SESSION 17
1. The three primary elements that determine the pressure in the cardiovascular system
are heart rate, stroke volume, and:
A. Baroreceptors
B. Peripheral resistance
C. Renin-Angiotensin-Aldosterone System (RAAS)
D. All of the above
ANSWER B.
Peripheral [Link] arterioles help regulate blood pressure in a constant basis and
are the most important factor
aLecting peripheral resistance. When small arterioles constrict, they are almost able to
stop the flow of the blood. Their high responsiveness to sympathetic nervous stimulation
cause them to constrict and increase blood pressure. Baroreceptors are pressure
receptors located in the arch of the aorta and carotid arteries that send information to the
brain when pressure increases. RAAS is a compensatory mechanism activated in the
kidney when blood pressure falls.
2. Untreated hypertension can result to which of the following:
A. Stroke
B. Renal failure
C. Loss of vision
D. All of the above
ANSWER D.
All of the above.
The force of the blood propelled against blood vessels can damage their linings, making
them susceptible to atherosclerosis and narrowing. When these happen, tiny vessels in the
retina, kidneys, and brain can be destroyed leading to unresponsiveness of the system
3. A student nurse was asked to take the blood pressure of a patient in the emergency
room. The BP reads 140/90 mmHg.
She would be correct to say that this BP belongs to ____________ classification.
A. Normal
B. Elevated
C. Stage 1 Hypertension
D. Stage 2 Hypertension
ANSWER D.
Stage 2 Hypertension. A category rating the severity of hypertension has been devised and
the classifications of blood pressure are as follows: Normal – systolic: <120 mmHg;
diastolic: <80 mmHg; Elevated – systolic: 120-129 mmHg; diastolic:
<80 mmHg; Stage 1 Hypertension – systolic: 130-139 mmHg; diastolic: 80-89 mmHg; Stage
2 Hypertension – systolic: less
than or equal to 140 mmHg; diastolic: less than or equal to 90 mmHg.
4. Which of the following medications will decrease the therapeutic eLects of quinapril
(Accupril)?
A. NSAIDs
B. Allopurinol
C. Antacids
D. All of the above
ANSWER A.
NSAIDs. Quinapril belongs to the class ACE inhibitors. NSAIDs are linked to decreased
antihypertensive eLects of ACE inhibitors. Allopurinol increases risk of hypersensitivity
when combined with ACE inhibitors.
5. A patient receiving nitroprusside begun manifesting headache, distant heart sounds,
imperceptible pulses, and shallow breathing. The nurse knows that these are signs of?
A. Reflex tachycardia
B. Hypothyroidism
C. Cyanide toxicity
D. Severe alteration of blood pressure
ANSWER C.
Cyanide toxicity. Nitroprusside is metabolized into cyanide. Other manifestations of
cyanide toxicity include pink color, loss of consciousness, and absence of reflexes.
6. the nurse is administering antihypertensive drugs to older adults patients. the nurse
knows that which adverse eLect is of most concern for these patients?
A. dry mouth
B. hypotension
C. restlessness
D. constipation
ANSWER B Hypotension. A client receiving furosemide (Lasix) as an adjunct to treatment of
hypertension returns for follow-up.
7. Which of the following objective data should the nurse consider when determining the
eLectiveness of the drug therapy?
A. Blood pressure log notes blood pressure 120/70-134/88 since discharge.
B. Weight loss of six pounds in the past month
C. Frequency of voiding of at least six times per day
D. Absence of edema in lower extremities
ANSWER A.
Maintenance of blood pressure within normal limits indicates that treatment goals are
achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has
promoted fluid loss, but are not the best measure of the drug's eLectiveness for
hypertension.
8. A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and
vomiting, and of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The
appropriate nursing intervention is to:
A. Administer both drugs as ordered.
B. Document the findings; the lab results are within normal limits.
C. Hold the digoxin and HCTZ.
D. Hold the digoxin, and give HCTZ as ordered.
ANSWER C.
Hold the digoxin and HCTZ. Thiazide diuretics increase serum digitalis levels by promoting
potassium loss, which increases the risk of digoxin toxicity. A digitalis level above 2.0 ng is
toxic.
9. Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of
220/110. What action by a new nurse would require intervention by the charge nurse?
A. The nurse inserts a Foley catheter.
B. The nurse documents the IV rate and status of site every 15 minutes.
C. The nurse uses electronic monitoring of blood pressure every hour.
D. The nurse cautions the client to call for assistance before getting out of bed.
ANSWER C.
Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored
very closely—e.g., every 5-15 minutes.
10. The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which
of the following client behaviors indicates understanding?
A. The client avoids taking the drug with grapefruit juice.
B. The client consumes three servings of alcohol daily.
C. The client breaks an enteric-coated tablet for ease of swallowing.
D. The client monitors blood pressure every week.
ANSWER A.
The client avoids taking the drug with grapefruit juice. Grapefruit juice increases absorption
of nifedipine, resulting in increased serum level. Blood pressure ideally should be
monitored more frequently. Alcohol intake of three times a day is excessive. Breaking
enteric tablets will interfere with time release of the medication.
11. A diuretic is added to the treatment regimen for a client with hypertension. The nurse
explains that diuretics help reduce
blood pressure by:
A. Removing serum potassium.
B. Dilating peripheral blood vessels.
C. Reducing sympathetic outflow.
D. Constricting blood vessels.
ANSWER C.
Reducing sympathetic outflow. Diuretics decrease blood volume, which in turn decreases
the workload of the heart and
reduces blood pressure. They do not dilate blood vessels. Some diuretics promote
potassium loss, but this does not reduce the blood pressure. Central-acting
antihypertensives work by blocking sympathetic outflow.
12. Atenolol (Tenormin) is prescribed for a client with hypertension. The nurse recognizes
that a safe dose for this drug is:
A. Atenolol (Tenormin) 100 mg b.i.d.
B. Atenolol (Tenormin) 150 mg q.d.
C. Atenolol (Tenormin) 50 mg b.i.d.
D. Atenolol (Tenormin) 75 mg b.i.d.
ANSWER C.
The maximum dosage range for Atenolol (Tenormin) is 100 mg/day.
13. Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side
eLects and instructs the client
to immediately report:
A. Blood pressure 110/70-114/78 for two successive readings.
B. Dizziness when changing positions.
C. Increased shortness of breath and orthopnea.
D. Weight loss of two pounds per week.
ANSWER C.
Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers decrease
myocardial contractility, increasing the risk of heart failure. Dizziness can occur, especially
when the medication is started. The BP is a desired reading.
14. The client is taking atenolol (Tenormin) and doxazosin (Cardura). what is the rationale
for combining 2 anti-HT drugs?
A. BP will decrease faster
B. Lower doses of both drugs may be given with fewer adverse eLects.
C. There is less daily medication dosing.
D. Combination therapy will treat the patient's other medical conditions.
ANSWER B.
The advantage of using a combo of 2 drugs like atenolol (Tenormin)-a beta blocker and
doxazosin (Cardura) an alpha1
antagonist is that Lower doses of both drugs may be given with fewer adverse eLects.
15. What health teaching should the nurse provide for the client receiving nadolol
(Corgard)?
A. Increase fluids & fiber to prevent constipation
B. Report weight gain of 1kg / month or more
C. Immediately stop taking meds if sexual dysfunction occurs.
D. Rise slowly after prolonged periods of sitting or lying down.
ANSWER D.
Rise slowly after prolonged periods of sitting or lying down.
SESSION 18
1. Nursing student Annie was assigned in the cardiovascular unit A wherein all the patients
have heart failure. Ms. Annie is aware that the primary treatment for heart failure (HF) is
which of the following?.
A. Increasing the heart rate so the heart can pump more blood
B. Decreasing the heart rate so the heart can rest
C. Increasing contractility so the heart will be able to pump more blood
D. Decreasing contractility to prevent muscle fatigue
ANSWER C.
Increasing contractility so the heart will be able to pump more blood. The complete answer
would be to make the heart beat eLiciently, that is to increase its force of contraction
without increasing the heart rate. Through this, more blood is pumped every beat without
overwhelming the heart because rate of contraction is not increased.
2. Which of the following is the most common cause of heart failure?
A. Hypertension
B. Valvular heart diseases
C. Cardiomyopathy
D. Coronary artery disease (CAD)
ANSWER D.
Coronary artery disease (CAD). It accounts for 95% of HF cases. CAD results to insuLicient
supply of blood in the heart.
This leads to hypoxia and loss of function of heart muscles.
3. Digoxin was prescribed to a patient with ventricular tachycardia. What should the nurse
do?
A. Administer the drug as ordered.
B. Discuss the order with the doctor.
C. Discontinue other intravenous medications before administering digoxin.
D. Count apical pulse for one full minute before administering.
ANSWER B.
Discuss the order with the [Link] is contraindicated in patients with ventricular
tachycardia and fibrillation because these are potentially fatal arrhythmias and need to be
treated with other medications.
4. What is the antidote for digoxin intoxication?
A. Diphenhydramine
B. Atropine sulfate
C. Digoxin immune fab (Digibind, DigiFab).
D. Phosphodiesterase inhibitors
ANSWER C.
Digoxin immune fab (Digibind, DigiFab).Digoxin Immune Fab or DigiFab, DigiBind should be
administered for serum digoxin levels of >10 ng/mL and serum potassium level of >5
mEq/mL.
5. An infant who is receiving cardiac glycosides has an apical pulse of 80 beats per minute.
Which is the best nursing
intervention for this assessment finding?
A. Administer drug as ordered.
B. Withdraw the drug and notify doctor.
C. Assess apical pulse every hour for the next five hours.
D. Decrease drug dose and administer.
ANSWER B.
Withdraw the drug and notify doctor.A low apical pulse (less than 90 for infants and less
than 60 for adults) can signal drug toxicity.
6. What signals the novice nurse that intravenous milrinone was combined to furosemide
in management of patients with
heart failure?
A. Presence of bubbles
B. Pink discoloration of the solution
C. Formation of precipitates
D. No obvious sign. Solution is clear.
ANSWER C.
Formation of precipitates.
Phosphodiesterase inhibitor-furosemide combination should be avoided. Alternate lines
should be used if both of these
drugs are given intravenously.
7. What is the therapeutic level for digoxin?
A. 0.5-2 ng/Ml
B. 1.5-2 ng/mL
C. 0.5-1.5 mg/mL
D. 0.5-2 mg/Ml
ANSWER A. 0.5-2 ng/mL.
8. In severe cardiac glycoside toxicity, all of the following should be in the bedside, except
_________.
A. Lidocaine
B. Phenytoin
C. Calcium channel blocker
D. A and B only
ANSWER C.
Calcium channel blockers. Lidocaine and potassium salts are used to treat arrhythmias.
Phenytoin is for treatment of seizures. Other medications and equipment at the bedside
include atropine for treatment of increased heart rate, and a cardiac monitor.
9. Type of angina which involves spasm of the blood vessels
A. Stable angina
B. Pre-infarction angina
C. Unstable angina
D. Prinzmetal angina
ANSWER D.
Prinzmetal angina. It is an unusual type of angina which involves the spasm of blood
vessels and not just by narrowing of vessels. Person with prinzmetal angina has angina at
rest and associated ECG changes.
10. Which instruction should be included in the discharge teaching for a patient with a
transdermal nitroglycerin (Nitro-Dur) patch?
A. "If you get chest pain, apply a second patch next to the first patch."
B. "If you get a headache, remove the patch for 4 hours and then reapply."
C. "Make sure to rub a lotion or cream on the skin before putting on a new patch."
D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or
shoulder."
ANSWER D.
Do not apply the patch to your arms below the elbows, to your legs below the knees, or to
skin folds. Apply the patch to clean, dry, hairless skin that is not irritated, scarred, burned,
broken, or calloused. Choose a diLerent area each day.
11. Contraction and relaxation in each cardiac cycle is controlled by:
A. autonomic nervous system
B. the heart
C. cranial nerves
D. central nervous system
ANSWER B.
The [Link] and relaxation is controlled by impulses arising spontaneously in the
SA node and transmitted via a specialized conducting system to activate all parts of the
muscle almost simultaneously. These rhythmic and continuous contractions are
controlled by the heart itself.
12. All of the following can cause arrhythmia, except:
A. Acidosis
B. respiratory depression
C. hyperkalemia
D. none of the above
ANSWER D.
None of the above. Electrolyte disturbances, hypoxic conditions, acidosis or accumulation
of waste products, and structural damage of the conduction system can lead to
arrhythmia.
13. Verapamil and diltiazem belong to which class of antiarrhythmics?
A. Class IV
B. Class III
C. Class Ia
D. Class II
ANSWER A.
Class IV. Verapamil and diltiazem are calcium-channel blockers and belong to Class IV
antiarrhythmics.
14. The conduction system of the heart include the following:
A. Sinoatrial node
B. Bundle of Purkinje
C. His Fibers
D. Atriomyocardial node
ANSWER A.
Sinoatrial node. Path of conduction is as follows: SA node -> AV node -> Bundle of His ->
Purkinje fibers.
15. The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by
reducing preload. What is
preload?" Which statement by the nurse explains preload to this patient?
A. "It is the blood return to the heart."
B. "It is the oxygen demand of the heart."
C. "It is the pressure against which the heart must pump."
D. "It is dilation of arteries and veins “
ANSWER A.
Preload is the return of blood to the heart. Preload, also known as the left ventricular end-
diastolic pressure (LVEDP), is the amount of ventricular stretch at the end of diastole.
SESSION 19
1. Lipid levels of individuals with coronary artery disease (CAD) is usually high. All of the
following are factors of CAD, except:
A. Men
B. Gout
C. Untreated Chlamydia infections
D. None of the above
ANSWER D.
None of the above. The incidence of CAD in men is higher than premenopausal women.
Gout injures the blood vessels because of accumulation of uric acid. Untreated bacterial
infections can also contribute to CAD.
2. Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the
nurse act on immediately?
A. Decreased haemoglobin
B. Elevated liver function tests
C. Elevated HDL
D. Elevated LDL
ANSWER B.
HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to
monitor liver function tests. The nurse should act on this finding immediately. Decreased
hemoglobin should be addressed but not immediately. It is most likely not related to the
administration of the HMG-CoA reductase inhibitor. Also, while an elevated LDL level must
be addressed, it is not as high a priority as the elevated liver function test results. An
elevated HDL is a positive finding and an encouraging result.
3. A patient is taking pravastatin sodium. Which assessment finding requires immediate
action by the nurse?
A. Headache
B. Slight nausea
C. Muscle pain
D. Fatigue
ANSWER C.
Patients who experience severe muscle pain while taking pravastatin sodium need to
report the findings right away, as this may be indicative of rhabdomyolysis, a muscle
disintegration that can become fatal.
4. Antihyperlipidemic agent that is used to decrease plasma cholesterol levels.
A. HMG-CoA reductase inhibitors
B. Phosphodiesterase inhibitors
C. Bile acid sequestrants
D. Cholesterol absorption inhibitor
ANSWER C.
Bile acid sequestrants. Bile acid contains a lot of cholesterol and bile acid sequestrants
bind to them to form an insoluble complex that is then excreted in the feces.
5. A pregnant woman needs a lipid-lowering agent. What would be the best class of lipid-
lowering agent for pregnant women?
A. HMG-CoA reductase inhibitors
B. Bile acid sequestrants
C. Cholesterol absorption inhibitors
D. Phosphodiesterase inhibitors
ANSWER B.
Bile acid sequestrants. This is the drug of choice for women of childbearing age. HMG-CoA
reductase inhibitor is pregnancy category X.
6. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient
reports abdominal discomfort and constipation. The nurse will provide which instruction to
the patient?
A. Increase fluid and slowly increase fiber intake.
B. Stop the medication.
C. Decrease oral fluids
D. Give stool softeners
ANSWER A.
Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms
can be reduced with increased fluids and foods high in fiber.
7. The only statin with outcome data to show eLectiveness in decreasing CAD and
incidence of myocardial infarction.
A. atorvastatin (Lipitor)
B. simvastatin (Zocor)
C. pravastatin (Pravachol)
D. fluvastatin (Lescol)
ANSWER C.
Pravastatin is an HMG-CoA reductase inhibitor that can prevent first MI even in patients
who do not have documented increase in cholesterol concentration.
8. Which organ(s) produce(s) clotting factors?
A. Bone marrow
B. Spleen and other lymphoid tissues
C. Liver
D. Both B and C
ANSWER C.
[Link] liver produces a cascade of clotting factors which contributes to the process of
coagulation by breaking down fibrinogen into insoluble fibrin threads
9. What is the first reaction to a blood vessel injury?
A. Vasodilation and swelling
B. Vasoconstriction
C. Bleeding
D. Blood coagulation
ANSWER B.
Vasoconstriction. This is especially helpful for very small injuries to the blood vessel
because vasoconstriction can seal oL any break and allow the area to heal.
10. Heparin is an anticoagulant. What family of anticoagulant medications does this drug
belong to?
A. Direct thrombin inhibitors
B. Indirect thrombin inhibitors
C. Vitamin K antagonists
D. Factor Xa inhibitors
ANSWER B.
Heparin is an anticoagulant that belongs to the Indirect Thrombin Inhibitors family.
11. Which statement below BEST describes how Heparin works as an anticoagulant?
A. “It inhibits clotting factors from synthesizing Vitamin K.”
B. “It inactivates the extrinsic pathways of coagulation.”
C. “It prevents Factor Xa from activating prothrombin to fibrinogen.”
12. Which patients below would be at a HIGH risk for developing adverse eLects of Heparin
drug therapy? Select all that
apply:
A. A 55-year-old male patient who is post-op day 1 from brain surgery.
B. A 45-year-old female patient with a pulmonary embolism.
C. A 36-year-old male patient with active peptic ulcer disease.
D. A 43-year-old female with uncontrolled atrial fibrillation.
ANSWER A and C.
These patients are both at risk for major bleeding if placed on an anticoagulant due to their
condition (one patient is post-op from brain surgery and the other patient has ulcers that
could bleed). Option B and D are candidates from Heparin therapy because the patient in
option B has a blood clot (Heparin can prevent it from getting bigger and developing new
blood clots), and the patient in option D is at risk for developing a blood clot.
13. A patient is ordered to start an IV continuous Heparin drip. Prior to starting the
medication, the nurse would ensure what information is gathered correctly before initiating
the drip?
A. Vital signs
B. Weight
C. PT/INR level
D. EKG
ANSWER B.
The nurse would want to make sure the documented weight of the patient is current and
accurate. This medication is weight-based. Therefore, for proper dosing to be administered,
a correct weight should be used.
14. What is the approximate NORMAL level range for an activated partial thromboplastin
time (aPTT)?
A. 20-25 seconds
B. 2-3 seconds
C. 30-40 seconds
D. 60-80 seconds
ANSWER C.
This is considered a (approximate...varies in labs) normal aPTT level in someone who is
NOT on Heparin.
15. A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is
your next nursing action per protocol?
A. Continue with the infusion because no change is needed based on this aPTT.
B. Increase the drip rate per protocol because the aPTT is too low.
C. Re-draw the aPTT STAT.
D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too
high.
ANSWER D.
The aPTT is 105 seconds, which is too high. Any aPTT value greater than 80 seconds places
the patient at risk for bleeding.
Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to
decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to
be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to
achieve a therapeutic response for Heparin.
SESSION 20
1. As a nurse you know that Ferrous should not be given with:
A. Dairy products
B. Antacids
C. Tetracyclines
D. All of the above.
ANSWER D. Ferrous should not be given with dairy products, antacids and tetracyclines
because these decreases the absorption of the drug.
2. What do you give with Ferrous sulfate, ferrous fumarate, or ferrous gluconate to help
promote absorption?
A. Vitamin C
B. Vitamin D
C. Vitamin E
D. Vitamin B12
ANSWER A.
Ferrous sulfate works best when you take it on an empty stomach. However, if it upsets
your stomach, you can take it with or after food. A doctor (or a pharmacist) may
recommend taking ferrous sulfate with orange juice or a vitamin C supplement.
Vitamin C is believed to increase the amount of iron absorbed by the body.
3. The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My
doctor said I have anemia. Are there little red blood cells in that shot?" What are the best
responses by the nurse?
A. "No, we do not give blood for anemia anymore."
B. "No, this medication stimulates your body to make red blood cells."
C. " Yes, this small amount of red blood cells will stimulate your bone marrow to produce
more cells in the kidney."
D. "No, this medication promotes clotting so you will not lose even more red blood cells."
ANSWER B
"No, this medication stimulates your body to make red blood cells." Blood transfusions are
given if anemia is severe. Epoetin alfa (Epogen) is not red blood cells and is not a clot
promoter.
4. The nurse is teaching a class on how red blood cell formation is regulated by the body to
a group of clients who have AIDS. The nurse evaluates that learning has occurred when the
clients make which statements?
A. "Red blood cell formation is regulated through chemicals called colony-stimulating
factors that come from white blood
cells."
B. "Red blood cell formation is regulated through messages from the hormone, secretin,
which is located in the kidney."
C. "Red blood cell formation is regulated through specific liver enzymes and a process
called hemochromatosis."
D. "Red blood cell formation is regulated through messages from the hormone
erythropoietin."
ANSWER D.
Regulation of hematopoiesis occurs through messages from hormones such as
erythropoietin.
5. The client receives chemotherapy as therapy for cancer. The physician orders epoetin
alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy.
What is the best response by the nurse?
A. "No, but it works with your chemotherapy to make it more eLective."
B. "No, this drug helps to counteract the nausea and vomiting caused by your
chemotherapy."
C. "No, it will stimulate your immune system to help you battle the cancer."
D. "No, this drug will help prevent anemia that can be caused by your chemotherapy."
ANSWER D.
Epoetin alfa (Procrit) is given to clients undergoing cancer chemotherapy to counteract the
anemia caused by antineoplastic agents. It is similar to a kidney hormone, erythropoietin,
and helps your body make more red blood cells.
Your kidney makes more erythro-poietin if it doesn’t get enough oxygen. Erythropoietin also
helps your body make hemoglobin.”
6. The client is receiving medication for the treatment of anemia. The nurse has taught the
client about this drug and about anemia. The nurse evaluates that learning has occurred
when the client makes which statement?
A. "My anemia could be caused by blood loss somewhere, but there are other causes too."
B. "My anemia was caused by drinking too many carbonated beverages with caLeine."
C. "There are many causes for anemia; mine was caused by heart failure and fluid
overload."
D. "I think my anemia occurred when I started that vegetarian diet."
ANSWER A.
"My anemia could be caused by blood loss somewhere, but there are other causes too.
"The three categories of blood loss are hemorrhage, increased erythrocyte destruction, and
impaired erythrocyte production.
7. The client had stomach cancer and a surgical removal of his stomach several years ago.
The physician prescribed cyanocobalamin (Nascobal). The client stopped this drug several
months ago. What will the nurse most likely assess in this client?
A. Memory loss, numbness in the limbs, and depression
B. A gradual decrease in red blood cell count
C. Jaundice and tarry stools
D. Low hemoglobin and hematocrit counts
ANSWER A. The most common cause of vitamin B12 deficiency (pernicious anemia) is
absence of intrinsic factor, a protein
8. What is the only potassium-sparing diuretics that can be used in children?
A. Furosemide
B. Spironolactone
C. Amiloride
D. Triamterene
ANSWER B.
Spironolactone. Potassium-sparing diuretics include spironolactone, amiloride, and
triamterene. Both amiloride and triamterene are not for use in children. Use of
spironolactone in children would require careful monitoring of electrolytes.
9. A patient receiving diuretics should alert the nurse if she feels the following:
A. insomnia
B. low-grade fever
C. muscle weakness
D. all of the above
ANSWER C.
Muscle weakness. This is a sign of hypokalemia and would require prompt intervention.
Other signs and symptoms of hypokalemia include arrhythmia and muscle cramps
10. A patient admitted for cerebral swelling complained of feeling light-headed and
nauseous while receiving mannitol. What should the nurse do?
A. Document, withdraw, and notify doctor.
B. Decrease mannitol flow.
C. Provide comfort measures.
D. Increase mannitol flow.
ANSWER A.
Document, withdraw, and notify doctor. A sudden drop in fluid level is one of the most
potentially fatal adverse eLects of mannitol. Manifestations include hypotension,
lightheadedness, nausea, and confusion.
11. The physician prescribes the patient a loop diuretic. As the nurse you know that this
type of diuretic causes diuresis by mainly aLecting what structure in the nephron?
A. Distal convoluted tubule
B. Descending limb of the loop of Henle
C. Proximal convoluted tubule
D. Ascending limb of the loop of Henle
ANSWER D.
Loop diuretics aLect the loop of Henle, specifically the ASCENDING limb (the thick part of
this limb).
12. Loop diuretics are eLective with inhibiting sodium reabsorption within the nephron
because it inhibits?
A. the sodium-chloride transporter
B. the eLects of aldosterone on the distal convoluted tubule
C. the sodium-potassium-chloride cotransporter
D. the transport of bicarbonate by the proximal convoluted tubule
ANSWER C.
Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2) cotransporter in the thick
ascending limb of the loop of Henle. This inhibits the amount of sodium that is reabsorbed
by the kidneys, which will cause the nephron to decrease the amount of water it
reabsorbs...hence leading to more water leaving the kidneys via the urine (leading to its
diuretics aLects).
Option A is how thiazide diuretics work, option B is how potassium-sparing diuretics work,
and option D is how carbonic anhydrase inhibitors work.
13. Your patient is ordered a loop diuretic at 1000. Which finding below would require you
to hold the dose and notify the physician for further orders?
A. Calcium level 9 mg/L
B. Potassium level 1.5 mEq/L
C. Blood pressure 102/78
D. Sodium level 144
ANSWER B.
Loop diuretics are known to decrease potassium levels due to the way they aLect how the
nephron wastes potassium (this happens in the distal convoluted tubule due to the high
concentrated amount of sodium in the filtrate...this tubule will exchange potassium and
hydrogen ions for sodium ions under the influence of aldosterone, which will lead
potassium to enter the filtrate and exit the body as urine.) secreted by stomach cells. This
protein is required for vitamin B12 to be absorbed from the intestine. Symptoms of
pernicious anemia involve the nervous system and include memory loss, confusion,
tingling or numbness in the limbs, and mood disturbances.
14. You’re providing discharge instructions to a patient who will be taking a loop diuretic at
home. Which statement by the patient demonstrates they did NOT understand the teaching
material and requires that you reinforce some of the teaching points?
A. “I will eat a diet rich in potatoes, bananas, avocadoes, strawberries, and spinach.”
B. “I will weight myself daily and report to my physician if I gain more than 3 lbs in 1 day.”
C. “I will change position slowly because I can become dizzy easily while taking this
medication.”
D. “This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L
or more of fluid per day.”
ANSWER D.
The patient should be educated on the signs and symptoms of dehydration (excessive
thirst, fatigue, hypotension etc.).
However, they should not be taught to consume 2L or more of fluid per day. Many patients
are prescribed loop diuretics to treat issues with fluid volume overload (example heart
failure). These patients must monitor how much fluid they are drinking. If too much fluid is
consumed this will cancel out the eLectiveness of the medication.
15. What electrolyte imbalances would the nurse monitor for in the patient who is taking a
loop diuretic? Select all that apply:
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypokalemia
ANSWER B & D.
Loop diuretics can cause hypokalemia, hyponatremia, and hypomagnesemia.
SESSION 21
1. A client is prescribed with Guaifenesin (Mucinex). The nurse determines that the client
understands the proper administration of this medication if the client states that he or she
will:
A. Drink extra fluids while taking this medication.
B. Take the medication with meals only.
C. Take an additional dose once fever and cough persist.
D. Limit oral fluid intake.
ANSWER A.
Guaifenesin is an expectorant. Drink extra fluids to help loosen the congestion and
lubricate the throat while taking this medication.
Option B: The medication does not have to be taken with meals.
Option C: Additional doses should not be taken without the prescription of the doctor.
Option D: Fluids are needed to loosen the secretions.
2. A nurse is about to administer Albuterol (Ventolin HFA) 2 puL and Budesonide (Pulmicort
Turbohaler) 2 puL by metered
dose inhaler. The nurse plans to administer by?
A. Alternating with a single puL each, starting with albuterol.
B. Alternating with a single puL each, starting with budesonide.
C. Budesonide inhaler first then the albuterol.
D. Albuterol inhaler first then the budesonide
ANSWER D.
Albuterol inhaler first then the budesonide. If two diLerent inhaled medications are
prescribed and one of the medications contains a corticosteroid, administer the
bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second. This will allow
for the widening of the air passages by the bronchodilator, making the corticosteroids more
eLective.
3. A nurse is about to administer Naloxone hydrochloride (Narcan) to a client with known
opioid overdose. Which of the following equipment should be readily available at the
bedside?
A. Suction machine.
B. Resuscitative equipment.
C. Nasogastric tube.
D. Dressing tray.
ANSWER B.
While administering Narcan, resuscitation equipment, oxygen, mechanical ventilator
should be readily available. Options A, C, and D are not used during the medication
therapy.
4. A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium
(Combivent). Upon reviewing the medical history of the patient, the nurse questions the
prescription if which of the following is noted?
A. History of smoking.
B. History of allergy to egg.
C. History of allergy to peanut.
D. History of a previous infection.
ANSWER C. History of allergy to peanut. The client with a peanut allergy should not take
ipratropium because the product contains soy lecithin, which is in the same plant family as
peanuts.
5. Montelukast (Singulair) is prescribed to a client with asthma. During the medication
therapy, which of the following
laboratories should be monitored?
A. Complete blood count (CBC).
B. Sodium and Potassium.
C. Calcium and Platelet count.
D. ALT and AST.
ANSWER D.
ALT and AST. Montelukast (Singulair) is a leukotriene receptor and is used with caution in
clients with impaired renal function. Alanine aminotransferase (ALT) and Aspartate
aminotransferase (AST) should be monitor while taking this medication. Options A, B, and
C are not related to the use of this medication.
6. The nurse is giving medication teachings to a client receiving theophylline. The nurse
instruct the client to limit the intake of which of the following?
A. Apple and banana.
B. Yogurt and cheese.
C. Tuna and oysters.
D. Cola and chocolate.
ANSWER D.
Cola and chocolate. Theophylline is a methylxanthine bronchodilator. The nurse instructs
the client to limit the intake of xanthine-containing foods such as chocolate, cola, and
coLee.
7. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the
following statements made by the client will need further instructions?
A. “I can eat gum after I drink the medicine”.
B. “I can take the medicine on an empty stomach”.
C. “I should avoid using alcohol”.
D. “I will avoid driving while using this medication”.
ANSWER B.
“I can take the medicine on an empty stomach”. This medicine should be taken with food
or milk to minimize gastrointestinal upset.
Option A: Use gum or hard candy to minimize dry mouth. Options C and D: The medication
causes drowsiness so avoid taking alcohol or engaging in activities which require mental
alertness such as driving a car.
8. Antitussives are useful in blocking the cough reflex and preserving the energy associated
with prolonged, nonproductive coughing. Antitussives are best used with the following
except:
A. Postoperative patients
B. COPD patients who tire easily
C. Patients with a dry, irritating cough
D. Asthma patients
ANSWER D.
Asthma patients. Option D: Patients with asthma need patent airways which coughing
could provide. Options A, B, and C: These conditions may warrant the use of antitussives.
9. Which of the following pathophysiological mechanisms that occur in the lung
parenchyma allows pneumonia to develop?
A. Atelectasis
B. Bronchiectasis
C. ELusion
D. Inflammation
ANSWER D.
Inflammation. Option D: The common feature of all type of pneumonia is an inflammatory
pulmonary response to the oLending organism or agent. Options A and B: Atelectasis and
bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur in
pneumonia. Option C: An eLusion is an accumulation of excess pleural fluid in the pleural
space, which may be a secondary response to pneumonia.
10. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the
following statements made by the client will need further instructions?
A. “I can eat gum after I drink the medicine”
B. “I can take the medicine on an empty stomach“
C. “I should avoid using alcohol”
D. “I will avoid driving while using this medication”
ANSWER B.
“I can take the medicine on an empty stomach”. Option B: This medicine should be taken
with food or milk to minimize gastrointestinal upset. Option A: Use gum or hard candy to
minimize dry mouth. Options C and D: The medication causes drowsiness so avoid taking
alcohol or engaging in activities which require mental alertness such as driving a car.
11. Nurse Zeke is giving instructions to her client who is taking antihistamine. Which of the
following nurse teachings isappropriate for the client?
A. Expect a relief in 24 hours
B. Be aware that you may have increased saliva
C. Be aware that you may need to take a decongestant
D. Avoid ingesting alcohol
ANSWER D.
Avoid ingesting alcohol. Option D: Because alcohol and antihistamines have sedating
properties, concurrent administration of these drugs should be avoided. Option A: Not all
antihistamines last 24 hours. Option B: Dry mouth is a common side eLect, not increased
salivation. Option C: Antihistamines and decongestants are often given together.
12. Andrew has vertigo, which antihistamine is best for his condition?
A. Terfenadine
B. Guaifenesin
C. Meclizine
D. Hydrocodone
ANSWER C.
Meclizine. Option C: Meclizine (Antivert) is given for vertigo and motion sickness. Option A:
Terfenadine is an antihistamine, but meclizine is the standard drug in the treatment of
vertigo. Option B and D: Choices C and D are not antihistamines.
13. Raul, a 20-year-old student, used to buy OTC drugs whenever he feels sick. Which of
the following statements best describes the danger of self-medication with over-the-
counter drugs?
A. Clients are not aware of the action of over-the-counter drugs.
B. Clients are not aware of the side eLects of over-the-counter drugs.
C. Clients minimize the eLects of over-the-counter drugs because they are available
without a prescription.
D. Clients do not realize the eLects of over-the-counter drugs.
ANSWER C. Clients minimize the eLects of over-the-counter drugs because they are
available without a prescription. Option
C: This choice is correct because it includes the other three risks noted in choices A, B, and
D.
14. Which histamine-2 antagonist is associated with the most drug interactions?
A. Prilosec
B. Nizatidine
C. Ranitidine
D. Cimetidine
ANSWER D. C
imetidine. Option D: Cimetidine was the first histamine-2 antagonist developed and is
associated with the most toxic drug interactions of the group.
15. Stephanie will be having her exam in pharmacology tomorrow. She should be aware
that antitussive is indicated to:
A. Encourage removal of secretions through coughing
B. Relieve rhinitis
C. Relieve a dry cough
D. Control a productive cough
ANSWER C.
Relieve a dry cough. Option C: An antitussive is a cough suppressant. Options A and D:
Represents the action of an expectorant. Option B: Describe the action of a decongestant.
SESSION 22
1. A client has been taking Ibuprofen for some quite time and was given Misoprostol
(Cytotec). Which of the following is exhibiting the therapeutic eLect of Cytotec?
A. Relief of gastric ulcer.
B. Relief of diarrhea.
C. Relief of vomiting.
D. Relief of constipation.
ANSWER A.
Relief of gastric ulcer. Misoprostol (Cytotec) is a synthetic (man-made) prostaglandin that
is used to reduce the risk of stomach ulcers in patients treated with nonsteroidal
antiinflammatory drugs (NSAIDs, for example, aspirin, ibuprofen, etc.).
Option B: Although a side eLect, but it is not the intended therapeutic eLect.
Options C and D are not related to the medication.
2. A geriatric patient is prescribed with Cimetidine (Tagamet) for the treatment of
heartburn. Which of the following is the
most frequent CNS side eLect?
A. Agitation.
B. Drowsiness.
C. Headache.
D. Somnolence
ANSWER A.
Agitation. Cimetidine an H2-receptor antagonist passes the blood brain barrier, and central
nervous system side eLects can happen. Most common serious side eLects are confusion,
agitation, depression, and disorientation. Options B, C, and D: They are considered as the
less common side eLect.
3. A nurse is administering an IV bolus of Cimetidine (Tagamet). Which of the following
should the nurse monitor closely follow the administration?
A. Respiratory rate.
B. Skin turgor.
C. Blood pressure.
D. Temperature.
ANSWER C. Blood pressure. Intravenous administration of Cimetidine causes hypotension.
Options A, B, and D are not related to this medication.
4. A client has been given Loperamide hydrochloride (Imodium). Which of the following
situation is the medication indicated to?
A. Abdominal pain.
B. Patients with an ileostomy.
C. Bloody Diarrhea.
D. Acute dysentery.
ANSWER B.
Patients with an [Link] hydrochloride is an antidiarrheal agent. It can also
be used to reduce the volume of drainage from an ileostomy. Options A, C, and D: It is
contraindicated in patients with abdominal pain in the absence of diarrhea, and in patients
with acute dysentery, which is characterized by blood in stools and high fever.
5. A client has been given Ondansetron (Zofran). For which condition should the nurse
administer this medication to the postoperative patient?
A. Vomiting.
B. Incisional pain.
C. Abdominal infection.
D. Atelectasis.
ANSWER A.
Vomiting. Ondansetron is used to prevent nausea and vomiting that may be caused by
surgery or by medicine to treat cancer (chemotherapy or radiation). Options B, C, and D,
are not related to this medication.
6. A client with a duodenal ulcer is diagnosed with H. pylori infection. The physician
prescribed Amoxicillin (Wymox),
Pantoprazole (Prevacid), and Clarithromycin (Biaxin). Which statement made by the nurse
correctly explains the purpose of these medications?
A. “These medicines will minimize acid production and will coat the ulcer”.
B. “These medicines will stop the acid production and will kill the bacteria”.
C. “The ulcer will heal because the medications will kill the bacteria”.
D. “These medicines will control the ulcer and motion sickness”.
ANSWER B.
“These medicines will stop the acid production and will kill the bacteria”. The triple therapy
treatment of H-pylori infection is the includes 2 antibiotics (Clarithromycin and Amoxicillin)
and one proton pump inhibitor such as omeprazole, lansoprazole, pantoprazole, or
esomeprazole.
7. A client is prescribed with Omeprazole (Prilosec). The nurse determines that the client is
receiving its therapeutic eLect if which of the following is stated by the client:
A. Relief of nausea and vomiting.
B. Decrease diarrheal episodes.
C. The absence of constipation.
D. Relief from GERD.
ANSWER D.
Relief from GERD. Omeprazole is used to treat symptoms of gastroesophageal reflux
disease (GERD) and other conditions caused by excess stomach acid. It is also used to
promote healing of erosive esophagitis (damage to your esophagus caused by stomach
acid). Options B, C, and D are not related to this medication.
8. A client has been prescribed with Pancrelipase (Pancrease). Which of the following
symptoms would prompt the nurse that the medication is having its therapeutic eLect if
which of the following is noted?
A. Negative abdominal pain.
B. An absence of constipation.
C. An absence of diarrhea.
D. Reduction of excess fat in feces.
ANSWER D.
Reduction of excess fat in feces. Pancrelipase is used to help improve food digestion in
certain conditions (cystic fibrosis, pancreatitis) where the pancreas is not working properly.
This medicine minimizes the amount of steatorrhea (fatty stools).
Options A, B, and C are not related to this medication.
9. A nurse is giving a nothing per orem instructions to a malnourished client with diarrhea
and frequent abdominal pain episodes which is about to receive a Total Parenteral
Nutrition. Which statement made by the nurse is the most appropriate?
A. “It will help in your weight loss”.
B. “It can assure you that you feel better after receiving TPN”.
C. “It will decrease your diarrhea and your bowel can rest”.
D. “It will give you less time in the hospital”.
ANSWER C.
“It will decrease your diarrhea, and your bowel can rest”. The priority in this kind of situation
is to stop diarrhea and to provide fluids and electrolyte thru the use of TPN. The bowel is
rested so that the abdominal cramping will also stop.
10. A client is receiving Sulfasalazine (Azulfidine) for the treatment of ulcerative colitis.
Which of the following assessment finding will concern the nurse most?
A. Drowsiness.
B. Decreased urine output.
C. Urine discoloration.
D. Vomiting.
ANSWER B.
Decreased urine output. Sulfasalazine is used to treat bowel inflammation, diarrhea (stool
frequency), rectal bleeding, and abdominal pain in patients with ulcerative colitis. It is
nephrotoxic, so a decrease in urine output is the most serious concern.
Options A, C, and D are also side eLects but are less serious.
11. A client has been prescribed with Sucralfate (Carafate) for the treatment of gastric
ulcer. The nurse instruct the client that this medication is taken?
A. 1 hour before meals.
B. 1 hour after meals.
C. At the same time with an antacid.
D. Lunch time.
ANSWER A.
One hour before meals. Sucralfate is a gastric protective agent. It works by forming a
protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in
the stomach. Taken by mouth on an empty stomach at least 1 hour before or 2 hours after
eating. Options B and D are incorrect. Option C: Do not take an antacid for at least 30
minutes before or after taking sucralfate.
12. Tincture of opium is given to a patient who is having diarrheal episodes. Which of the
following is true regarding this medication?
A. Opium tincture is not a controlled substance.
B. Opium tincture can be used with medications like naltrexone and buprenorphine.
C. Has an unpleasant taste and it can be diluted with 15-30 ml water.
D. It increases intestinal motility and peristalsis.
ANSWER C.
Has an unpleasant taste and can be diluted with 15-30 ml of water. Opium tincture is an
oral liquid medication used to control diarrhea. It has an unpleasant taste so it should be
diluted with 15-30 ml of water. Option A: Opium tincture contains morphine which is a
controlled substance. Option B: Opium tincture should not be used with medications like
naltrexone and buprenorphine because they increase sedation and lower beneficial eLect
of opium tincture. Option D: It is an antidiarrheal, so a decrease motility and peristalsis is
expected.
13. A nurse is giving medicine instructions to a client with hemorrhoids who is receiving a
Mineral oil. Which of the following statements made by the client indicates a further
teaching?
A. “I can take it at least 2 hours before bedtime”.
B. “It can interfere with the absorption of the vitamin E that I am taking”.
C. “If I miss a dose of mineral oil liquid, I’ll take it as soon as I remember”.
D. “I can use mineral oil liquid for an extended period to prevent further damage”.
ANSWER D.
“I can use mineral oil liquid for an extended period to prevent further damage”. Mineral oil
liquid is a lubricant laxative that works by slowing the absorption of water from the bowel,
which softens the stool. The use of mineral oil liquid for a long time may result in loss of
normal bowel function. Options A, B, and C are true regarding mineral oil.
14. A nurse is giving discharge instructions to a client who is receiving a bulk-forming
laxative as part of the home medications. All of which are examples of bulk-forming
laxative, except?
A. Docusate Sodium (Colace).
B. Methylcellulose (Citrucel).
C. Polycarbophil (Fibercon).
D. Psyllium (Metamucil).
ANSWER A.
Docusate Sodium (Colace). Option A is an example of surfactant laxative.
15. What is the priority nursing intervention for a client receiving an antiemetic?
A. Monitor intake and output.
B. Keep items far away from the bed.
C. Give the client privacy by letting him walking around the room.
D. Keep bed in low position with side rails up.
ANSWER D.
Keep bed in low position with side rails up.
Antiemetics can cause drowsiness; hence the priority nursing intervention is to protect the
client from injury such as raising the side rails and keeping the bed in low position. Option A
is not the most priority intervention. Options B and C will risk the client for fall.
1. Nurse Ejay is assigned to a telephone triage. A client called who was stung by a
honeybee and is asking for help. The client reports of pain and localized swelling but has no
respiratory distress or other symptoms of anaphylactic shock.
What is the appropriate initial action that the nurse should direct the client to perform?
A. Removing the stinger by scraping it.
B. Applying a cold compress.
C. Taking an oral antihistamine.
D. Calling emergency number.
ANSWER A.
Since the stinger will continue to release venom into the skin, removing the stinger should
be the first action that the nurse should direct to the [Link] B and C: After removing
the stinger, Antihistamine and cold compress follow. Option D: The caller should be further
advised about symptoms that require emergency assistance.
2. An osmotic diuretic used in emergency, trauma, critical care, and neurosurgical settings
to treat cerebral edema and to reduce increased intracranial pressure.
A. Mannitol
B. Lidocaine
C. Furosemide
D. Albuterol
ANSWER A.
The most rapid and eLective means of decreasing tissue water and brain bulk is
osmotherapy. Osmotic therapy is intended to draw water out of the brain by an osmotic
gradient and to decrease blood viscosity. These changes would decrease ICP and increase
cerebral blood flow (CBF). Mannitol is the most popular osmotic agent. Osmotic therapy
using mannitol reduces ICP by mechanisms that remain unclear. Mannitol is thought to
decrease brain volume by decreasing overall water content, to reduce blood volume by
vasoconstriction, to reduce CSF volume by decreasing water content. Mannitol may
also improve cerebral perfusion by decreasing viscosity or altering red blood cell rheology.
Lastly, mannitol may exert a protective eLect against biochemical injury
3. A client arrives in the emergency unit and reports that a concentrated household cleaner
was splashed in both eyes. Which of the following nursing actions is a priority?
A. Use Restasis (Allergan) drops in the eye.
B. Flush the eye repeatedly using sterile normal saline.
C. Examine the client’s visual acuity.
D. Patch the eye.
ANSWER B.
Flush the eye repeatedly using sterile normal saline. Initial emergency action during a
chemical splash to the eye includes immediate continuous irrigation of the aLected eye
with normal saline. Option A: Restasis (Allergan) drops are used to treat dry eyes. Option C:
Patching the eye is not part of the first line treatment of a chemical splash. Option D: After
irrigation, visual acuity then is assessed.
4. A 5-year-old client was admitted to the emergency unit due to ingestion of unknown
amount of chewable vitamins for children at an unknown time. Upon assessment, the child
is alert and with no symptoms. Which of the following information should be reported to
the physician immediately?
A. The child has been treated multiple times for injuries caused by accidents.
B. The vitamin that was ingested contains iron.
C. The child was nauseated and vomited once at home.
D. The child has been treated several times for toxic substance ingestion
ANSWER B.
The vitamin that was ingested contains iron. Iron is a toxic substance that can lead to
massive hemorrhage, shock, coma, and kidney failure.
5. Which of the following is a concentrated, high-carbohydrate solution given to treat
insulin-induced hypoglycemia or insulin shock?
A. Dextrose 50%
B. Glocagon
C. Mannitol
D. Sodium bicarbonate
ANSWER A.
Dextrose 50% is given by injection to treat insulin shock (low blood sugar caused by using
insulin and then not eating a meal or eating enough food afterward). This medicine works
by quickly increasing the amount of glucose in your blood
6. Epinephrine is administered to a female patient. The nurse should expect this agent to
rapidly aLect:
A. Adrenergic receptors.
B. Muscarinic receptors.
C. Cholinergic receptors.
D. Nicotinic receptors.
ANSWER A.
Adrenergic receptors. Epinephrine (adrenaline) rapidly aLects both alpha and beta
adrenergic receptors eliciting a sympathetic (fight or flight) response. Muscarinic receptors
are cholinergic receptors and are primarily located at parasympathetic junctions.
Cholinergic receptors respond to acetylcholine stimulation. Cholinergic receptors include
muscarinic and nicotinic receptors. Nicotinic receptors are cholinergic receptors activated
by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.
7. An anxious female client complains of chest tightness, tingling sensations, and
palpitations. Deep, rapid breathing, and carpal spasms are noted. Which of the following
priority action should the nurse do first?
A. Provide oxygen therapy.
B. Notify the physician immediately.
C. Administer anxiolytic medication as ordered.
D. Have the client breathe into a brown paper bag.
ANSWER D.
Have the client breathe into a brown paper bag. The client is suLering from hyperventilation
secondary from anxiety, the initial action is to let the client breathe in a paper bag that will
allow the rebreathing of carbon dioxide.
8. A nurse is providing discharge instruction to a woman who has been treated for
contusions and bruises due to a domestic violence. What is the priority intervention for this
client?
A. Making a referral to a counselor.
B. Making an appointment to follow up on the injuries.
C. Advising the client about contacting the police.
D. Arranging transportation to a safe house.
ANSWER D.
Arranging transportation to a safe house. Safety is a priority for this client and she should
not return to a place where violence could recur. Options A, B, and C: These are important
for the long-term management of this case.
9. In the work setting, what is the primary responsibility of the nurse in preparation for
disaster management, that includes natural disasters and bioterrorism incidents?
A. Being aware of the signs and symptoms of potential agents of bioterrorism.
B. Making ethical decisions regarding exposing self to potentially lethal substances.
C. Being aware of the agency’s emergency response plan.
D. Being aware of what and how to report to the Centers for Disease Control and
Prevention.
ANSWER C.
Being aware of the agency’s emergency response plan. In disasters preparedness, the
nurse should know the emergency response plan. This gives guidance that includes the
roles of the team members, responsibilities and mechanism of reporting.
10. Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the
following. Indicate the exception:
A. Tinnitus
B. Perioral numbness
C. Dizziness
D. Hypertension
ANSWER D.
Manifestations of local anesthetic toxicity typically appear 1-5 minutes after the injection,
but onset may range from 30 seconds to as long as 60 minutes. Initial manifestations may
also vary widely. Classically, patients experience symptoms of central nervous system
(CNS) excitement such as the following: Circumoral and/or tongue numbness, metallic
taste, lightheadedness, dizziness, visual and auditory disturbances (diLiculty focusing and
tinnitus), disorientation and drowsiness.
11. Which of the following is used to treat significant ventricular dysrhythmias?
A. Lidocaine
B. Mannitol
C. Naloxone
D. Dopamine
ANSWER A.
Lidocaine is an IV antiarrhythmic agent that has moderate eLicacy against ventricular
arrhythmias. It is particularly useful in the setting of myocardial infarction or ischemia. It
may be used as an alternative to amiodarone in the management of recurrent or shock
refractory ventricular fibrillation/tachycardia. Lidocaine blocks cardiac sodium channels
shortening the action potential and is used intravenously only for arrhythmia.
12. A patient presents to the emergency department with severe respiratory distress, hives,
and edema after being stung on the face by a bee. Which are accurate nursing
assessments of the situation?
A. Hypotension and bronchospasm will progress rapidly if treatment is delayed.
B. The patient is suLering from anaphylactic shock.
C. Epinephrine and diphenhydramine are the drugs of choice as first-line agents.
D. Prompt treatment with drug therapy will prevent this syndrome from occurring again.
ANSWER A, B & C.
Treatment will not prevent anaphylaxis from occurring again. All other statements are true.
13. Which finding indicates that administration of glucagon has been eLective? The patient
experiences
A. An improvement in level of consciousness.
B. An elevation in respiratory rate.
C. Suppression of heart rate.
D. Reduction in blood pressure.
ANSWER A. Glucagon is used for treatment of patients with severe hypoglycemia. An
improved level of consciousness indicates elevation of blood sugar. A blood sugar analysis
should also be obtained.
14. A patient is experiencing both atrial and ventricular dysrhythmias. The nurse anticipates
administration of which medication?
A. Adenosine
B. Amiodarone
C. Atropine
D. Epinephrine
ANSWER B.
Amiodarone is used for the treatment of atrial and ventricular dysrhythmias. Adenosine is
used for the treatment of PSVT.
Atropine is used for the treatment of symptomatic bradycardia. Epinephrine is used for the
treatment of cardiac arrest.
15. A dopamine infusion was started in a patient's antecubital vein during resuscitation
after cardiac arrest. The electronic infusion device is now sounding an alert for an
occlusion. What is the most important immediate concern for the nurse?
A. Infiltration with phentolamine will be necessary if there is extravasation
B. An interruption in the infusion can produce hypotension in the patient.
C. The device will need to be reported to the hospital's clinical engineering department for
service
D. The patient could develop hypertension as a result of the alarm.
ANSWER B.
An interruption in the infusion can produce hypotension in the patient. Dopamine agonists
can markedly reduce blood pressure, and precipitous changes can occur even with the first
dose. Dopamine agonists lower blood pressure primarily by venous and arterial dilation
through inhibition of the sympathetic nervous system.