicates that the medication is
effective? Hydralazine hydrochloride is a potent ganglionic-blocking agent
that will decrease the blood pressure by vasodilation. It may be
A. Muscle spasms subside. given by slow intravenous push during an episode of extreme
B. Blood pressure declines. hypertension. Options 1, 3, and 4 are not intended effects of the
C. Intensity of seizure activity declines. medication.
D. The client states that she feels better.
C. A blood pressure of 130/84 mm Hg
A client reports to the clinic for follow-up after a 1-month treatment
with acebutolol (Sectral). The nurse determines that a therapeutic
Acebutolol is a beta-adrenergic blocker used primarily to manage
effect of the medication has occurred if which response is noted?
mild to moderate hypertension or cardiac dysrhythmias. The ex-
pected therapeutic response is a controlled blood pressure within
A. Palpable peripheral pulses
normal limits. Although a pulse rate of 88 beats per minute is also
B. Maintenance of desired weight
normal, no reference is made regarding the quality or regularity
C. A blood pressure of 130/84 mm Hg
of the pulse. Options 1 and 2 are unrelated to the action of the
D. An apical rate of 88 beats per minute
medication.
A client has a prescription for niacin. The nurse determines that C. The serum cholesterol level
the client understands the importance of this therapy if the client
verbalizes the importance of which periodic monitoring? Niacin is used as adjunctive therapy in the management of hy-
perlipidemia. This is used in conjunction with a low-fat, low-cho-
A. The creatinine level lesterol diet; exercise; and smoking cessation. Serum cholesterol
B. Renal function studies and triglyceride levels are monitored periodically to assess the
C. The serum cholesterol level effectiveness of therapy. The laboratory studies in options 1, 2,
D. The blood urea nitrogen level and 4 assess renal function.
A client with aldosteronism has been instructed on spironolactone
D. "This medication will decrease my blood glucose."
(Aldactone) treatment. Which client statement indicates that the
client needs further teaching about the medication?
Spironolactone is a potassium-retaining diuretic. It does not lower
blood glucose. Spironolactone counteracts the effect of aldos-
A. "My potassium level will increase."
terone, promotes sodium and water excretion, decreases circulat-
B. "This medication will make me void frequently."
ing volume, and therefore decreases blood pressure and inhibits
C. "My blood pressure should get back to normal."
the excretion of potassium.
D. "This medication will decrease my blood glucose."
A client with chronic atrial fibrillation is being started on mainte-
nance therapy with atenolol (Tenormin) for dysrhythmia suppres- D. I can stop taking the prescribed digoxin (Lanoxin) after starting
sion. The nurse determines that the client needs instruction about this new medication."
this medication when making which statement?
Medication-specific teaching points for atenolol (Tenormin) in-
A. "I will take the dose at the same time each day." clude taking the medication exactly as prescribed, not abruptly
B. "I will avoid sudden discontinuation of this medication." discontinuing the medication, taking the medication with food if GI
C. "I will take the medication with food if GI upset occurs." upset occurs, wearing a Medic-Alert bracelet or tag, and having
D. I can stop taking the prescribed digoxin (Lanoxin) after starting periodic checks of heart rhythm and blood counts.
this new medication."
Nifedipine (Procardia) has been prescribed for a client with Ray-
naud's disease, and the nurse reinforces medication instructions C. "Nausea and drowsiness are expected, and if they occur, I don't
with the client about the medication. Which statement by the client really need to worry about it."
indicates a need for further teaching?
Nifedipine is a calcium antagonist that reduces smooth muscle
A. "I will contact my doctor if I get short of breath." contractibility by inhibiting the movement of calcium ions in slow
B. "I will call my doctor if I get headaches that worsen." channels. Its side effects include headache, flushing, peripheral
C. "Nausea and drowsiness are expected, and if they occur, I don't edema, and postural hypotension. Overdose of the medication
really need to worry about it." produces nausea, drowsiness, confusion, and slurred speech. If
D. "I need to get up slowly when I change positions because the signs of overdose occur, the health care provider is notified.
medicine causes hypotension."
The nurse has completed client teaching about heart failure
D. Weight gain of 2 to 3 pounds in a few days
and prescribed medications that include digoxin (Lanoxin) and
furosemide (Lasix). The nurse documents that the teaching goals
Clients with heart failure should immediately report weight gain,
have been met if the client states knowing to report which symp-
loss of appetite, shortness of breath with activity, edema, per-
tom?

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 NCLEX Cardiovascular Medication Questions (Saunders)
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A. Sudden increase in appetite sistent cough, and nocturia. A high urine output is expected with
B. Cough that accompanies a cold these medications. A cough that accompanies a cold is normal. A
C. High urine output during the day sudden increase in appetite is insignificant.
D. Weight gain of 2 to 3 pounds in a few days
B. Apical pulse rate

The nurse is preparing to administer digoxin (Lanoxin) to an adult Digoxin is a cardiac glycoside that is used to manage and treat
client. The nurse checks which important item before administer- heart failure and to control ventricular rates in clients with atrial
ing the medication? fibrillation. Before administering the medication, the nurse needs
to assess the apical heart rate for 60 seconds. If the pulse rate is
A. Blood pressure less than 60 beats per minute in an adult client, the nurse would
B. Apical pulse rate withhold the medication and contact the health care provider
C. Neurological signs because a low pulse rate may be an indication of toxicity. Options
D. Level of consciousness 1, 3, and 4 may be a component of the assessment, depending
on the client's diagnosis. However, these assessments are not
specifically associated with the use of digoxin.
Vasopressin (Pitressin) is prescribed for the client with diabetes D. Coronary artery disease
insipidus. During data collection, the nurse is particularly cautious
in checking the client for which preexisting condition? Because of its powerful vasoconstrictive actions, vasopressin can
cause adverse cardiovascular effects. By constricting arteries of
A. Depression the heart, vasopressin can cause angina pectoris and even my-
B. Endometriosis ocardial infarction, especially if administered to clients with coro-
C. Pheochromocytoma nary artery disease. In addition, vasopressin may cause gangrene
D. Coronary artery disease by decreasing blood flow in the periphery.
A client has taken his first dose of lisinopril (Zestril) about 2 hours
ago and begins to develop fullness in his face and hoarseness.
B. Determine the client's ability to breathe effectively.
Which action should the nurse take first?
The client is experiencing angioedema, an adverse effect of the
A. Ask the client when the hoarseness first developed.
medication, which involves facial swelling and hoarseness. As-
B. Determine the client's ability to breathe effectively.
sessing the ability to breathe effectively takes priority over as-
C. Determine the client's blood pressure to determine effective-
sessing the blood pressure, preventing dizziness, or determining
ness.
how long the client has been hoarse.
D. Instruct the client to stay in the resting position to prevent
dizziness.
A client takes digoxin (Lanoxin) 0.25 mg by prescription every
D. Listen to the client's apical pulse. If it is less than 60 beats per
day. When the nurse enters the client's room, with the medication,
minute, withhold the medication.
the client's meal tray is untouched and the client says he has no
appetite. Which action is the most appropriate?
Anorexia is a common early sign of digoxin toxicity. Another sign
of digoxin toxicity is an apical pulse rate of less 60 beats per
A. Check the client's temperature, radial pulse rate, and respira-
minute. If the apical pulse rate is less than 60 beats per minute,
tory rate.
the dose should be withheld and the health care provider notified.
B. Administer one half the prescribed amount to avoid digoxin
The remaining options are incorrect actions and would harm the
toxicity.
client (option 2) or delay needed intervention (options 1 and 3).
C. Offer to bring back the digoxin to the client when his appetite
Additionally, a radial pulse is not as accurate as an apical pulse
improves.
and should not be used to determine the possibility of digoxin
D. Listen to the client's apical pulse. If it is less than 60 beats per
toxicity.
minute, withhold the medication.
A 1-year-old child has been prescribed digoxin (Lanoxin) to treat
C. The child's pulse is less than 80 beats per minute.
heart failure (HF). When should the nurse plan on withholding the
prescribed dose of the medication?
The normal pulse rate for a 1-year-old child is about 100 beats per
minute. A missed dose is withheld if 4 hours have elapsed. Fever
A. A dose is missed by more than 1 hour.
is not a contraindication to giving the medication. Knowing that a
B. The child has a fever greater than 101° F.
sign of digoxin toxicity is a decreased heart rate, the most likely
C. The child's pulse is less than 80 beats per minute.
choice is option 3, which indicates a relative bradycardia.
D. The child's pulse is more than 100 beats per minute.
Thrombolytic therapy is being administered to a client following an
A. Dissolve the thrombus.
acute inferior myocardial infarction. Which goal should the nurse
plan for the client taking this medication?
Thrombolytic medication causes lysis of blood clots. Anticoagu-

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 NCLEX Cardiovascular Medication Questions (Saunders)
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A. Dissolve the thrombus.
lants prevent further clot formation. Beta blockers, nitrates, and
B. Prevent platelet aggregation.
calcium-channel blockers are used to reduce myocardial oxygen
C. Inhibit further clot formation.
demand. Thrombolytics do not prevent platelet aggregation.
D. Reduce myocardial oxygen demand.
The nurse is caring for a client who is receiving hydralazine C. Blood pressure
(Apresoline). The nurse evaluates the effectiveness of the med-
ication by monitoring which client parameters? Hydralazine is an antihypertensive medication used in the man-
agement of moderate to severe hypertension. It is a vasodila-
A. Cardiac rate tor medication that decreases afterload, so it is important that
B. Urine output the blood pressure be monitored. The remaining options are not
C. Blood pressure specifically related to determining the effectiveness of this med-
D. Blood glucose level ication.
A client has received atropine sulfate intravenously during a sur-
gical procedure. The nurse monitors the client for which side effect C. Urinary retention
of the atropine sulfate in the postoperative period?
Atropine sulfate is an anticholinergic medication that causes
A. Diarrhea tachycardia, drowsiness, blurred vision, dry mouth, constipation,
B. Bradycardia and urinary retention. The nurse monitors the client for any of
C. Urinary retention these effects in the postoperative period.
D. Excessive salivation
A client receiving total parenteral nutrition (PN) has a history of
heart failure. The health care provider has prescribed furosemide
(Lasix) 40 mg orally daily to prevent fluid overload. The nurse C. Potassium
should monitor which laboratory value to identify an adverse effect
from this medication? Furosemide is a potassium-losing diuretic, and insufficient re-
placement of potassium may lead to hypokalemia. Although the
A. Sodium glucose, sodium, and magnesium levels may be monitored, these
B. Glucose laboratory values are not specific to administering furosemide.
C. Potassium
D. Magnesium
A client is receiving heparin sodium by continuous intravenous
A. Protamine sulfate
(IV) infusion. The licensed practical nurse (LPN) is concerned
that the client received a bolus of medication when the tubing
If the tubing is removed from an IV pump and the tubing is not
was removed from the IV pump during a gown change. The LPN
clamped, the client will receive a bolus of the solution and the
immediately notifies the registered nurse or health care provider
medication contained in the solution. The client who receives a
and then checks to see whether which medication is available in
bolus dose of heparin is at risk for bleeding. A partial thrombo-
the medication supply area in case it is prescribed?
plastin time (PTT) will be drawn and evaluated. If the results of
the PTT are too high, a dose of protamine sulfate, the antidote for
A. Protamine sulfate
heparin, may be prescribed. Amicar is an antifibrinolytic (inhibits
B. Enoxaparin (Lovenox)
clot breakdown). Lovenox is an anticoagulant. Vitamin K is the
C. Aminocaproic acid (Amicar)
antidote for warfarin sodium (Coumadin).
D. Phytonadione (vitamin K)
A client returning to the medical nursing unit following cardiac C. Cardiac monitor
catheterization has a stat prescription to receive a dose of pro-
cainamide. The licensed practical nurse assisting in caring for the Procainamide is an antidysrhythmic medication often used to
client obtains which piece of equipment to adequately determine treat ventricular dysrhythmias that do not adequately respond to
the client's response to this medication? lidocaine. The effectiveness of this medication is best determined
by evaluating the client's cardiac rhythm. Therefore, a cardiac
A. Glucometer monitor is of greatest value, although the blood pressure cuff
B. Pulse oximeter and pulse oximeter would provide general information about the
C. Cardiac monitor client's cardiovascular status. A glucometer is not needed for this
D. Noninvasive blood pressure cuff client with the information presented.
A client with angina pectoris has just been started on medication
A. Vital signs
therapy with nitroglycerin (Nitrostat). In planning care for this
client, the nurse should place priority on measuring which data?
The nurse would place priority on measuring vital signs, especially
the blood pressure, because of the vasodilator action of the med-
A. Vital signs
ication. Drug levels are not measured for nitroglycerin, and the
B. Serum glucose
medication does not affect serum glucose level. Intake and output
C. Intake and output
may be measured as part of the general plan of care for the client
D. Therapeutic serum drug levels

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 NCLEX Cardiovascular Medication Questions (Saunders)
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with heart disease, but it is not directly related to administration of
this medication.
B. "I need to notify the health care provider if nausea occurs."

If nausea occurs, it is not necessary to notify the health care

The nurse has reinforced instructions to a client receiving provider. The client should be instructed to consume noncaf-
enalapril maleate (Vasotec). Which statement by the client indi- feinated carbonated beverages, unsalted crackers, or dry toast
cates a need for further teaching? to alleviate the nausea. To reduce the hypotensive effect of this
medication, the client is instructed to rise slowly from a lying to
A. "I need to rise slowly from a lying to sitting position." a sitting position and to permit the legs to dangle from the bed
B. "I need to notify the health care provider if nausea occurs." momentarily before standing. The client should report signs of a
C. "I need to notify the health care provider if a sore throat occurs." sore throat or fever to the health care provider because these may
D. "I know that several weeks of therapy may be required for the indicate infection. The client should be notified that several weeks
full therapeutic effect." may be needed for the full therapeutic effect of blood pressure
reduction. The client should also be instructed not to skip doses or
discontinue the medication because severe rebound hypertension
can occur.
A. Protamine sulfate
The nurse is asked to assist in preparing a heparin sodium infu- B. Intravenous tubing
sion for a client with a diagnosis of thrombophlebitis. Which items D. Intravenous infusion controller
should the nurse have available for this procedure? Select all that E. Intravenous insertion equipment
apply.
Vitamin K is the antidote for warfarin sodium (Coumadin) so this is
A. Protamine sulfate an unnecessary item. Protamine sulfate is the antidote for heparin
B. Intravenous tubing and should be available if heparin overdose occurs. Heparin is
C. Phytonadione (vitamin K) administered by the intravenous (IV) route so IV insertion equip-
D. Intravenous infusion controller ment is needed. IV tubing will be necessary for connection of the
E. Intravenous insertion equipment IV solution with the prescribed heparin dosage to the client's IV
catheter. Heparin is always infused via an IV pump or controller.
The nurse is assisting in developing a plan of care for a client A. Potential for injury
receiving warfarin sodium (Coumadin). The nurse selects which
problem as the priority in caring for this client? Anticoagulant therapy predisposes the client to injury because
of the inhibitory effects of the medication on the body's normal
A. Potential for injury blood-clotting mechanism. Bruising, bleeding, and hemorrhage
B. Potential for infection may occur in the course of activities of daily living and with other
C. Fluid volume overload activities. Options 2, 3, and 4 are not specifically related to the
D. Potential for inability to tolerate activity care of a client receiving anticoagulants.
A client with angina pectoris who was given a first dose of newly
A. Takes the client's blood pressure
prescribed nitroglycerin (Nitrostat) sublingual tablet complains of
slight dizziness and headache. The nurse takes which action first?
Clients receiving nitroglycerin for the first time are more likely
to experience side effects of this coronary vasodilator, which in-
A. Takes the client's blood pressure
cludes a drop in blood pressure and headache. The nurse should
B. Tells the client not to worry about it
take the blood pressure first. The nurse can then give aceta-
C. Reports the findings to the health care provider
minophen for headache and document or report the side effects.
D. Gives the client a dose of acetaminophen (Tylenol) prescribed
The nurse should not ignore a client's concerns (option 2).
as needed (PRN)
A client arrives at the health care clinic for follow-up care and
evaluation of the effectiveness of prazosin (Minipress). Which
B. Decrease in blood pressure
finding indicates a therapeutic effect related to the use of this
medication?
Prazosin is an antihypertensive medication. The principal indi-
cation for its use is hypertension. A decrease in blood pressure
A. Increased platelet count
indicates a therapeutic effect of the medication. Options 1, 3, and
B. Decrease in blood pressure
4 are unrelated to the use of this medication.
C. Increased red blood cell count
D. Decrease in blood glucose level
A client is at risk for pulmonary embolism and is on anticoagulant
C. Administer the next dose of warfarin sodium.
therapy with warfarin sodium (Coumadin). The nurse is told that
the client's prothrombin time is 18 seconds with a control of 11
The therapeutic range for prothrombin time (PT) is one and one
seconds. Which action should the nurse plan?
half to two times the control for clients at high risk for thrombus.

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 NCLEX Cardiovascular Medication Questions (Saunders)
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A. Double the next dose of warfarin sodium.
Based on the client's control value, the therapeutic range for this
B. Withhold the next dose of warfarin sodium.
individual is 16.5 to 22 seconds. The nurse should administer the
C. Administer the next dose of warfarin sodium.
next dose as usual.
D. Cut the next dose of warfarin sodium in half.
The nurse is reinforcing dietary instructions to a client who is
D. Citrus fruits
taking spironolactone (Aldactone). The nurse instructs the client
to avoid which food in the daily diet?
Spironolactone is a potassium-retaining diuretic. Hyperkalemia is
the principal adverse effect. Clients are instructed to restrict their
A. Rice
intake of potassium-rich foods, such as citrus fruits and bananas.
B. Salad
Options 1, 2, and 3 are appropriate food items to include in the
C. Oatmeal
daily diet.
D. Citrus fruits
The nurse is collecting data from a client with hypertension being
A. Bumetanide
treated with diuretic therapy. The nurse should monitor the client
for hypokalemia if the client is receiving which diuretic?
Bumetanide is a loop diuretic, which places this client at risk for
hypokalemia. The nurse assesses this client carefully for signs
A. Bumetanide
of hypokalemia, monitors serum potassium levels, and encour-
B. Triamterene (Dyrenium)
ages intake of potassium sources in the diet. Spironolactone,
C. Amiloride HCl (Midamor)
triamterene, and amiloride HCl are potassium-retaining diuretics.
D. Spironolactone (Aldactone)
A. Anorexia

The nurse is caring for a client receiving digoxin (Lanoxin). The Digoxin is a cardiac glycoside used to manage and treat heart
nurse monitors the client for which early manifestation of digoxin failure and to control ventricular rates in clients with atrial fib-
toxicity? rillation. The most common early symptoms of toxicity include
gastrointestinal disturbances such as anorexia, nausea, and vom-
A. Anorexia iting. Neurological abnormalities also can occur early and include
B. Photophobia fatigue, headache, depression, weakness, drowsiness, confusion,
C. Facial pain and nightmares. Facial pain, personality changes, and ocular dis-
D. Yellow color perception turbances (photophobia, light flashes, halos around bright objects,
yellow or green color perception) are also signs of toxicity but are
not early signs.
C. "Take pulse rate each day."
D. "Weigh at the same time each day."
The nurse is reinforcing discharge teaching to the client who E. "Palpitations may occur early in therapy."
was given a prescription for nifedipine (Adalat) for blood pressure F. "Be careful when rising from sitting to standing."
management. Which instructions should the nurse reinforce? Se-
lect all that apply. Nifedipine is a calcium-channel blocker. Its therapeutic outcome is
to decrease blood pressure. Its method of action is blockade of the
A. "Increase water intake." calcium channels in vascular smooth muscle, promoting vasodi-
B. "Increase calcium intake." lation. Side effects that can occur early in therapy include reflex
C. "Take pulse rate each day." tachycardia (palpitations) and first-dose hypotension, leading to
D. "Weigh at the same time each day." orthostatic hypotension. Weight should be checked regularly to
E. "Palpitations may occur early in therapy." monitor for early signs of heart failure. Also the client is taught to
F. "Be careful when rising from sitting to standing." take his or her own pulse. Nifedipine does not affect serum calcium
levels. Increased water intake is not indicated in the client with
cardiovascular disease.
The nursing student demonstrates understanding of the patho-
D. "When blood pressure begins to decrease, the heart responds
physiology of reflex tachycardia in the client taking an antihyper-
with tachycardia as a compensatory mechanism to raise the blood
tensive medication by making which statement?
pressure."
A. "Tachycardia results from the suppression of the influx of ion-
Reflex tachycardia can be produced by dilation of arterioles or
ized calcium into the vessel wall."
veins. The mechanism of reflex tachycardia is as follows: (1)
B. "Fluid is retained by the kidneys in an attempt to increase blood
arteriolar dilation causes a direct decrease in arterial pressure;
volume, resulting in tachycardia."
(2) baroreceptors in the aortic arch and carotid sinus sense the
C. "Renin, secreted by the kidney in response to lowered blood
drop in pressure and relay this information to the vasomotor center
pressure, increases epinephrine secretion and stimulation of the
of the medulla; and (3) in an attempt to bring blood pressure
sinoatrial node."
back up, the medulla sends impulses along sympathetic nerves
D. "When blood pressure begins to decrease, the heart responds
instructing the heart to beat faster. Therefore, options 1, 2, and 3
with tachycardia as a compensatory mechanism to raise the blood
are incorrect.
pressure."
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 NCLEX Cardiovascular Medication Questions (Saunders)
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The nurse is reinforcing instructions to a client with essential D. "The medication reduces my need for exercise."
hypertension about medication therapy with irbesartan (Avapro).
Which client statement would indicate a need for further teaching? The medication irbesartan is an antihypertensive, and with any
antihypertensive, the client must maintain a healthy lifestyle, which
A. "I will take the medication each morning." includes dietary modifications and exercise. Antihypertensives
B. "I should stop smoking and drinking caffeine." should be taken in the morning. Smoking and consuming caffeine
C. "I will monitor my blood pressure frequently." must be avoided. The client should be taught how to monitor his
D. "The medication reduces my need for exercise." own blood pressure.
The nurse is reviewing laboratory results of a digoxin level for
the client taking digoxin (Lanoxin). Which laboratory result would D. 2.5 ng/mL
warrant health care provider notification immediately?
Digoxin has a narrow therapeutic range. The therapeutic range is
A. 0.5 ng/mL 0.5 to 2 ng/mL. Drug levels higher than therapeutic level greatly
B. 0.9 ng/mL increase the risk of toxicity. The results noted in options 1, 2, and
C. 1.4 ng/mL 3 are within therapeutic range.
D. 2.5 ng/mL
The nurse notes that a client is being treated with nesiritide
(Natrecor). The nurse should expect this client to be experiencing A. Heart failure
which disorder?
Nesiritide is a synthetic form of human B-type natriuretic peptide
A. Heart failure (BNP) indicated only for short-term, intravenous therapy of hos-
B. Polycythemia pitalized clients with acutely decompensated heart failure. It is not
C. Hepatic failure used for the disorders noted in options 2, 3, or 4.
D. Myocardial infarction
B. "The medication causes relaxation in your arteries and veins
A client taking an angiotensin-converting enzyme (ACE) inhibitor and decreases the heart's work."
reviewed the medication information sheet and notes that the
medication is used to treat hypertension. He states, "I have heart ACE inhibitors produce multiple benefits in heart failure. By lower-
failure. Why am I taking this medicine?" The nurse responds by ing arteriolar tone, these medications improve regional blood flow,
making which statement? and by reducing cardiac afterload, they increase cardiac output.
By causing venous dilation, they reduce pulmonary congestion
A. "There must be some mistake; I will check the medication and peripheral edema. By dilating blood vessels in the kidney,
prescriptions." they increase renal blood flow and thereby promote excretion of
B. "The medication causes relaxation in your arteries and veins sodium and water. This loss of fluid has two beneficial effects:
and decreases the heart's work." (1) it helps reduce edema and (2) by lowering blood volume, it
C. "The medication makes your heart beat faster, and this im- decreases venous return to the heart, thereby reducing right-heart
proves blood flow to your tissues." size. Also by suppressing aldosterone and by reducing local pro-
D. "An additional medication will be added to the ACE inhibitor to duction of angiotensin II in the heart, ACE inhibitors may prevent
strengthen your heart muscle." or reverse pathological changes in cardiac structure. Therefore,
options 1, 3, and 4 are incorrect.
The nurse should anticipate the use of which medications in the A. Diuretics
treatment of the client with heart failure? Select all that apply. D. Cardiac glycosides
E. Phosphodiesterase (PDE) inhibitors
A. Diuretics F. Angiotensin-converting enzyme (ACE) inhibitors
B. Anticoagulants
C. Anticholinergics Medications recommended for treatment of heart failure include
D. Cardiac glycosides diuretics, cardiac glycosides such as digoxin (Lanoxin), PDE in-
E. Phosphodiesterase (PDE) inhibitors hibitors, and ACE inhibitors. Clients in heart failure do not need
F. Angiotensin-converting enzyme (ACE) inhibitors anticoagulants or anticholinergics.
A client taking an aldosterone antagonist known as eplerenone
(Inspra) for hypertension asks about side effects of this medica-
D. Elevated potassium level
tion. The nurse tells the client that which sign/symptom is a side
effect?
Eplerenone is a selective aldosterone receptor blocker. The med-
ication is used for hypertension and heart failure and has one
A. Coughing
significant side effect: hyperkalemia. Therefore, options 1, 2, and
B. Rash and urticaria
3 are incorrect.
C. Headache and dizziness
D. Elevated potassium level
The nurse is attending an in-service education session on the
therapeutic use of calcium-channel blockers. The instructor of

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 NCLEX Cardiovascular Medication Questions (Saunders)
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the session determines that teaching has been effective when A. Angina
the nurse correctly identifies that these medications are used for C. Hypertension
which disorders? Select all that apply. D. Dysrhythmias

A. Angina Calcium-channel blockers are medications that prevent calcium

B. Glaucoma ions from entering cells. These agents have their greatest effects
C. Hypertension on the heart and blood vessels. They are used widely to treat
D. Dysrhythmias hypertension, angina pectoris, and cardiac dysrhythmias. They
E. Acute kidney injury are not used to treat glaucoma, acute kidney injury, or glomeru-
F. Glomerulonephritis lonephritis.
A. Provide a second sublingual dose in 5 minutes.
The hospitalized client with angina continues to have chest pain
after the initial administration of a sublingual nitroglycerin tablet. To terminate an acute anginal attack, sublingual nitroglycerin
The nurse should take which action? should be administered as soon as the pain begins. Administration
should not be delayed until the pain has become severe. In the
A. Provide a second sublingual dose in 5 minutes. hospitalized client, if pain is not relieved in 5 minutes, the client
B. Continue dosing at 10-minute intervals for 1 hour. should take another dose sublingually, and then a third tablet
C. Instruct the client to swallow the next tablet whole. is taken 5 minutes later. Anginal pain that does not respond to
D. Use distraction techniques such as deep breathing and im- nitroglycerin may indicate myocardial infarction. If the client is
agery. having a myocardial infarction, distraction techniques such as
deep breathing and imagery will not relieve the pain.
The nurse is reinforcing medication instructions to a client who
A. It inhibits hepatic synthesis of cholesterol.
has been prescribed simvastatin (Zocor). Which is the action of
simvastatin?
The process of cholesterol reduction begins with inhibition of he-
patic HMG-CoA reductase, the rate-limiting enzyme in cholesterol
biosynthesis. In response to decreased cholesterol production,
A. It inhibits hepatic synthesis of cholesterol.
hepatocytes synthesize more HMG-CoA reductase. As a result,
B. It increases lipid metabolism of cholesterol.
cholesterol synthesis is restored. However, for reasons that are
C. It sequesters fat in the colon promoting fecal excretion of
not fully understood, inhibition of cholesterol synthesis causes
cholesterol.
hepatocytes to synthesize more low-density lipoproteins (LDL)
D. It increases glomerular filtration promoting renal excretion of
receptors. Therefore, options 2, 3, and 4 are incorrect.
cholesterol.
D. Muscle pain and weakness
The nurse is discharging a client from the hospital who was given
a prescription for atorvastatin (Lipitor). The nurse should tell the
Atorvastatin can injure muscle tissue. The muscle injury can
client to report which adverse effect to the health care provider
progress to myositis, which is muscle inflammation associated
immediately?
with moderate elevation of creatine kinase ([CK] an enzyme re-
leased from injured muscle). Myositis, in turn, may progress to
A. Tiredness and fatigue
potentially fatal rhabdomyolysis, defined as muscle disintegration
B. Flushing and redness
or dissolution, associated with a marked elevation of CK and
C. Flatulence and constipation
possibly with renal failure. Options 1 and 2 are not related to
D. Muscle pain and weakness
atorvastatin therapy. Option 3 is an expected side effect.
Clients who are given a prescription for sildenafil (Viagra) should B. Nitroglycerin (Nitrostat)
be taught that a potentially fatal medication interaction can occur
with which medication? Both sildenafil and nitrates promote vasodilation and hypotension.
If these medications are combined, life-threatening hypotension
A. Warfarin (Coumadin) could result. Therefore, sildenafil is contraindicated for clients
B. Nitroglycerin (Nitrostat) taking nitrates. At least 24 hours should elapse after the last dose
C. Acetaminophen (Tylenol) of sildenafil before a nitrate is given. The medications in options
D. Acetylsalicylic acid (aspirin) 1, 3, and 4 are not contraindicated.
A client is being discharged home, and the health care provider
has prescribed spironolactone (Aldactone) for the client. The
D. "I know I need to eat foods that are high in potassium because
nurse reinforces instructions to the client about the medication.
of the diuretic effect of the medication."
Which statement by the client indicates a need for further teaching
by the nurse?
This medication is a potassium-retaining diuretic that is used
to treat edema, hypertension, fluid retention and overload, and
A. "I know I should contact my doctor if I develop a rash while
to increase urine output. Because the medication is a potassi-
taking this medication."
um-retaining diuretic and an adverse effect of the medication is
B. "My doctor told me that I should sit on the side of the bed in the
hyperkalemia, the client should be cautioned about consuming
morning before standing up."
C. "I know I need to weigh myself every day when I get home
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 NCLEX Cardiovascular Medication Questions (Saunders)
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because of the medication."
foods that are high in potassium. The other options are correct
D. "I know I need to eat foods that are high in potassium because
client statements.
of the diuretic effect of the medication."
A child is being sent home on digoxin (Lanoxin) after being diag-
nosed with a congenital heart defect. The medication needs to be B. "Give the medication in the morning 20 to 30 minutes before a
given once a day. Which should the nurse reinforce in the teaching feeding."
plan for the family?
Digoxin should be given in the morning before a feeding so that
A. "You may give the medication using a medication dropper." a parent can get in the routine of administering the medication.
B. "Give the medication in the morning 20 to 30 minutes before a The medication must be accurately measured and drawn up in
feeding." a syringe, never measured in a dropper. If the dose is vomited,
C. "If your child vomits the dose, repeat the dose and then resume it is skipped that day and the dose is resumed the next day. If
the schedule in the morning." the medication is forgotten in the morning, it is given as soon as
D. "If you forget to give the medication in the morning, omit the remembered that day.
dose and resume it the following morning."
A client is being treated for moderate hypertension and has been
taking diltiazem (Cardizem) for several months. The client is seen
by the health care provider, and Prinzmetal's angina is diagnosed.
C. Prevents influx of calcium ions in vascular smooth muscle
The nurse planning care for the client understands that which
action of the medication will provide a therapeutic effect for this
Diltiazem is a calcium-channel blocker that inhibits calcium influx
new diagnosis?
through the slow channels of the membrane of smooth muscle
cells. Calcium-channel blockers decrease myocardial oxygen de-
A. Increases oxygen demands within the myocardium
mands and block calcium channels, thereby decreasing the force
B. Increases the force of contraction of ventricular tissues
of contraction of the ventricular tissue.
C. Prevents influx of calcium ions in vascular smooth muscle
D. Leads to an increase in calcium absorption in the vascular
smooth muscle
A client is being discharged with a prescription for propranolol D. Medication should be withheld if the pulse rate drops below 60
(Inderal). When reinforcing instructions to the client about the beats per minute.
medication, the nurse should include which information?
Most beta blockers may be administered with food or on an
A. Gentle exercising will prevent orthostatic hypotension. empty stomach, but propranolol is absorbed best if taken with
B. Hot baths and showers are advised to increase vasodilation. meals or directly after eating. Exercise will not prevent orthostatic
C. Medication should be taken on an empty stomach to enhance hypotension. Hot showers and baths are not advised because of
absorption. their vasodilating effect. The client needs to be instructed how to
D. Medication should be withheld if the pulse rate drops below 60 take the pulse rate and to notify the health care provider if the
beats per minute. heart rate falls below 60 beats per minute.
The nurse is reinforcing dietary instructions to a client who is
taking triamterene (Dyrenium). The nurse instructs the client that
A. Apple
it is acceptable to consume which food item daily?
Triamterene is a potassium-retaining diuretic, which means that
A. Apple
the client must avoid the intake of foods high in potassium. Options
B. Banana
2, 3, and 4 are high-potassium food items.
C. Avocado
D. Baked potato
A client is experiencing impotence after taking an antihyperten-
sive medication. The client states, "I would sooner have a stroke D. "You are concerned about the side effects of your medication?"
than keep living with the side effects of this medication." The nurse
should make which appropriate response to the client? Reflection of the client's comment lets the client know that you are
hearing his concerns without judging. The nurse cannot under-
A. "I can understand completely." stand what the client is experiencing (option 1). Option 3 devalues
B. "You wouldn't really want to have a stroke." the health care provider's judgment. Option 2 is confrontational
C. "That health care provider should change your prescription." and unsupportive.
D. "You are concerned about the side effects of your medication?"
A health care provider tells the nurse that a potassium-retaining
diuretic is being prescribed for the client with heart failure. The
C. Spironolactone (Aldactone)
nurse reviews the health care provider's prescriptions, expecting
that which medication will be prescribed?
Spironolactone is a potassium-retaining diuretic that promotes
A. Furosemide (Lasix)

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 NCLEX Cardiovascular Medication Questions (Saunders)
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B. Ethacrynic acid (Edecrin)
sodium excretion while conserving potassium. Options 1, 2, and
C. Spironolactone (Aldactone)
4 identify diuretics that do not conserve potassium.
D. Hydrochlorothiazide (HCTZ)
A client receiving nifedipine (Procardia) for angina complains of
feeling listless, with generalized weakness and no energy. The
nurse recognizes that which statement is true in regard to these C. These symptoms are expected effects of the medication.
symptoms?
The client receiving a calcium-channel blocking agent such as
A. These symptoms are unrelated to taking the medication. nifedipine may develop weakness and lethargy as expected ef-
B. These symptoms indicate underdosing of the medication. fects of the medication. Options 1, 2, and 4 are incorrect.
C. These symptoms are expected effects of the medication.
D. These symptoms indicate a toxic reaction to the medication.
Warfarin sodium (Coumadin) is prescribed for a client. The nurse
C. International Normalized Ratio (INR)
expects that the health care provider will prescribe which labora-
tory test to monitor for a therapeutic effect of the medication?
The INR will assess for the therapeutic effect of warfarin sodium,
and the aPTT will assess the therapeutic effect of heparin sodium.
A. Platelet count
The RBC and platelet counts will assess red blood cell concen-
B. Red blood cell (RBC) count
tration and the client's potential for bleeding, respectively. Warfarin
C. International Normalized Ratio (INR)
sodium doses are determined based on the results of the INR.
D. Activated partial thromboplastin time (aPTT)
The nurse is administering a dose of a prescribed diuretic to an
assigned client. The nurse should plan to monitor the client for A. Bumetanide
hypokalemia as a side effect of therapy if the client is receiving
which medication? Bumetanide is a loop diuretic that places the client at risk for hy-
pokalemia. The nurse would monitor this client carefully for signs
A. Bumetanide of hypokalemia, monitor serum potassium levels, and encourage
B. Triamterene (Dyrenium) intake of high-potassium foods. The other medications listed are
C. Spironolactone (Aldactone) potassium-sparing diuretics.
D. Amiloride HCl (Midamor)
A client with a history of hypertension has been prescribed tri-
amterene (Dyrenium). The nurse determines that the client un- C. Bananas
derstands the effect of this medication on the diet if the client
states to avoid which fruit? Triamterene is a potassium-retaining diuretic, and the client
should avoid foods high in potassium. Fruits that are naturally
A. Pears higher in potassium include avocados, bananas, fresh oranges
B. Apples and mangoes, nectarines, papayas, and dried prunes and other
C. Bananas dried fruits.
D. Cranberries
A client who has developed atrial fibrillation that is not responding
to medication therapy has begun taking warfarin (Coumadin). The D. Broccoli
nurse is reinforcing dietary discharge teaching with the client. The
nurse should plan to teach the client to avoid which food while Anticoagulant medications work by antagonizing the action of
taking this medication? vitamin K, which is needed for clotting. When a client is taking an
anticoagulant, foods high in vitamin K often are omitted from the
A. Cherries diet. Vitamin K is found in large amounts in green leafy vegetables
B. Potatoes such as broccoli, cabbage, turnip greens, and lettuce. The other
C. Spaghetti options listed are foods that are lower in vitamin K.
D. Broccoli
B. Atenolol (Tenormin)
The nurse is reviewing the health care provider's prescription
sheet for the preoperative client, which states that the client must Atenolol is a beta blocker. Beta blockers should not be stopped
be on nothing by mouth (NPO) status after midnight. The nurse abruptly, and the health care provider should be contacted about
should clarify whether which medication should be given to the the administration of this medication before surgery. If a beta
client rather than withheld? blocker is stopped abruptly, the myocardial need for oxygen is
increased. Cyclobenzaprine is a skeletal muscle relaxant. Ferrous
A. Ferrous sulfate sulfate is an oral iron preparation used to treat iron deficiency
B. Atenolol (Tenormin) anemia. Conjugated estrogen is an estrogen used for hormonal
C. Cyclobenzaprine (Flexeril) replacement therapy in postmenopausal women. The other three
D. Conjugated estrogen (Premarin) medications may be withheld before surgery without undue effects
on the client.

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 NCLEX Cardiovascular Medication Questions (Saunders)
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The nurse is caring for a child with heart failure and provides
instructions to the mother regarding the procedure for adminis- A. "I can mix the medication with food."
tration of the prescribed digoxin (Lanoxin). Which statement by
the mother indicates a need for further teaching? Medication should not be mixed with food because this method
of administration would not ensure that the child received the
A. "I can mix the medication with food." prescribed dose. The parents need to be instructed that if the child
B. "I need to take the child's pulse before administering the med- vomits after the digoxin is administered, they are not to repeat the
ication." dose. In addition, the parents should be instructed that if a dose is
C. "If more than one dose is missed, I need to call the health care missed and it is not identified until 4 or more hours later, the dose
provider." should not be administered. If more than one dose is missed, the
D. "If the child vomits after the medication is given, I should not health care provider needs to be notified.
repeat the dose."
A child with a right-to-left cardiac shunt is receiving propranolol
(Inderal-LA). The health care provider visits the child and writes B. Glucose level
prescriptions in the child's record. The licensed practical nurse
(LPN) reviews the prescriptions and notes that the child is placed Propranolol, a beta blocker, is used in the palliative treatment of
on a nothing-by-mouth (NPO) status. The LPN consults with the hypercyanotic episodes. It can cause hypoglycemia if adminis-
registered nurse and prepares to monitor which parameter close- tered in a child who is NPO or hypovolemic. The nurse should
ly? monitor glucose levels every 4 to 6 hours if the child is NPO or
hypovolemic and receiving propranolol. The health care provider
A. Sodium level should be notified if the glucose level is less than 60 mg/dL. The
B. Glucose level laboratory tests noted in options 1, 3, and 4 are not related to the
C. Blood urea nitrogen administration of this medication.
D. White blood cell count
D. Avoid taking products containing acetylsalicylic acid (aspirin).
The nurse has provided discharge instructions to a client being
Warfarin sodium is an anticoagulant. The client should avoid
placed on long-term anticoagulant therapy with warfarin sodium
taking aspirin because of its antiplatelet properties and should
(Coumadin). The nurse reminds the client to do which?
avoid taking other over-the-counter medications without checking
with the health care provider first because they could contain
A. Reduce alcohol intake to 12 oz daily.
ingredients that would interact with the warfarin sodium. The client
B. Alternate the timing of the daily dose.
should avoid alcohol while taking warfarin sodium, per health care
C. Take any over-the-counter medications as needed.
provider's directions. The client should take the medication at the
D. Avoid taking products containing acetylsalicylic acid (aspirin).
same time each day to increase compliance and keep therapeutic
blood levels stable.
B. Audible expiratory wheezes
A client recently began medication therapy with propranolol (In-
deral-LA). The nurse should be most concerned after noting the
Propranolol is a beta blocker. Audible expiratory wheezes could
presence of which effect in this client?
indicate bronchospasm, a serious adverse reaction. Beta blockers
that are not cardioselective may induce this reaction, particularly
A. Complaints of insomnia
in clients with chronic obstructive pulmonary disease or asthma.
B. Audible expiratory wheezes
A normal decrease in blood pressure and heart rate is expected.
C. Blood pressure of 136/84 from 162/90 mm Hg
Insomnia is a frequent mild side effect and should continue to be
D. Heart rate of 86 beats per minute decreased to 78
monitored.
A client with myocardial infarction is a candidate for alteplase
B. Bleeding
(Activase) therapy. The nurse assisting in the care of this client is
aware that it will be necessary to monitor for which adverse effect
Alteplase is a thrombolytic medication, which means that it breaks
of this therapy?
down or dissolves clots. Because of its action, the principal ad-
verse effect is bleeding. Local or systemic infection could occur
A. Infection
with poor aseptic technique during medication administration, but
B. Bleeding
it is rare. Allergic reaction is not a frequent response. Muscle
C. Allergic reaction
weakness is not an adverse effect of this medication.
D. Muscle weakness
The nurse has a prescription to give a first dose of hydrochloroth-
D. Sulfa drugs
iazide (HCTZ) to an assigned client. The nurse should question
the prescription if the client had a history of allergy to which item?
Thiazide diuretics such as hydrochlorothiazide are sulfa-based
medications, and a client with a sulfa allergy is at risk for an allergic
A. Iodine
reaction. A sulfa allergy must be communicated to the pharmacist,
B. Shellfish
health care provider, nurse, and other health care providers. The
C. Penicillin
other options are incorrect.
D. Sulfa drugs
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 NCLEX Cardiovascular Medication Questions (Saunders)
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The nurse has a prescription to give a client a scheduled dose of
digoxin (Lanoxin). Before administering the medication, the nurse
B. Loss of appetite, nausea, and vomiting
routinely screens for which signs/symptoms that could indicate
early signs of digoxin toxicity?
Loss of appetite and nausea are early signs of digoxin toxicity.
Other signs of digoxin toxicity include bradycardia, visual alter-
A. Dyspnea, edema, and palpitations
ations (e.g., green and yellow vision or seeing spots or halos),
B. Loss of appetite, nausea, and vomiting
confusion, vomiting, or diarrhea. The other options are incorrect.
C. Chest pain, hypotension, and paresthesias
D. Constipation, dry mouth, and sleep disorder
A. Furosemide (Lasix)
A client has arrived at the emergency department complaining
of weakness, an irregular heartbeat, and lethargy. The nurse is Furosemide (Lasix) is a potassium-losing diuretic. As a diuretic,
attempting to discover what caused these symptoms. The nurse it will cause the client to urinate ("pee"). However, it may lower
asks the client "Have you been prescribed any new medications?" the serum potassium level as well, which can result in weakness,
The client tells the nurse "About 2 weeks ago I was prescribed fatigue, and changes in the electrical activity of the heart causing
a drug to make me pee, but I don't know the name." The nurse an irregular heartbeat, bradycardia, and other ECG abnormali-
determines that the client is referring to which medication? ties. Oxybutynin is used for an overactive bladder to reduce the
frequency of urination when only a small amount of urine is in
A. Furosemide (Lasix) the bladder and would not cause this client's symptoms. Lanoxin
B. Lanoxin (Digoxin) and metoprolol are cardiac medications used to regulate the heart
C. Oxybutynin (Ditropan) rate, not to assist in urination, so although these medications'
D. Metoprolol (Lopressor) side effects may cause similar symptoms, neither would be the
medication the client was prescribed to increase urination.
A client is receiving a continuous heparin infusion for venous A. Platelets
thromboembolism treatment. Which laboratory monitoring should E. Activated partial thromboplastin time (aPTT)
the nurse plan to check during a continuous heparin infusion?
Select all that apply. A continuous heparin infusion requires monitoring the platelet
count for heparin-induced thrombocytopenia and activated par-
A. Platelets tial thromboplastin time to monitor blood clotting time. Warfarin
B. Prothrombin time (PT) (Coumadin) is monitored using the International Normalized Ratio
C. Recombinant factor VIIa (INR). The INR is a standardized system of reporting prothrombin
D. International normalized ratio (INR) time (PT). Recombinant factor VIIa is used to reverse the antico-
E. Activated partial thromboplastin time (aPTT) agulant effect of fondaparinux (Arixtra).
A. Wear a Medic Alert bracelet.
B. Check urine and stool for blood.
A client is being discharged from the hospital on warfarin
C. Notify your dentist before an appointment.
(Coumadin) for venous thromboembolism (VTE) prevention.
Which instructions should the nurse reinforce in the client's teach-
Warfarin (Coumadin) is an anticoagulant and bleeding is the major
ing plan? Select all that apply.
complication. Teaching for the client includes wearing a Medic
Alert bracelet to notify health care providers an anticoagulant is
A. Wear a Medic Alert bracelet.
being taken. Blood in the urine and stool may indicate the dose is
B. Check urine and stool for blood.
too high. Certain dental procedures require temporarily stopping
C. Notify your dentist before an appointment.
an anticoagulant because of the risk of bleeding. The prescribed
D. Take a double dose to make up for a missed dose.
dosage must be taken at the same time each day to maintain
E. You do not have to take the medication at same time each day.
therapeutic effect. A double dose to make up for a missed dose is
not done because this will increase the risk of bleeding.
A. Relief of anxiety
The health care provider has prescribed morphine sulfate intra- C. Reduction of oxygen consumption
venous push for a client with pulmonary edema. Which therapeu- E. Improvement in efficacy of breathing
tic effects should the nurse expect in this client? Select all that
apply. Pulmonary edema requires pharmacological treatment. Morphine
sulfate administrated by intravenous push is used in clients with
A. Relief of anxiety pulmonary edema for its cardiovascular effects and to relieve
B. Decreased respiratory rate anxiety. It relieves anxiety thereby decreasing oxygen demand. It
C. Reduction of oxygen consumption reduces preload and afterload, vasodilating pulmonary and sys-
D. Prevention of cardiac dysrhythmias temic blood vessels, decreasing oxygen demand, and improving
E. Improvement in efficacy of breathing efficacy of breathing. Decreasing the respiratory rate and prevent-
ing cardiac dysrhythmias are not therapeutic effects of morphine.

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Drugs Affecting the Cardiovascular System - Pharm exam 3
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Treatment Goals
- In patients 60+ without diabetes or chronic kidney disease- BP
less than 150/90
- In patients 18-59 - BP less than 140/90

Dietary Management
-BP can be reduced by adhering to a diet abundant with fruits and
Hypertension (HTN)
vegetables and low fat dairy profducts

Lifestyle Management
-Aerobic exercise lowers BP
-If overweight, goal to lose 10 pounds
-Limit alcohol consumption (2 or less a day for men 1 for women)
-No smoking
ACE inhibitor
-Blocks enzyme that converts angiotensin I to angiotensin II
-Prevents/reverses remodeling of heart muscle and blood vessel
walls

-Used for heart failure, hypertension, decrease morbidity and

mortality in CVS disorders

Adverse effects
-Well tolerated
-Low incidence, serious adverse: neutropenia, agranulocytosis,
proteinuria, glomerulonephritis, angioedema
Captopril (Capoten) -Persistent cough
-Acute hypotension
-Hypokalemia

Contraindication
-BBW- pregnancy -injury and death to fetus
-Hx angioedema with previous tx ACEI

-May increase serum concentration of digoxin and lithium

Administration
-Should take 1 hour before/2 hours after meals
-May crush tablets
ARB
-Blocks vasoconstriction and aldosterone -secreting effects of
angiotensin II at various receptor sites
-Prevents angiotensin II from combining at various receptor sites
-Increases renal flow and enhances excretion of chloride, calcium,
magnesium, and phosphate

Used for hypertension

-Patients with type 2 DM w/ diabetic neuropathy
-Maximal effects in 3-6 weeks

Losartan (Cozaar) Adverse Effects

-Well tolerated
-Dizziness, heartburn, diarrhea, decreased touch sensation
-Angioedema

Contraindication
BBW- pregnancy

Increase Effects
-Alcohol, antihypertensive agents, diuretics
-Herbs and foods: alfalfa, aloe, bitter melon, back cohosh, celery,
garlic, marshmallow, st. jons wort

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Decrease Effects
-CYP2C9 inducers (rifampicin)
-Grapefruit juice
Calcium channel blocker (CCB)
-Inhibits influx of calcium ions across cardiac and smooth muscle
depolarization- resulting in relaxation and vasodilation (lower BP)

-Used for hypertension and CAD

Adverse Effects
-Cardiac: drowsiness, fatigue, flushing, palpations, edema
-Nausea, abdominal pain

Preventing Interactions
Amlodipine (Norvasc)
-Cyclosproine
-Simvastin

Increase Effects
-Adenosine
-Barbituates, antihypertensive agents, duloxetine
-Grapefruit juice

Decrease Effects
-Rifampin, carbamzepine, phenytoin
-St. Jons wort
-Angina results from deficit in myocardial oxygen supply in relation
to myocardial oxygen demand
-Most often caused by atherosclerotic plaque in the coronary
arteries
Coronary Artery Disease
Goals
-Relieve acute anginal pain
-Reduce number and severity of acute anginal attacks
Stable Angina
-When myocardial oxygen demand surpasses oxygen supply to
the heart muscle -ischemia
-Described as substernal chest pain
-Pain may be associated with nausea, vomiting, dizziness, di-
aphoresis, dyspnea, fear of impending doom
Coronary Artery Disease: Clinical Manifestations
Acute Coronary Syndromes - Unstable Angina
-Manifestations similar to those of stable angina
-Acute pain typically occurs at rest, usually lasts 20+ mins
-Often develop with less exertion than previous episodes of angi-
na
-Often occurs hours or days before an acute MI
Organic Nitrates

Pharmacokinetics- IV, SL, spray, PO, topical, patch

-Converted to nitric oxide

-Relaxes smooth muscle in blood vessel walls
-Relieves anginal pain by venous dilation, coronary artery dilation,
arteriole dilation

-Used for relief of sudden onset-angina, acute-onset chest pain

and prophylaxis

Adverse Effects
-Majority r/t hemodynamic changes responsible for preload re-

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duction and vasodilation
-Severe headache
-Dizziness, bradycardia, syncope, hypotension and orthostatic
hypotension

Contraindications
-Hypersensitivity, severe anemia, hypotension, hypovolemia
-Nitro and phosphodiesterase enzyme type 5 inhibitor (sildenafil-
viagra)
-Caution: presence head injury or cerebral hemorrhage & renal
impairment

Increase Effects
Nitroglycerin (Nitro-Bid, Nitro-Dur)
-Calcium channel blockers, alcohol, apirazole, ACEI, narcotics,
sildenafil, folate, vitamin E, hawthorn

Decrease Effects
-Acetaminophen, sulfonylureas, vasopressin, Vitamin C

Administration
-Take VS first
SL or spray taken as soon as chest pain develops
-SL dose administation - 5 mins apart
-Nitro ointment - use dose measuring application papers supplied
with ointment
-Store in dry cool dark environment
Beta adrenergic blocker

Cardioselectivity
-Ability of drug to selectively block beta I receptors
-Block beta 2 receptors found in smooth muscle in lungs, blood
vessels, and other organs
-Selectivity diminished at higher doses where it inhibits beta2
receptors in bronichial and vascular musculature

-Used for angina treatment, prophylaxis and treatment of MI

BBW for use with CAD

Adverse Effects
-Cardiac r/t beta adrenergic blockers: heart failure, serious brady-
dysrythmias, depression of atrioventricular node
-Bronchospasm
Atenolol (Tenormin)
Contraindications
-Hypersensitivity, 2nd or 3rd degree heart block, cardiogenic
shock
-Severe bradycardia, heart failure, hypotension

Increase Effects
-Alcohol, digoxin, diltiazem, verapamil, sidenafil

Decrease Effects
-Adrenergic drugs (epinephrine)
-Orange juice

Administration
-IV over 2.5 mins
-IV bolus or continuous drip
Calcium channel blocker
- Inhibits influx of calcium entering through slow channels -pro-
duces vasodilation of peripheral blood vessels and coronary ar-
teries

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-DOES NOT AFFECT HR

-Used for stable, variant, and unstable angina, mild to severe HTN,
Raynauds phenomenon

Adverse Effects
-Cardiac: d/t excessive vasodilation
-Constipation, nausea, gingival hyperplasia

Contraindications
-Hypersensitivity, angina related to overdose of cocaine, amphet-
amines

Nifedipine (Adalat, Procardia) Drugs Increase Effects

-Cisapride, dolasetron, primozide
-Grapefruit juice

Drugs Decrease Effects

-Calcium containing products
-Carbamazepine, phyntyoin, rifampin
-Quinidine
-Digoxin

Administration
-May take with or without food
-Dont crush or break sustained release formulations
-DONT STOP ABRUPTLY
Adjuvant medication to treat CAD

ex; atrovastatin, cholestryamine, niacin

Dyslipidemic Drugs
-Useful in management of risk factors for atherosclerosis and
vascular disorders such as CAD, stroke, peripheral artrerial in-
sufficiency
Adjuvant medication used to treat CAD
Antihypertensive Drugs
-Drugs that decrease peripheral vascular resistance useful in
angina
Adjuvant medication used to treat CAD
Angiotensin-Converting Enzyme Inhibitors
-May be given to most patients routinely
Adjuvant medication to treat CAD

-Produces antiplatelet effect: irreversibly acetylating active site of

Aspirin COX-1
-Has been shown to substantially reduce mortality when admin-
istered during evolving MI
-Loading dose 162-325mg of uncoated asprin
Adjuvant medication used to treat CAD

ex; clopidogrei

-Antiplatelet effects similar to aspirin

Adenosine Diphosphate Receptor Antagonists
-Inhibit AP receptor on surface of platelets

-Drawbacks: delayed onset action, irreversible inhibitory effects

on platelets, no reversing agent/ antidote, significant individual
variability in platelet respose
Morphine

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Adjuvant medication to treat CAD

-Useful in relieving pain, reducing anxiety, decreasing preload

Adjuvant medication used to treat CAD

-Purpose following STEMI

Thrombolytic Drugs
-Drugs simulate conversion of plasminogen to plasmin
-In coronary circulation restoration of blood flow reduces morbitity
and mortality by limiting MI size
Inotrope

Pharmacokinetics
-PO: tablet, elixir, capsules
-Parenteral: IV, IM

-A patient with heart failure experiences decreased contractility

of the heart which impairs the hearts ability to pump blood ade-
quately
-Produces cardioteonic (positive inotropic) effect
-Increases force of myocardial contractility

-Used for mild to moderate heart failure in adults and children

-Control ventricular response rate in older adults with chronic atrial
fibrillation

Contraindications
-Severe myocarditis, ventricular tachycardia, ventricular fibrilla-
tion
-Caution with acute MI, heart block, stokes-adams syndrome,
Digoxin (Lanoxin) wolff-parkinson-white syndrome
-Caution with hypokalemia, hypomagnesemia, hypercalcemia
-Renal impairment

Preventing Interactions
-Dosage must be reduced by approx. 50% with administration of
amiodarone, quinidine, verapamil

Drugs Increase Effects

-Adrenergic agents (epinephrine)
-Antithyroid agents
-Calcium preperations
-Ginseg, hawthrone, licorice

Drugs Decrease Effects

-Antacids, oral laxitives, aminoglycosides, acarbose, psylium, st.
jons wort

Administration
-Assess apical pulse
-With food or after meals
Adverse Effects
-Patient at greater risk for developing toxicities
-Concern of hypokalemia
-Signs of toxicity: life threatening heart rhythms, ranging from slow
to rapid ventricular rhythm
Digoxin (Lanoxin) Toxicity
Contributing Factors
-Accumulation of larger than necessary doses
-Rapid loading or digitalization
-Extremes in age, electrolyte imbalance, hypoxia, hypothyroidism

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Phosphodiesterase Inhibitor (cardio inotropic agent)

-Increases force of contraction of ventricles

-Cause systemic and pulmonary vasodilation by excreting direct
relaxant effect on vascular smooth muscles
-Increases levels of cyclic adenosin monophosphate (cAMP) in
myocardial cells by inhibiting phosphodiesterase

- Indicated long term as bridge therapy in HF

-should be considered for short term IV administration only
Milrinone Lactate (Primacor)
Adverse Effects
-Development of potentially fatal ventricular dysrhythmias
-Hypotension, SVT, chest pain, angina
-Headache, thrombocytopenia, hypokalemia

Contraindications
-Category C meds
-Hypersensitivity
-Hx severe aortic or pulmonic valvular disease
Loop Diuretic

-Inhibits sodium and chloride reabsorption in ascending limb of

loop of henle
-Produce significant diuresis

-Useful when given alone or in combo with other antihypertensive

agents to treat HTN
-Used to manage actue pulmonary edema, HF, hepatic and renal
disease

Adverse Effects
-Fluid and electrolyte imbalances
-Ototoxicity - possible to avoid ( high plasma drug levels)

Contraindications
-Sensitivity, allergy to sulfonamides, anuria, pregnancy
Furosemide (Lasix)
Other Drugs
-Bumetanide (Bumex)
-Torsemide (Demadex)

Preventing Interactions
-Furosemide may decrease effects of insulin or oral antidiabetic
drugs

Drugs Increase Effects

-Aminoglycosides, cephalosporins, corticosteroids, digoxin

Drugs Decrease Effects

-Ibuprofen, Phenytoin

Administration
-IV injection over 1-2 mins
Thiazide Diuretic

-Acts to decrease reabsorption of sodium, water, choride, and

bicarbonate, in distal convoluted tubule
-Most sodium is reabsorbed before it reaches distal tubule

-Used to treat moderate HTN and edema associated with HF and

nephrotic syndromes

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Adverse Effects
- Hypersensitivity, hypotension, weakness
-GI: diarrhea, constipation
-Elecrolyte imbalance, hyperglycemia, paresthesia, eretcile dys-
functioin

Contraindications
-Renal decompensation
-Anuria

Preventing Interactions
Hydrochlorothiazide (Esidrix) -Thiazide diuretics can increase effects of ACEIs, other HTN
agents, allopurinol, calcitrol, lithium

Drugs Increase Effects

-Alcohol, barbiturates, MAOIs, opioids, beta adregenic blockers,
carbamazepine, chlorpropamide, corticosteriods, digoxin

Drugs Decrease Effects

-Cholestryamine, methylphenidate, NSAIDs

Administration
-Has ceiling threshold
-Ceiling dose depends on type of diuretic and extent of disease
Potassium Sparing Diuretic

-Competitively inhibits mineralcorticoid receptors

-Blocks effects of aldosterone in renal tubules
-Blocks sodium retaining effects of aldosterone

-Used for treatment of HF, ascites, hypokalemia, HTN, prima-

ry/secondary hyperaldosteronism

Adverse Effects
-Dizziness, headache, abdominal cramping, diarrhea, deepening
of voice, gynecomastica, menstrual irregularities, testicular atro-
phy
-Increased risk of gastric bleeding

Spironolactone (Aldactone) Contraindications

-Hypersensitivity, renal insufficiency, pregnancy

Preventing Interactions
-med increases half life of digoxin and may reduce renal clearance
of lithium

Drugs Increase Effects

-ACEIs, ARBs, potassium containing drugs, tarcolimus, beta
drenergic blockers

Drugs Decrease Effects

-Alcohol, antihypertensive drugs, salicylates

Administration
-Same time each day with food
Serum potassium level less than 3.5 mEq/L

To Prevent
Hypokalemia
-Giving supplemental potassium
-Increase food intake potassium
-Restrict dietary sodium intake

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Serum potassium level over 5 mEq/L

To Prevent
Hyperkalemia -Avoid potassium sparing diuretics and potassium supplements in
patients with renal impairment
-Avoid excessive amounts of potassium chloride supplement
-Avoid salt substitutes
-Black cohosh
-California poppy
-Coleus
-Goldenseal
Foods that Increase Effects of Diuretics -Hawthorne
-Mistletoe
-Periwinkle
-Quinine
-Shepherd's purse
-American ginseng
-Bayberry
-Blue cohosh
Foods the Decrease Effects of Diuretics
-Ginger
-Kola
-Licorice
Osmotic Diuretic

-Onset 1-3 hours

-Reduction of intracranical pressure in 15-30 mins
-Half life 1-1.6hrs
-Excretion primarily as unchanged drug in urine
-Drug is freely filterable at glomerular rate
Mannitol (Osmitrol)
-Produces rapid diuresis
-Increased osmotic pressure causes water to be pulled from ex-
travascular sites into blood stream

-Useful in managing oliguria or anuria

-May prevent acute renal failure

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 Pharmacology Cardiac NCLEX Questions
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The client is also taking a diuretic that decreases her potassium
level. The nurse expects that a low potassium level (hypokalemia)
could have what effect on the digoxin?
a. Increase the serum digoxin sensitivity level
a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level
When a client first takes a nitrate, the nurse expects which symp-
tom that often occurs?

a. Nausea and vomiting b. Headaches

b. Headaches
c. Stomach cramps
d. Irregular pulse rate
The nurse acknowledges that beta blockers are as effective as
antianginals because they do what?

a. Increase oxygen to the systemic circulation. c. Decrease heart rate and decrease myocardial contractility.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
The health care provider is planning to discontinue a client's
beta blocker. What instruction should the nurse give the client
regarding the beta blocker?

a. The beta blocker should be abruptly stopped when another

cardiac drug is prescribed. b. The beta blocker should NOT be abruptly stopped; the dose
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
should be tapered down.
c. The beta blocker dose should be maintained while taking an-
other antianginal drug.
d. Half the beta blocker dose should be taken for the next several
weeks.
The beta blocker acebutolol (Sectral) is prescribed for dysrhyth-
mias. The nurse knows that what is the primary purpose of the
drug?
c. To block the beta1-adrenergic receptors in the cardiac tissues
a. To increase the beta1 and beta2 receptors in the cardiac tissues
b. To increase the flow of oxygen to the cardiac tissues
c. To block the beta1-adrenergic receptors in the cardiac tissues
d. To block the beta2-adrenergic receptors in the cardiac tissues
A nurse is monitoring a client with angina for therapeutic effects
of nitroglycerin. Which assessment finding indicates that the ni-
troglycerin has been effective?
d. Client stating that pain is 0 out of 10
a. Blood pressure 120/80 mm Hg
b. Heart rate 70 beats per minute
c. ECG without evidence of ST changes
d. Client stating that pain is 0 out of 10
The nurse is monitoring a client during IV nitroglycerin infusion.
Which assessment finding will cause the nurse to take action?

a. Blood pressure 110/90 mm Hg d. Chest pain

b. Flushing
c. Headache
d. Chest pain
Which statement made by the client demonstrates a need for
further instruction regarding the use of nitroglycerin?

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a. "If I get a headache, I should keep taking nitroglycerin and use
Tylenol for pain relief."
b. "I should keep my nitroglycerin in a cool, dry place." d. "I can take up to five tablets at 3-minute intervals for chest pain
c. "I should change positions slowly to avoid getting dizzy." if necessary."
d. "I can take up to five tablets at 3-minute intervals for chest pain
if necessary."
Which client assessment would assist the nurse in evaluating
therapeutic effects of a calcium channel blocker?

a. Client states that she has no chest pain. a. Client states that she has no chest pain.
b. Client states that the swelling in her feet is reduced.
c. Client states the she does not feel dizzy.
d. Client states that she feels stronger.
The client asks the nurse how nitroglycerin should be stored while
traveling. What is the nurse's best response?

a. "You can protect it from heat by placing the bottle in an ice

chest."
b. "It's best to keep it in its original container away from heat and
b. "It's best to keep it in its original container away from heat and
light."
light."
c. "You can put a few tablets in a resealable bag and carry it in
your pocket."
d. "It's best to lock them in the glove compartment to keep them
away from heat and light."
Which statement indicates to the nurse that the client understands
sublingual nitroglycerin medication instructions?

a. "I will take up to five doses every 3 minutes for chest pain." d. "I should sit or lie down after I take a nitroglycerin tablet to
b. "I can chew the tablet for the quickest effect." prevent dizziness."
c. "I will keep the tablets locked in a safe place until I need them."
d. "I should sit or lie down after I take a nitroglycerin tablet to
prevent dizziness."
The nurse is monitoring a client taking digoxin (Lanoxin) for
treatment of heart failure. Which assessment finding indicates a
therapeutic effect of the drug?
b. Heart rate 58 beats per minute
a. Heart rate 110 beats per minute
b. Heart rate 58 beats per minute
c. Urinary output 40 mL/hr
d. Blood pressure 90/50 mm Hg
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. Evaluate digoxin levels.
a. Evaluate digoxin levels.
b. Withhold the furosemide
c. Administer potassium.
d. Document the findings and reassess in 1 hour.
Which assessment finding will alert the nurse to suspect early
digoxin toxicity?

a. Loss of appetite with slight bradycardia a. Loss of appetite with slight bradycardia
b. Blood pressure 90/60 mm Hg
c. Heart rate 110 beats per minute
d. Confusion and diarrhea
What must the nurse monitor when titrating intravenous nitroglyc-
erin for a client? (Select all that apply.)

a. Continuous oxygen saturation

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b. Continuous blood pressures
c. Hourly ECGs
b. Continuous blood pressures
d. Presence of chest pain
d. Presence of chest pain
e. Serum nitroglycerin levels
f. Visual acuity
A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25
mg/day. What type of electrolyte imbalance does the nurse expect
to occur?
b. Hypokalemia
a. Hypocalcemia
b. Hypokalemia
c. Hyperkalemia
d. Hypermagnesemia
What would cause the same client's electrolyte imbalance?

a. High dose of digoxin

c. Hydrochlorothiazide
b. Digoxin taken daily
c. Hydrochlorothiazide
d. Low dose of hydrochlorothiaizde
A nurse teaching a client who has diabetes mellitus and is taking
hydrochlorothiazide 50 mg/day. The teaching should include the
importance of monitoring which levels?
d. Serum glucose (sugar)
a. Hemoglobin and hematocrit
b. Blood urea nitrogen (BUN)
c. Arterial blood gases
d. Serum glucose (sugar)
A client has heart failure and is prescribed Lasix. The nurse is
aware that furosemide (Lasix) is what kind of drug?

a. Thiazide diuretic c. High-ceiling (loop) diuretic

b. Osmotic diuretic
c. High-ceiling (loop) diuretic
d. Potassium-sparing diuretic
The nurse acknowledges that which condition could occur when
taking furosemide?

a. Hypokalemia a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
The client has been receiving spironolactone (Aldactone) 50
mg/day for heart failure. The nurse should closely monitor the
client for which condition?
b. Hyperkalemia
a. Hypokalemia
b. Hyperkalemia
c. Hypoglycemia
d. Hypermagnesemia
A client who has angina is prescribed nitroglycerin. The nurse
reviews which appropriate nursing interventions for nitroglycerin
(Select all that apply.)
a. Have the client lie down when taking a nitroglycerin sublingual
a. Have the client lie down when taking a nitroglycerin sublingual tablet.
tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain
b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
persists. e. Warn client against ingesting alcohol while taking nitroglycerin.
c. Apply Transderm-Nitro patch to a hairy area to protect skin from
burning.
d. Call the health care provider after taking 5 tablets if chest pain
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persists.
e. Warn client against ingesting alcohol while taking nitroglycerin.
Which laboratory value will the nurse report to the health care
provider as a potential adverse response to hydrochlorothiazide
(HydroDIURIL)?
b. Fasting blood glucose level of 140 mg/dL
a. Sodium level of 140 mEq/L
b. Fasting blood glucose level of 140 mg/dL
c. Calcium level of 9 mg/dL
d. Chloride level of 100 mEq/L
What is the best information for the nurse to provide to the
client who is receiving spironolactone (Aldactone) and furosemide
(Lasix) therapy?

a. "Moderate doses of two different diuretics are more effective

b. "This combination promotes diuresis but decreases the risk of
than a large dose of one."
hypokalemia."
b. "This combination promotes diuresis but decreases the risk of
hypokalemia."
c. "This combination prevents dehydration and hypovolemia."
d. "Using two drugs increases the osmolality of plasma and the
glomerular filtration rate."
A client taking spironolactone (Aldactone) has been taught about
the therapy. Which menu selection indicates that the client under-
stands teaching related to this medication?
c. Fish
a. Apricots
b. Bananas
c. Fish
d. Strawberries
A client is ordered furosemide (Lasix) to be given via intravenous
push. What interventions should the nurse perform? (Select all
that apply.)
b. Assess lung sounds before and after administration.
a. Administer at a rate no faster than 20 mg/min.
c. Assess blood pressure before and after administration.
b. Assess lung sounds before and after administration.
d. Maintain accurate intake and output record.
c. Assess blood pressure before and after administration.
d. Maintain accurate intake and output record.
e. Monitor ECG continuously.
f. Insert an arterial line for continuous blood pressure monitoring.
A client with hyperaldosteronism is prescribed spironolactone
(Aldactone). What assessment finding would the nurse evaluate
as a positive outcome?
c. Decreased aldosterone
a. Decreased potassium level
b. Decreased crackles in the lung bases
c. Decreased aldosterone
d. Decreased ankle edema
A client's blood pressure (BP) is 145/90. According to the guide-
lines for determining hypertension, the nurse realizes that the
client's BP is at which stage?
c. Stage 1 hypertension
a. Normal
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension
The nurse acknowledges that the first-line drug for treating this
client's blood pressure might be which drug?
a. Diuretic
a. Diuretic
b. Alpha blocker
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c. ACE inhibitor
d. Alpha/beta blocker
The nurse explains that which beta blocker category is preferred
for treating hypertension?

a. Beta1 blocker a. Beta1 blocker

b. Beta2 blocker
c. Beta1 and beta2 blockers
d. Beta2 and beta3 blockers
Captopril (Capoten) has been ordered for a client. The nurse
teaches the client that ACE inhibitors have which common side
effects?
d. Constant, irritating cough
a. Nausea and vomiting
b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough
Which statement indicates that the client needs additional in-
struction about antihypertensive treatment?

a. "I will check my blood pressure daily and take my medication

when it is over 140/90." a. "I will check my blood pressure daily and take my medication
b. "I will include rest periods during the day to help me tolerate the when it is over 140/90."
fatigue my medicine may cause."
c. "I will change my position slowly to prevent feeling dizzy."
d. "I will not mow my lawn until I see how this medication makes
me feel."
A nurse is caring for a client who is taking an angiotensin-convert-
ing enzyme inhibitor and develops a dry, nonproductive cough.
What is the nurse's priority action?

a. Call the health care provider to switch the medication.

a. Call the health care provider to switch the medication.
b. Assess the client for other symptoms of upper respiratory
infection.
c. Instruct the client to take antitussive medication until the symp-
toms subside.
d. Tell the client that the cough will subside in a few days.
A client is prescribed a noncardioselective beta1 blocker. What
nursing intervention is a priority for this client?

a. Assessment of blood glucose levels b. Respiratory assessment

b. Respiratory assessment
c. Orthostatic blood pressure assessment
d. Teaching about potential tachycardia
A client is admitted to the emergency department with an acute
myocardial infarction. Which drug category does the nurse expect
to be given to the client early for the prevention of tissue necrosis
following blood clot blockage in a coronary or cerebral artery?
c. Thrombolytic agent
a. Anticoagulant agent
b. Antiplatelet agent
c. Thrombolytic agent
d. Low-molecular-weight heparin (LMWH)
The nurse knows that the client's cholesterol level should be within
which range?

a. 150 to 200 mg/dL a. 150 to 200 mg/dL

b. 200 to 225 mg/dL
c. 225 to 250 mg/dL
d. Greater than 250 mg/dL

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 Pharmacology Cardiac NCLEX Questions
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A client's high-density lipoprotein (HDL) is 60 mg/dL. What does
the nurse acknowledge concerning this level?

a. It is lower than the desired level of HDL. b. It is the desired level of HDL.
b. It is the desired level of HDL.
c. It is higher than the desired level of HDL.
d. It is a much lower HDL level than desired.
When a client is taking ezetimibe (Zetia), she asks the nurse how
it works. The nurse should explain that Zetia does what?

a. Inhibits absorption of dietary cholesterol in the intestines.

b. Binds with bile acids in the intestines to reduce LDL levels. a. Inhibits absorption of dietary cholesterol in the intestines.
c. Inhibits HMG-CoA reductase, which is necessary for choles-
terol production in the liver.
d. Forms insoluble complexes and reduces circulating cholesterol
in blood.
The nurse plans which intervention to decrease the flushing re-
action of niacin?

a. Administer niacin with an antacid.

b. Administer aspirin 30 minutes before nicotinic acid.
b. Administer aspirin 30 minutes before nicotinic acid.
c. Administer diphenhydramine hydrochloride (Benadryl) with
niacin.
d. Apply cold compresses to the head and neck.
The nurse is reviewing instructions for a client taking an
HMG-CoA reductase inhibitor (statin). What information is essen-
tial for the nurse to include?
b. "Take this medication at the same time each day."
a. "Take this medication on an empty stomach."
b. "Take this medication at the same time each day."
c. "Take this medication with breakfast."
d. "Take this medication with an antacid."
A client is prescribed gemfibrozil (Lopid) for treatment of hyperlipi-
demia type IV. What is important for the nurse to teach the client?

a. "Take aspirin before the medication if you experience facial

flushing." b. "You may experience headaches with this medication."
b. "You may experience headaches with this medication."
c. "You will need to have weekly blood drawn to assess for hyper-
kalemia."
d. "Cholesterol levels will need to be assessed daily for one week."
Which statement made by the client indicates understanding
about discharge instructions on antihyperlipidemic medications?

a. "Antihyperlipidemic medications will replace the other interven-

tions I have been doing to try to decrease my cholesterol."
d. "I will continue my exercise program to help increase my
b. "It is important to double my dose if I miss one in order to
high-density lipoprotein serum levels."
maintain therapeutic blood levels."
c. "I will stop taking the medication if it causes nausea and
vomiting."
d. "I will continue my exercise program to help increase my
high-density lipoprotein serum levels."
A client is prescribed ezetimibe (Zetia). Which assessment finding
will require immediate action by the nurse?

a. Headache. c. Muscle pain.

b. Slight nausea.
c. Muscle pain.
d. Fatigue.

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A nurse is caring for a client taking cholestyramine (Questran).
The client is complaining of constipation. What will the nurse do?

a. Call the health care provider to change the medication. c. Have the client increase fluids and fiber in his diet.
b. Tell the client to skip a dose of the medication.
c. Have the client increase fluids and fiber in his diet.
d. Administer an enema to the client.
Which statement indicates to the nurse that the client needs
further medication instruction about colestipol (Colestid)?

a. "The medication may cause constipation, so I will increase fluid

and fiber in my diet."
d. "I should stir the powder in as small an amount of fluid as
b. "I should take this medication 1 hour after or 4 hours before my
possible to maintain potency of the medication."
other medications."
c. "I might need to take fat-soluble vitamins to supplement my
diet."
d. "I should stir the powder in as small an amount of fluid as
possible to maintain potency of the medication."
Which assessment finding in a client taking an HMG-CoA reduc-
tase inhibitor will the nurse act on immediately?

a. Decreased hemoglobin b. Elevated liver function tests

b. Elevated liver function tests
c. Elevated HDL
d. Elevated LDL
A 70-year-old client who is taking several cardiac antidysrhythmic
medications has been prescribed simvastatin (Zocor) 80 mg/day.
What is essential information for the nurse to teach the client?
b. "These factors may put you at higher risk for myopathy."
a. "This dose may lower your cholesterol too much."
b. "These factors may put you at higher risk for myopathy."
c. "You should not take this drug with cardiac medications."
d. "This combination will cause you to have nausea and vomiting."
A client diagnosed with hypercholesterolemia is prescribed lo-
vastatin (Mevacor). The nurse is reviewing the client's history
and would contact the health care provider about which of these
conditions in the client's history?
b. Hepatic disease
a. Chronic pulmonary disease
b. Hepatic disease
c. Leukemia
d. Renal disease
The nurse would question an order for cholestyramine (Questran)
if the client has which condition?

a. Impaction a. Impaction
b. Glaucoma
c. Hepatic disease
d. Renal disease
The nurse reviews the history for a client taking atorvastatin
(Lipitor). What will the nurse act on immediately?

a. Client takes medications with grape juice. c. Client is on oral contraceptives.

b. Client takes herbal therapy including kava kava.
c. Client is on oral contraceptives.
d. Client was started on penicillin for a respiratory infection.

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