NUA 285 Pharmacotherapeutics at Georgian Court University
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Free NUA 285 Pharmacotherapeutics at Georgian Court University Questions
What parameter should concern the nurse the most in a patient taking digitalis?
- Heart rate of 88 beats per minute and regular
- Heart rate of 52 beats per minute and irregular
- Heart rate of 100 beats per minute and irregular
- Heart rate of 60 beats per minute and regular
Explanation
B. Heart rate of 52 beats per minute and irregular
Explanation
Digitalis (digoxin) slows conduction through the atrioventricular (AV) node and increases the force of myocardial contraction. A heart rate below 60 beats per minute or an irregular rhythm may indicate digitalis toxicity or excessive drug effect. The nurse should withhold the medication and notify the healthcare provider immediately. Signs of digoxin toxicity include bradycardia, irregular pulse, nausea, vomiting, visual disturbances (yellow or green halos), and confusion. The nurse should always check the apical pulse for one full minute before administering digoxin and monitor serum digoxin and potassium levels, as hypokalemia increases toxicity risk.
What is the primary indication for diltiazem in the management of cardiovascular conditions?
- To treat hypertension and angina
- To prevent thromboembolism
- As an antiarrhythmic agent
- To manage heart failure
Explanation
A. To treat hypertension and angina
Explanation
Diltiazem is a calcium channel blocker (CCB) that works by inhibiting calcium influx into vascular smooth muscle and cardiac cells. This leads to vasodilation, decreased myocardial oxygen demand, and reduced cardiac workload. It is primarily used to treat hypertension and chronic stable or variant angina, improving blood flow to the myocardium and lowering blood pressure.
While diltiazem also has antiarrhythmic properties (used for atrial fibrillation or flutter), its main indication is the management of hypertension and angina. It is not used in heart failure, as it can reduce myocardial contractility and worsen ventricular function in those patients.
The nurse is caring for a patient with glaucoma. The patient is being treated with a beta-blocker. Which other health condition, if identified, would be a contraindication of the medication?
- Diabetes
- Fungal infections
- Asthma
- Gout
Explanation
C. Asthma
Explanation
Beta-blockers, even when used as ophthalmic drops for glaucoma, can be systemically absorbed and may cause bronchoconstriction by blocking β₂ receptors in the lungs. This effect can trigger or worsen asthma attacks and other obstructive pulmonary conditions. For patients with asthma, nonselective beta-blockers such as timolol are contraindicated. In such cases, alternate medications like prostaglandin analogs or selective treatments should be prescribed to manage intraocular pressure safely.
A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect?
- Constipation
- Seizures
- Insomnia
- Bradycardia
Explanation
A. Constipation
Explanation
Mydriatic eye drops, such as atropine sulfate, have anticholinergic properties that can cause systemic effects if absorbed through the conjunctiva or nasolacrimal duct. These effects include constipation, dry mouth, urinary retention, blurred vision, and tachycardia due to inhibition of the parasympathetic nervous system. To minimize systemic absorption, the nurse should apply gentle pressure to the inner canthus (nasolacrimal duct) for 1–2 minutes after instilling the drops. This prevents the drug from entering systemic circulation and reduces the risk of anticholinergic side effects.
The nurse is teaching a client about sucralfate. Which statement made by the patient requires additional teaching?
- "I need to take sucralfate 30 minutes after meals."
- "I need to report pain or vomiting of blood."
- "I need to take my antacid 30 minutes before or 30 minutes after sucralfate."
- "I need to increase my fluid intake."
Explanation
A. "I need to take sucralfate 30 minutes after meals."
Explanation
Sucralfate is a mucosal protectant that forms a barrier over ulcers, protecting them from stomach acid and promoting healing. It must be taken on an empty stomach, typically 1 hour before meals and at bedtime, to be effective. Therefore, the statement about taking it after meals shows a misunderstanding and requires further teaching. Patients should also be instructed to separate sucralfate from antacids by at least 30 minutes, report pain or signs of GI bleeding (vomiting blood, black stools), and increase fluid intake to prevent constipation, a common side effect.
A client is receiving furosemide (Lasix). The nurse should monitor for which adverse effect of the medication?
- Nausea
- Increased urinary output
- Dizziness and lightheadedness
- Gastric upset
Explanation
C. Dizziness and lightheadedness
Explanation
Furosemide (Lasix) is a loop diuretic that promotes rapid excretion of sodium and water, reducing blood volume. This can lead to hypotension and electrolyte imbalances, particularly hypokalemia. Dizziness and lightheadedness are common adverse effects caused by decreased blood pressure and fluid loss. The nurse should monitor the client’s blood pressure, electrolyte levels, and hydration status, and advise the client to rise slowly from sitting or lying positions to prevent falls.
The nurse provides teaching for a patient who will begin taking montelukast sodium (Singulair). Which statement by the patient indicates a need for further teaching?
- "I will use this as needed for acute symptoms."
- "I will need to have periodic laboratory tests while taking this medication."
- "I will take one tablet daily at bedtime."
- "I will begin participating in a smoking cessation program at work."
Explanation
A. "I will use this as needed for acute symptoms."
Explanation
Montelukast (Singulair) is a leukotriene receptor antagonist used for the prevention and long-term management of asthma and to relieve symptoms of allergic rhinitis. It is not a rescue medication and should not be used to treat acute asthma attacks or sudden bronchospasm. The patient’s statement indicates a misunderstanding that requires correction. Montelukast is taken once daily, typically in the evening, and helps prevent airway inflammation and bronchoconstriction over time. Patients may also need periodic liver function tests, and smoking cessation further supports respiratory health and asthma control.
A 60-year-old female patient reports that she has been taking bisacodyl tablets (over-the-counter) daily for 3 months. Which would be the most appropriate response by the nurse?
- This medication may cause your bowels to lose their normal activity.
- If you take this medication, you don't need to eat a high fiber diet.
- This medication can be taken every day for the rest of your life.
- You may take this medication along with antacids.
Explanation
A. This medication may cause your bowels to lose their normal activity.
Explanation
Bisacodyl is a stimulant laxative that promotes bowel movements by irritating the intestinal mucosa and increasing peristalsis. Long-term use can cause laxative dependence, leading to decreased bowel tone and loss of normal bowel function. The nurse should advise the patient to discontinue chronic use and instead adopt lifestyle changes such as increasing dietary fiber, fluid intake, and physical activity to promote regular bowel function safely.
A client is experiencing an anaphylactic allergic reaction after eating peanuts. The client is ordered to receive epinephrine (Adrenalin). This medication is considered a nonspecific adrenergic receptor drug because it innervates __________ receptor sites.
- Beta-adrenergic
- Alpha-adrenergic
- Dopamine
- Alpha and beta adrenergic
Explanation
D. Alpha and beta adrenergic
Explanation
Epinephrine is a nonselective adrenergic agonist, meaning it stimulates both alpha and beta receptors throughout the body. Activation of alpha receptors causes vasoconstriction, which increases blood pressure and reduces airway swelling. Stimulation of beta₁ receptors increases heart rate and cardiac output, while beta₂ receptor activation causes bronchodilation, improving airflow during anaphylaxis. This combined action makes epinephrine the drug of choice for treating severe allergic reactions and anaphylactic shock.
A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine?
- Client reports decreased groin pain of 3 on a 1 to 10 scale.
- The client tolerates a second dose of medication with no greater than 1+ peripheral edema.
- The client’s blood pressure when arising from resting position is at premedication levels.
- Respirations are unlabored.
Explanation
D. Respirations are unlabored.
Explanation
Epinephrine is administered during angioedema to counteract severe allergic reactions that cause airway swelling and respiratory distress. A therapeutic response is demonstrated by improved airway patency, reduced swelling, and unlabored respirations, indicating that the airway obstruction has resolved. The nurse should continue to monitor oxygen saturation, respiratory rate, and breath sounds. Other options, such as pain relief or changes in peripheral edema, are unrelated to the effectiveness of epinephrine in reversing life-threatening airway compromise.
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