Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 26

Question 1 Type: MCSA The patient has hypertension and asks the nurse how this can lead to heart failure. What is the best response by the nurse? 1. "Hypertension causes resistance in your blood vessels or afterload! your heart works harder and weakens." 2. "Hypertension li"its the ability of your heart to stretch before e"ptyin# or afterload! your heart works harder and weakens." 3. "Hypertension causes resistance in your aorta or afterload! your heart works harder and weakens." 4. "Hypertension li"its the a"ount of blood enterin# your left ventricle or afterload! your heart works harder and weakens." Correct Answer: $ ationa!e 1% The "ost co""on cause of increased afterload is an increase in peripheral resistance due to hypertension. Afterload refers to peripheral resistance not to the a"ount of blood enterin# the left ventricle. The ability of the heart to stretch before enterin# is known as preload not afterload. Afterload refers to peripheral resistance not to resistance in the aorta. ationa!e 2% The "ost co""on cause of increased afterload is an increase in peripheral resistance due to hypertension. Afterload refers to peripheral resistance not to the a"ount of blood enterin# the left ventricle. The ability of the heart to stretch before enterin# is known as preload not afterload. Afterload refers to peripheral resistance not to resistance in the aorta. ationa!e 3% The "ost co""on cause of increased afterload is an increase in peripheral resistance due to hypertension. Afterload refers to peripheral resistance not to the a"ount of blood enterin# the left ventricle. The ability of the heart to stretch before enterin# is known as preload not afterload. Afterload refers to peripheral resistance not to resistance in the aorta. ationa!e 4% The "ost co""on cause of increased afterload is an increase in peripheral resistance due to hypertension. Afterload refers to peripheral resistance not to the a"ount of blood enterin# the left ventricle. The ability of the heart to stretch before enterin# is known as preload not afterload. Afterload refers to peripheral resistance not to resistance in the aorta. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% '"ple"entation
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

&earnin$ *utcome: ,./0 Question 2 Type: MCMA The patient co"es to the e"er#ency depart"ent co"plainin# of cou#hin# and difficulty breathin#. The patient1s dia#nosis is heart failure. He asks the nurse how difficulty breathin# could be a heart proble". What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "The ri#ht side of your heart has weakened and blood has entered your lun#s." 2. "The ri#ht side of your heart has enlar#ed and cannot effectively pu"p blood." 3. "What you have is called con#estive heart failure." 4. "The left side of your heart is weak and pu"ps blood too 2uickly." ,. "The left side of your heart has weakened and blood has entered your lun#s." Correct Answer: 0 3 ationa!e 1% When the left ventricle cannot co"pensate for increased preload blood backs up into the lun#s resultin# in cou#h and shortness of breath. 4eft heart failure is so"eti"es called con#estive heart failure. 4eft/ sided not ri#ht/sided heart failure is associated with pul"onary con#estion. 5i#ht/sided heart failure results in peripheral ede"a not pul"onary con#estion. Heart failure results fro" the inability of the left ventricle to pu"p blood not pu"pin# blood too 2uickly. ationa!e 2% When the left ventricle cannot co"pensate for increased preload blood backs up into the lun#s resultin# in cou#h and shortness of breath. 4eft heart failure is so"eti"es called con#estive heart failure. 4eft/ sided not ri#ht/sided heart failure is associated with pul"onary con#estion. 5i#ht/sided heart failure results in peripheral ede"a not pul"onary con#estion. Heart failure results fro" the inability of the left ventricle to pu"p blood not pu"pin# blood too 2uickly. ationa!e 3% When the left ventricle cannot co"pensate for increased preload blood backs up into the lun#s resultin# in cou#h and shortness of breath. 4eft heart failure is so"eti"es called con#estive heart failure. 4eft/ sided not ri#ht/sided heart failure is associated with pul"onary con#estion. 5i#ht/sided heart failure results in peripheral ede"a not pul"onary con#estion. Heart failure results fro" the inability of the left ventricle to pu"p blood not pu"pin# blood too 2uickly. ationa!e 4% When the left ventricle cannot co"pensate for increased preload blood backs up into the lun#s resultin# in cou#h and shortness of breath. 4eft heart failure is so"eti"es called con#estive heart failure. 4eft/ sided not ri#ht sided heart failure is associated with pul"onary con#estion. 5i#ht/sided heart failure results in peripheral ede"a not pul"onary con#estion. Heart failure results fro" the inability of the left ventricle to pu"p blood not pu"pin# blood too 2uickly.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e ,% When the left ventricle cannot co"pensate for increased preload blood backs up into the lun#s resultin# in cou#h and shortness of breath. 4eft heart failure is so"eti"es called con#estive heart failure. 4eft/ sided not ri#ht/sided heart failure is associated with pul"onary con#estion. 5i#ht/sided heart failure results in peripheral ede"a not pul"onary con#estion. Heart failure results fro" the inability of the left ventricle to pu"p blood not pu"pin# blood too 2uickly. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% '"ple"entation &earnin$ *utcome: ,./, Question 3 Type: MCMA The nurse teaches the patient about di#o6in 74ano6in8 to6icity and deter"ines that learnin# has occurred when the patient "akes which state"ent7s8? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "' should li"it "y fluids while takin# this "edication." 2. "'t is okay to keep takin# "y #insen#." 3. "'f ' have nausea it "eans ' "ust stop the "edication." 4. "' can drink oran#e 9uice every "ornin#." ,. "' "ust check "y pulse and not take the "edication if it is less than .-." Correct Answer: 0 ) 3 ationa!e 1% :ran#e 9uice is a source of potassiu" which will "ini"i;e the risk for di#o6in 74ano6in8 to6icity. (ausea by itself "ay be a side effect but it is not necessarily indicative of di#o6in 74ano6in8 to6icity. Si6ty beats per "inute is the #enerally accepted li"it for withholdin# di#o6in 74ano6in8. <insen# "ay increase the risk of di#o6in 74ano6in8 to6icity. =ehydration can increase the risk for di#o6in 74ano6in8 to6icity! the patient "ust not li"it fluids. ationa!e 2% :ran#e 9uice is a source of potassiu" which will "ini"i;e the risk for di#o6in 74ano6in8 to6icity. (ausea by itself "ay be a side effect but it is not necessarily indicative of di#o6in 74ano6in8 to6icity. Si6ty beats per "inute is the #enerally accepted li"it for withholdin# di#o6in 74ano6in8. <insen# "ay increase the risk of di#o6in 74ano6in8 to6icity. =ehydration can increase the risk for di#o6in 74ano6in8 to6icity! the patient "ust not li"it fluids.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 3% :ran#e 9uice is a source of potassiu" which will "ini"i;e the risk for di#o6in 74ano6in8 to6icity. (ausea by itself "ay be a side effect but it is not necessarily indicative of di#o6in 74ano6in8 to6icity. Si6ty beats per "inute is the #enerally accepted li"it for withholdin# di#o6in 74ano6in8. <insen# "ay increase the risk of di#o6in 74ano6in8 to6icity. =ehydration can increase the risk for di#o6in 74ano6in8 to6icity! the patient "ust not li"it fluids. ationa!e 4% :ran#e 9uice is a source of potassiu" which will "ini"i;e the risk for di#o6in 74ano6in8 to6icity. (ausea by itself "ay be a side effect but it is not necessarily indicative of di#o6in 74ano6in8 to6icity. Si6ty beats per "inute is the #enerally accepted li"it for withholdin# di#o6in 74ano6in8. <insen# "ay increase the risk of di#o6in 74ano6in8 to6icity. =ehydration can increase the risk for di#o6in 74ano6in8 to6icity! the patient "ust not li"it fluids. ationa!e ,% :ran#e 9uice is a source of potassiu" which will "ini"i;e the risk for di#o6in 74ano6in8 to6icity. (ausea by itself "ay be a side effect but it is not necessarily indicative of di#o6in 74ano6in8 to6icity. Si6ty beats per "inute is the #enerally accepted li"it for withholdin# di#o6in 74ano6in8. <insen# "ay increase the risk of di#o6in 74ano6in8 to6icity. =ehydration can increase the risk for di#o6in 74ano6in8 to6icity! the patient "ust not li"it fluids. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./3 Question 4 Type: MCSA The nurse teaches the patient about lisinopril 7&rinivil8 and evaluates that additional teachin# is re2uired when the patient "akes which state"ent? 1. "' will "onitor "y blood pressure until "y ne6t appoint"ent." 2. "' will avoid usin# salt substitutes for seasonin#." 3. "'t takes a while for this "edication to take effect." 4. "' don1t need to worry about havin# blood tests done." Correct Answer: ) ationa!e 1% The use of AC+ inhibitors can lead to neutropenia and the patient should be "onitored for this side effect by havin# his absolute neutrophil count 7A(C8 "easured. &otassiu" should be li"ited to avoid hyperkale"ia. >lood pressure should be "onitored to assess effectiveness of the "edication. 't takes a while for lisinopril 7&rinivil8 to beco"e effective.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 2% The use of AC+ inhibitors can lead to neutropenia and the patient should be "onitored for this side effect by havin# his absolute neutrophil count 7A(C8 "easured. &otassiu" should be li"ited to avoid hyperkale"ia. >lood pressure should be "onitored to assess effectiveness of the "edication. 't takes a while for lisinopril 7&rinivil8 to beco"e effective. ationa!e 3% The use of AC+ inhibitors can lead to neutropenia and the patient should be "onitored for this side effect by havin# his absolute neutrophil count 7A(C8 "easured. &otassiu" should be li"ited to avoid hyperkale"ia. >lood pressure should be "onitored to assess effectiveness of the "edication. 't takes a while for lisinopril 7&rinivil8 to beco"e effective. ationa!e 4% The use of AC+ inhibitors can lead to neutropenia and the patient should be "onitored for this side effect by havin# his absolute neutrophil count 7A(C8 "easured. &otassiu" should be li"ited to avoid hyperkale"ia. >lood pressure should be "onitored to assess effectiveness of the "edication. 't takes a while for lisinopril 7&rinivil8 to beco"e effective. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./3 Question , Type: MCSA The patient will receive an '? infusion of "ilrinone 7&ri"acor8 as treat"ent for acute heart failure. What is the priority plan by the nurse? 1. &lan to "onitor for atrial fibrillation. 2. &lan to "onitor the +C< continuously. 3. &lan to take vital si#ns every $3 "inutes. 4. &lan to "onitor for hypertension. Correct Answer: , ationa!e 1% The patient1s +C< is usually "onitored continuously durin# the infusion of "ilrinone 7&ri"acor8. ?ital si#ns should be assessed continuously not every $3 "inutes while the patient receives "ilrinone 7&ri"acor8. Hypotension not hypertension is an adverse effect of "ilrinone 7&ri"acor8. ?entricular dysrhyth"ias not atrial fibrillation are an adverse effect of "ilrinone 7&ri"acor8. ationa!e 2% The patient1s +C< is usually "onitored continuously durin# the infusion of "ilrinone 7&ri"acor8. ?ital si#ns should be assessed continuously not every $3 "inutes while the patient receives "ilrinone 7&ri"acor8. Hypotension not hypertension is an adverse effect of "ilrinone 7&ri"acor8. ?entricular dysrhyth"ias not atrial fibrillation are an adverse effect of "ilrinone 7&ri"acor8.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 3% The patient1s +C< is usually "onitored continuously durin# the infusion of "ilrinone 7&ri"acor8. ?ital si#ns should be assessed continuously not every $3 "inutes while the patient receives "ilrinone 7&ri"acor8. Hypotension not hypertension is an adverse effect of "ilrinone 7&ri"acor8. ?entricular dysrhyth"ias not atrial fibrillation are an adverse effect of "ilrinone 7&ri"acor8. ationa!e 4% The patient1s +C< is usually "onitored continuously durin# the infusion of "ilrinone 7&ri"acor8. ?ital si#ns should be assessed continuously not every $3 "inutes while the patient receives "ilrinone 7&ri"acor8. Hypotension not hypertension is an adverse effect of "ilrinone 7&ri"acor8. ?entricular dysrhyth"ias not atrial fibrillation are an adverse effect of "ilrinone 7&ri"acor8. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./) Question 6 Type: MCSA The physician orders "etoprolol 7Toprol/@48 for several patients. The nurse will hold the "edication and contact the physician for which patient? 1. The patient with an apical pulse rate of $-2. The patient with co"pensated heart failure 3. The patient with chronic bronchitis 4. The patient with a history of "i#raines Correct Answer: 0 ationa!e 1% >eta/blockers are contraindicated for patients with chronic bronchitis. >eta/blockers "ay be used for patients with "i#raines. >eta/blockers "ay be used for patients with co"pensated heart failure. >eta/blockers "ay be used for patients with apical pulse rates of $--. ationa!e 2% >eta/blockers are contraindicated for patients with chronic bronchitis. >eta/blockers "ay be used for patients with "i#raines. >eta/blockers "ay be used for patients with co"pensated heart failure. >eta/blockers "ay be used for patients with apical pulse rates of $--. ationa!e 3% >eta/blockers are contraindicated for patients with chronic bronchitis. >eta/blockers "ay be used for patients with "i#raines. >eta/blockers "ay be used for patients with co"pensated heart failure. >eta/blockers "ay be used for patients with apical pulse rates of $--.

Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 4% >eta/blockers are contraindicated for patients with chronic bronchitis. >eta/blockers "ay be used for patients with "i#raines. >eta/blockers "ay be used for patients with co"pensated heart failure. >eta/blockers "ay be used for patients with apical pulse rates of $--. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% '"ple"entation &earnin$ *utcome: ,./. Question Type: MCSA The patient receives di#o6in 74ano6in8. Which assess"ent findin#s would indicate adverse effects to this "edication? 1. Tachycardia and hypotension 2. >lurred vision and tachycardia 3. Anore6ia and nausea 4. Anore6ia and constipation Correct Answer: 0 ationa!e 1% Anore6ia and nausea are co""on adverse effects of di#o6in 74ano6in8. Hypotension can occur but bradycardia occurs not tachycardia. >lurred vision can occur but bradycardia occurs not tachycardia. Anore6ia can occur but diarrhea is "ore likely than constipation. ationa!e 2% Anore6ia and nausea are co""on adverse effects of di#o6in 74ano6in8. Hypotension can occur but bradycardia occurs not tachycardia. >lurred vision can occur but bradycardia occurs not tachycardia. Anore6ia can occur but diarrhea is "ore likely than constipation. ationa!e 3% Anore6ia and nausea are co""on adverse effects of di#o6in 74ano6in8. Hypotension can occur but bradycardia occurs not tachycardia. >lurred vision can occur but bradycardia occurs not tachycardia. Anore6ia can occur but diarrhea is "ore likely than constipation. ationa!e 4% Anore6ia and nausea are co""on adverse effects of di#o6in 74ano6in8. Hypotension can occur but bradycardia occurs not tachycardia. >lurred vision can occur but bradycardia occurs not tachycardia. Anore6ia can occur but diarrhea is "ore likely than constipation. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in#
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./A Question . Type: MCSA The nurse volunteers at a senior citi;en center. The nurse assesses which senior citi;en as havin# the #reatest risk of developin# heart failure? 1. A 3-/year/old black fe"ale who s"okes 2. A A3/year/old white "ale who is overwei#ht 3. A .B/year/old black "ale with hypertension 4. A 3,/year/old white fe"ale with asth"a Correct Answer: 0 ationa!e 1% A#e race and hypertension lead to an increased risk for developin# hypertension. 5ace and s"okin# are risk factors but bein# fe"ale and youn#er decreases the overall risk. A#e and obesity are risk factors but not as "uch as a#e black race and hypertension. Asth"a by itself is not considered a si#nificant risk factor in the develop"ent of heart failure. ationa!e 2% A#e race and hypertension lead to an increased risk for developin# hypertension. 5ace and s"okin# are risk factors but bein# fe"ale and youn#er decreases the overall risk. A#e and obesity are risk factors but not as "uch as a#e black race and hypertension. Asth"a by itself is not considered a si#nificant risk factor in the develop"ent of heart failure. ationa!e 3% A#e race and hypertension lead to an increased risk for developin# hypertension. 5ace and s"okin# are risk factors but bein# fe"ale and youn#er decreases the overall risk. A#e and obesity are risk factors but not as "uch as a#e black race and hypertension. Asth"a by itself is not considered a si#nificant risk factor in the develop"ent of heart failure. ationa!e 4% A#e race and hypertension lead to an increased risk for developin# hypertension. 5ace and s"okin# are risk factors but bein# fe"ale and youn#er decreases the overall risk. A#e and obesity are risk factors but not as "uch as a#e black race and hypertension. Asth"a by itself is not considered a si#nificant risk factor in the develop"ent of heart failure. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

&earnin$ *utcome: ,./$ Question / Type: MCSA The patient receives furose"ide 74asi68 and di#o6in 74ano6in8 to#ether. Which laboratory findin#s will the nurse assess as increasin# the patient1s risk for di#o6in 74ano6in8 to6icity? 1. Hyponatre"ia and hyperkale"ia 2. Hyper"a#nese"ia and hyponatre"ia 3. Hypercalce"ia and hyperkale"ia 4. Hypokale"ia and hypocalce"ia Correct Answer: ) ationa!e 1% Hypokale"ia and hypocalce"ia can result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will increase a patient1s risk for di#o6in 74ano6in8 to6icity. Hypercalce"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyper"a#nese"ia and hyponatre"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyponatre"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. ationa!e 2% Hypokale"ia and hypocalce"ia can result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will increase a patient1s risk for di#o6in 74ano6in8 to6icity. Hypercalce"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyper"a#nese"ia and hyponatre"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyponatre"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. ationa!e 3% Hypokale"ia and hypocalce"ia can result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will increase a patient1s risk for di#o6in 74ano6in8 to6icity. Hypercalce"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyper"a#nese"ia and hyponatre"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyponatre"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. ationa!e 4% Hypokale"ia and hypocalce"ia can result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will increase a patient1s risk for di#o6in 74ano6in8 to6icity. Hypercalce"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. Hyper"a#nese"ia and hyponatre"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

Hyponatre"ia and hyperkale"ia do not result fro" an interaction with furose"ide 74asi68 and di#o6in 74ano6in8 so it will not increase the patient1s risk for di#o6in 74ano6in8 to6icity. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./3 Question 10 Type: MCSA The patient receives captopril 7Capoten8 as treat"ent for heart failure. Which adverse effect will the nurse plan to report to the physician? 1. The patient develops a cou#h. 2. The patient develops diarrhea. 3. The patient develops dehydration. 4. The patient develops facial flushin#. Correct Answer: $ ationa!e 1% A cou#h is an adverse effect of captopril 7Capoten8 and should be reported to the physician. =iarrhea is not an adverse effect of captopril 7Capoten8. Cacial flushin# is not an adverse effect of captopril 7Capoten8. =ehydration is not an adverse effect of captopril 7Capoten8. ationa!e 2% A cou#h is an adverse effect of captopril 7Capoten8 and should be reported to the physician. =iarrhea is not an adverse effect of captopril 7Capoten8. Cacial flushin# is not an adverse effect of captopril 7Capoten8. =ehydration is not an adverse effect of captopril 7Capoten8. ationa!e 3% A cou#h is an adverse effect of captopril 7Capoten8 and should be reported to the physician. =iarrhea is not an adverse effect of captopril 7Capoten8. Cacial flushin# is not an adverse effect of captopril 7Capoten8. =ehydration is not an adverse effect of captopril 7Capoten8. ationa!e 4% A cou#h is an adverse effect of captopril 7Capoten8 and should be reported to the physician. =iarrhea is not an adverse effect of captopril 7Capoten8. Cacial flushin# is not an adverse effect of captopril 7Capoten8. =ehydration is not an adverse effect of captopril 7Capoten8. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./3 Question 11 Type: MCSA The patient receives enalapril 7?asotec8 as treat"ent for heart failure. What is the best nursin# assess"ent followin# the initial ad"inistration of this dru#? 1. Assess the patient for ototo6icity. 2. Assess the patient1s blood pressure. 3. Assess the patient for an irre#ular pulse. 4. Assess the patient for a serious rash. Correct Answer: , ationa!e 1% Severe hypotension known as first/dose pheno"enon can occur after the initial ad"inistration of enalapril 7?asotec8. :toto6icity is an adverse effect of loop diuretics. StevensDEohnson syndro"e is an adverse effect of beta blockers. 'rre#ular pulse is an adverse effect of beta blockers. ationa!e 2% Severe hypotension known as first/dose pheno"enon can occur after the initial ad"inistration of enalapril 7?asotec8. :toto6icity is an adverse effect of loop diuretics. StevensDEohnson syndro"e is an adverse effect of beta blockers. 'rre#ular pulse is an adverse effect of beta blockers. ationa!e 3% Severe hypotension known as first/dose pheno"enon can occur after the initial ad"inistration of enalapril 7?asotec8. :toto6icity is an adverse effect of loop diuretics. StevensDEohnson syndro"e is an adverse effect of beta blockers. 'rre#ular pulse is an adverse effect of beta blockers. ationa!e 4% Severe hypotension known as first/dose pheno"enon can occur after the initial ad"inistration of enalapril 7?asotec8. :toto6icity is an adverse effect of loop diuretics. StevensDEohnson syndro"e is an adverse effect of beta blockers. 'rre#ular pulse is an adverse effect of beta blockers. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./A Question 12 Type: MCSA
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The patient takes insulin for diabetes "ellitus. The physician orders "etoprolol 74opressor8 for hypertension. After "edication teachin# the nurse deter"ines that learnin# has occurred when the patient "akes which state"ent? 1. "' "i#ht not need to check "y blood su#ars as often with "etoprolol 74opressor8." 2. "' "i#ht be able to chan#e fro" insulin to a pill with "etoprolol 74opressor8." 3. "' "i#ht need less insulin when ' take "etoprolol 74opressor8." 4. "' "i#ht need "ore insulin when ' take "etoprolol 74opressor8." Correct Answer: 0 ationa!e 1% Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less insulin. Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less not "ore insulin. Metoprolol 74opressor8 will not chan#e a diabetic patient1s need for insulin! the patient "i#ht 9ust re2uire less insulin. The patient will "ost likely need "ore fre2uent blood #lucose assess"ents as "etoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin. ationa!e 2% Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less insulin. Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less not "ore insulin. Metoprolol 74opressor8 will not chan#e a diabetic patient1s need for insulin! the patient "i#ht 9ust re2uire less insulin. The patient will "ost likely need "ore fre2uent blood #lucose assess"ents as "etoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin. ationa!e 3% Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less insulin. Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less not "ore insulin. Metoprolol 74opressor8 will not chan#e a diabetic patient1s need for insulin! the patient "i#ht 9ust re2uire less insulin. The patient will "ost likely need "ore fre2uent blood #lucose assess"ents as "etoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin. ationa!e 4% Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less insulin. Metoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin and oral hypo#lyce"ic a#ents so the patient "i#ht re2uire less not "ore insulin. Metoprolol 74opressor8 will not chan#e a diabetic patient1s need for insulin! the patient "i#ht 9ust re2uire less insulin. The patient will "ost likely need "ore fre2uent blood #lucose assess"ents as "etoprolol 74opressor8 "ay enhance the hypo#lyce"ic effects of insulin. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

&earnin$ *utcome: ,./3 Question 13 Type: MCSA The patient has heart failure and receives di#o6in 74ano6in8. &rior to dischar#e what will the best teachin# plan by the nurse include? 1. "5eport a wei#ht #ain of , or "ore pounds per day." 2. "5eport "ental chan#es such as euphoria." 3. "Stop the "edication if your pulse is 3.." 4. "'f you "iss a dose take two doses." Correct Answer: $ ationa!e 1% Wei#ht #ain could indicate fluid retention and a worsenin# of heart failure. &atients should not take a double dose! this is considered an overdose that could lead to to6icity. 'f the pulse is 3. the patient should notify the physician and not stop the "edication unless directed to do so. Mental depression is "ore likely to occur than euphoria. ationa!e 2% Wei#ht #ain could indicate fluid retention and a worsenin# of heart failure. &atients should not take a double dose! this is considered an overdose that could lead to to6icity. 'f the pulse is 3. the patient should notify the physician and not stop the "edication unless directed to do so. Mental depression is "ore likely to occur than euphoria. ationa!e 3% Wei#ht #ain could indicate fluid retention and a worsenin# of heart failure. &atients should not take a double dose! this is considered an overdose that could lead to to6icity. 'f the pulse is 3. the patient should notify the physician and not stop the "edication unless directed to do so. Mental depression is "ore likely to occur than euphoria. ationa!e 4% Wei#ht #ain could indicate fluid retention and a worsenin# of heart failure. &atients should not take a double dose! this is considered an overdose that could lead to to6icity. 'f the pulse is 3. the patient should notify the physician and not stop the "edication unless directed to do so. Mental depression is "ore likely to occur than euphoria. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./3 Question 14
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Type: MCSA The patient has a history of cardiac disease and receives di#o6in 74ano6in8. The nurse deter"ines that education about dietary needs with this "edication has been effective when the patient "akes which selection for lunch? 1. Cotta#e cheese peach salad and blueberry pie 2. >aked fish sweet potatoes and banana puddin# 3. <reen bean soup whole/wheat bread and an apple 4. Ha"bur#er Crench fries and chocolate chip cookies Correct Answer: , ationa!e 1% Cish sweet potatoes and bananas are hi#h in potassiu" which will help prevent di#o6in to6icity. The ha"bur#er is hi#h in potassiu" but the Crench fries are not appropriate for a cardiac patient. <reen bean soup whole/wheat bread and an apple are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. Cotta#e cheese peach salad and blueberry pie are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. ationa!e 2% Cish sweet potatoes and bananas are hi#h in potassiu" which will help prevent di#o6in to6icity. The ha"bur#er is hi#h in potassiu" but the Crench fries are not appropriate for a cardiac patient. <reen bean soup whole/wheat bread and an apple are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. Cotta#e cheese peach salad and blueberry pie are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. ationa!e 3% Cish sweet potatoes and bananas are hi#h in potassiu" which will help prevent di#o6in to6icity. The ha"bur#er is hi#h in potassiu" but the Crench fries are not appropriate for a cardiac patient. <reen bean soup whole/wheat bread and an apple are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. Cotta#e cheese peach salad and blueberry pie are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. ationa!e 4% Cish sweet potatoes and bananas are hi#h in potassiu" which will help prevent di#o6in to6icity. The ha"bur#er is hi#h in potassiu" but the Crench fries are not appropriate for a cardiac patient. <reen bean soup whole/wheat bread and an apple are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. Cotta#e cheese peach salad and blueberry pie are not si#nificant sources of potassiu" needed to help prevent di#o6in to6icity. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./) Question 1,
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Type: MCSA Which individual listed below would be at the #reatest risk for developin# heart disease? 1. 03/year/old with diabetes "ellitus and prehypertension 2. A3/year/old with &arkinsonFs disease and nor"al blood pressure 3. 3,/year/old with osteoporosis and sta#e $ hypertension 4. .G/year/old with sta#e , hypertension and recent "yocardial infarction Correct Answer: ) ationa!e 1% Cardiac tissue weakens as people a#e and can be caused or accelerated by chronic hypertension "yocardial infarction diabetes "ellitus and other cardiac/related diseases. The .G/year/old patient has the "ost risk factors for developin# heart failure. 7p. 0,38 ationa!e 2% Cardiac tissue weakens as people a#e and can be caused or accelerated by chronic hypertension "yocardial infarction diabetes "ellitus and other cardiac/related diseases. The .G/year/old patient has the "ost risk factors for developin# heart failure. 7p. 0,38 ationa!e 3% Cardiac tissue weakens as people a#e and can be caused or accelerated by chronic hypertension "yocardial infarction diabetes "ellitus and other cardiac/related diseases. The .G/year/old patient has the "ost risk factors for developin# heart failure. 7p. 0,38 ationa!e 4% Cardiac tissue weakens as people a#e and can be caused or accelerated by chronic hypertension "yocardial infarction diabetes "ellitus and other cardiac/related diseases. The .G/year/old patient has the "ost risk factors for developin# heart failure. 7p. 0,38 "!o#a! ationa!e: Co$niti%e &e%e!: Hnderstandin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./$ Question 16 Type: MCSA Which state"ent is accurate re#ardin# the physiolo#ical chan#es associated with heart failure? 1. >lood backs up into the lun#s due to ri#ht ventricular hypertrophy. 2. The walls of the heart shrink leadin# to lower cardiac output. 3. Cardiac re"odelin# occurs after prolon#ed ventricular hypertrophy.
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4. >lood pressure increases resultin# in lowered afterload. Correct Answer: 0 ationa!e 1% Heart walls thicken and enlar#e with heart failure. These chan#es occur over ti"e and are referred to as cardiac re"odelin#. >lood can back up into the lun#s but this would be a result of left ventricular hypertrophy not ri#ht. >lood pressure can #o up but would result in a hi#her not lower afterload. ationa!e 2% Heart walls thicken and enlar#e with heart failure. These chan#es occur over ti"e and are referred to as cardiac re"odelin#. >lood can back up into the lun#s but this would be a result of left ventricular hypertrophy not ri#ht. >lood pressure can #o up but would result in a hi#her not lower afterload. ationa!e 3% Heart walls thicken and enlar#e with heart failure. These chan#es occur over ti"e and are referred to as cardiac re"odelin#. >lood can back up into the lun#s but this would be a result of left ventricular hypertrophy not ri#ht. >lood pressure can #o up but would result in a hi#her not lower afterload. ationa!e 4% Heart walls thicken and enlar#e with heart failure. These chan#es occur over ti"e and are referred to as cardiac re"odelin#. >lood can back up into the lun#s but this would be a result of left ventricular hypertrophy not ri#ht. >lood pressure can #o up but would result in a hi#her not lower afterload. "!o#a! ationa!e: Co$niti%e &e%e!: Hnderstandin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./, Question 1Type: MCSA Which of the followin# would lead to an increase in cardiac output? 1. 5educed cardiac contractility 2. Hypovole"ia 3. &eripheral vascular resistance 4. 'ncrease in preload Correct Answer: ) ationa!e 1% 'ncreased preload results in a "ore forceful contraction and increases cardiac output. Hypovole"ia is a lower blood volu"e and will result in lower cardiac output. &eripheral vascular resistance increases afterload and increases the workload on the heart. A reduction in cardiac contractility results in lower preload and subse2uent cardiac output.
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ationa!e 2% 'ncreased preload results in a "ore forceful contraction and increases cardiac output. Hypovole"ia is a lower blood volu"e and will result in lower cardiac output. &eripheral vascular resistance increases afterload and increases the workload on the heart. A reduction in cardiac contractility results in lower preload and subse2uent cardiac output. ationa!e 3% 'ncreased preload results in a "ore forceful contraction and increases cardiac output. Hypovole"ia is a lower blood volu"e and will result in lower cardiac output. &eripheral vascular resistance increases afterload and increases the workload on the heart. A reduction in cardiac contractility results in lower preload and subse2uent cardiac output. ationa!e 4% 'ncreased preload results in a "ore forceful contraction and increases cardiac output. Hypovole"ia is a lower blood volu"e and will result in lower cardiac output. &eripheral vascular resistance increases afterload and increases the workload on the heart. A reduction in cardiac contractility results in lower preload and subse2uent cardiac output. "!o#a! ationa!e: Co$niti%e &e%e!: Hnderstandin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./0 Question 1. Type: MCSA Which of the followin# "edications would be of "ost help to increase "yocardial contractility in a patient with heart failure? 1. =i#o6in 74ano6in8 2. 4isinopril 7&rinivil8 3. Carvedilol 7Core#8 4. Curose"ide 74asi68 Correct Answer: $ ationa!e 1% Cardiac #lycosides increase cardiac output by increasin# the force of contraction. =iuretics lower blood volu"e beta blockers lower heart rate and AC+ inhibitors lower peripheral vascular resistance and blood volu"e. ationa!e 2% Cardiac #lycosides increase cardiac output by increasin# the force of contraction. =iuretics lower blood volu"e beta blockers lower heart rate and AC+ inhibitors lower peripheral vascular resistance and blood volu"e.
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ationa!e 3% Cardiac #lycosides increase cardiac output by increasin# the force of contraction. =iuretics lower blood volu"e beta blockers lower heart rate and AC+ inhibitors lower peripheral vascular resistance and blood volu"e. ationa!e 4% Cardiac #lycosides increase cardiac output by increasin# the force of contraction. =iuretics lower blood volu"e beta blockers lower heart rate and AC+ inhibitors lower peripheral vascular resistance and blood volu"e. "!o#a! ationa!e: Co$niti%e &e%e!: 5e"e"berin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./3 Question 1/ Type: MCSA 4isinopril 7&rinivil8 is often used to treat heart failure because it lowers blood volu"e. Which of the followin# best e6plains how lisinopril lowers blood volu"e? 1. 't has an anta#onistic effect on an#iotensin/convertin# en;y"e. 2. 't lowers aldosterone secretion a hor"one that increases sodiu" reabsorption. 3. 't causes hypernatre"ia and increased renal tubule per"eability resultin# in a diuretic effect. 4. 't causes a diuretic effect by lowerin# the a"ount of sodiu" lost in the urine. Correct Answer: , ationa!e 1% AC+ inhibitors lower blood volu"e by lowerin# the secretion of aldosterone fro" the adrenal corte6. Aldosterone is a hor"one that increases the reabsorption of sodiu" and water. AC+ inhibitors have an anta#onistic effect on an#iotensin/convertin# en;y"e but this action lowers blood pressure by reducin# peripheral vascular resistance not by lowerin# blood volu"e. 'ncreasin# sodiu" in the blood will not lower blood volu"e. ationa!e 2% AC+ inhibitors lower blood volu"e by lowerin# the secretion of aldosterone fro" the adrenal corte6. Aldosterone is a hor"one that increases the reabsorption of sodiu" and water. AC+ inhibitors have an anta#onistic effect on an#iotensin/convertin# en;y"e but this action lowers blood pressure by reducin# peripheral vascular resistance not by lowerin# blood volu"e. 'ncreasin# sodiu" in the blood will not lower blood volu"e. ationa!e 3% AC+ inhibitors lower blood volu"e by lowerin# the secretion of aldosterone fro" the adrenal corte6. Aldosterone is a hor"one that increases the reabsorption of sodiu" and water. AC+ inhibitors have an anta#onistic effect on an#iotensin/convertin# en;y"e but this action lowers blood pressure by reducin#
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peripheral vascular resistance not by lowerin# blood volu"e. 'ncreasin# sodiu" in the blood will not lower blood volu"e. ationa!e 4% AC+ inhibitors lower blood volu"e by lowerin# the secretion of aldosterone fro" the adrenal corte6. Aldosterone is a hor"one that increases the reabsorption of sodiu" and water. AC+ inhibitors have an anta#onistic effect on an#iotensin/convertin# en;y"e but this action lowers blood pressure by reducin# peripheral vascular resistance not by lowerin# blood volu"e. 'ncreasin# sodiu" in the blood will not lower blood volu"e. "!o#a! ationa!e: Co$niti%e &e%e!: Hnderstandin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./3 Question 20 Type: MCSA Which state"ent is accurate re#ardin# the use of beta/adrener#ic blockers for use in patients with heart failure? 1. Hi#her doses are used initially until opti"al vital si#ns are achieved. 2. =osa#e chan#es are done on a daily basis for the first , weeks. 3. This dru# class does not have an effect on the bronchioles of the lun#s. 4. They are #enerally used in co"bination with other heart/failure dru#s. Correct Answer: ) ationa!e 1% >eta/adrener#ic blockers are rarely used to treat heart failure alone. They are co""only used in co"bination with AC+ inhibitors. 'nitial doses are s"all and are doubled every , weeks until the opti"al dose is achieved. >eta/adrener#ic blockers can be selective to beta$ receptors or non/selective. (on/selective blockers block beta$ and beta, receptors. The blocka#e of beta, receptors can affect the bronchioles of the lun#s. ationa!e 2% >eta/adrener#ic blockers are rarely used to treat heart failure alone. They are co""only used in co"bination with AC+ inhibitors. 'nitial doses are s"all and are doubled every , weeks until the opti"al dose is achieved. >eta/adrener#ic blockers can be selective to beta$ receptors or non/selective. (on/selective blockers block beta$ and beta, receptors. The blocka#e of beta, receptors can affect the bronchioles of the lun#s. ationa!e 3% >eta/adrener#ic blockers are rarely used to treat heart failure alone. They are co""only used in co"bination with AC+ inhibitors. 'nitial doses are s"all and are doubled every , weeks until the opti"al dose is achieved. >eta/adrener#ic blockers can be selective to beta$ receptors or non/selective. (on/selective blockers block beta$ and beta, receptors. The blocka#e of beta, receptors can affect the bronchioles of the lun#s.

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ationa!e 4% >eta/adrener#ic blockers are rarely used to treat heart failure alone. They are co""only used in co"bination with AC+ inhibitors. 'nitial doses are s"all and are doubled every , weeks until the opti"al dose is achieved. >eta/adrener#ic blockers can be selective to beta$ receptors or non/selective. (on/selective blockers block beta$ and beta, receptors. The blocka#e of beta, receptors can affect the bronchioles of the lun#s. "!o#a! ationa!e: Co$niti%e &e%e!: Hnderstandin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./3 Question 21 Type: MCSA Which vital si#n is of #reatest concern to the nurse prior to ad"inisterin# di#o6in 74ano6in8? 1. Heart rate 2. Te"perature 3. >lood pressure 4. 5espiratory rate Correct Answer: $ ationa!e 1% An apical pulse should be checked for one full "inute prior to ad"inisterin# di#o6in. 'f the heart rate is low 7#enerally .- bp"8 the "edication should be held and the orderin# practitioner infor"ed. =i#o6in can suppress electrical activity within the heart and lower heart rate. ationa!e 2% An apical pulse should be checked for one full "inute prior to ad"inisterin# di#o6in. 'f the heart rate is low 7#enerally .- bp"8 the "edication should be held and the orderin# practitioner infor"ed. =i#o6in can suppress electrical activity within the heart and lower heart rate. ationa!e 3% An apical pulse should be checked for one full "inute prior to ad"inisterin# di#o6in. 'f the heart rate is low 7#enerally .- bp"8 the "edication should be held and the orderin# practitioner infor"ed. =i#o6in can suppress electrical activity within the heart and lower heart rate. ationa!e 4% An apical pulse should be checked for one full "inute prior to ad"inisterin# di#o6in. 'f the heart rate is low 7#enerally .- bp"8 the "edication should be held and the orderin# practitioner infor"ed. =i#o6in can suppress electrical activity within the heart and lower heart rate. "!o#a! ationa!e: Co$niti%e &e%e!: 5e"e"berin# C!ient 'eed: &hysiolo#ical 'nte#rity
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./3 Question 22 Type: MCSA Which of the followin# is the "ost serious adverse effect associated with "ilrinone 7&ri"acor8? 1. ?entricular dysrhyth"ia 2. (ausea 3. Headache 4. Atrial dysrhyth"ia Correct Answer: $ ationa!e 1% Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhyth"ias. Atrial dysrhyth"ias can occur but ventricular dysrhyth"ias are "ore serious. Headache and nausea also can occur but are not as serious as ventricular dysrhyth"ias. ationa!e 2% Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhyth"ias. Atrial dysrhyth"ias can occur but ventricular dysrhyth"ias are "ore serious. Headache and nausea also can occur but are not as serious as ventricular dysrhyth"ias. ationa!e 3% Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhyth"ias. Atrial dysrhyth"ias can occur but ventricular dysrhyth"ias are "ore serious. Headache and nausea also can occur but are not as serious as ventricular dysrhyth"ias. ationa!e 4% Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhyth"ias. Atrial dysrhyth"ias can occur but ventricular dysrhyth"ias are "ore serious. Headache and nausea also can occur but are not as serious as ventricular dysrhyth"ias. "!o#a! ationa!e: Co$niti%e &e%e!: 5e"e"berin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./3 Question 23 Type: MCMA The nurse is concerned that a patient is developin# ri#ht heart failure. What did the nurse assess in this patient?
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Ankle ede"a 2. +nlar#ed liver 3. =isplaced apical heart rate 4. Shortness of breath ,. Cou#h Correct Answer: $ , 0 ationa!e 1% 'n ri#ht heart failure the blood backs up into veins resultin# in peripheral ede"a. ationa!e 2% 'n ri#ht heart failure the blood backs up into veins resultin# in en#or#e"ent of or#ans such as the liver. ationa!e 3% A displaced apical heart rate would indicate cardiac hypertrophy which is associated with ri#ht heart failure. ationa!e 4% Shortness of breath is a "anifestation of left heart failure. ationa!e ,% A cou#h is a "anifestation of left heart failure. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: &hysiolo#ical Adaptation 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./, Question 24 Type: MCMA The nurse is carin# for a patient who has been dia#nosed with heart failure. The nurse knows that which conditions "ay have contributed to the develop"ent of heart failure in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Hncontrolled hypertension
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

2. Coronary artery disease 3. =iabetes 4. H'? ,. Mitral stenosis Correct Answer: $ , 0 3 ationa!e 1% Hncontrolled hypertension is associated with the develop"ent of heart failure. ationa!e 2% Coronary artery disease is associated with the develop"ent of heart failure. ationa!e 3% =iabetes is associated with the develop"ent of heart failure. ationa!e 4% H'? is not associated with the develop"ent of heart failure. ationa!e ,% Mitral stenosis is associated with the develop"ent of heart failure. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: &hysiolo#ical Adaptation 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./$ Question 2, Type: MCMA The nurse is educatin# a patient dia#nosed with heart failure 7HC8. The nurse knows that instruction re#ardin# co"pensatory "echanis"s has been effective when the patient states Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "My heart enlar#ed in order to co"pensate for the effects of heart failure." 2. "My nervous syste" kicks in to co"pensate for the effects of heart failure." 3. "My body will decrease blood flow to other or#ans in order to co"pensate for heart failure." 4. "My body will increase urine output in order to co"pensate for the effects of heart failure." ,. "My body will produce anti/infla""atory a#ents to co"pensate for heart failure."
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

Correct Answer: $ , 0 ationa!e 1% ?entricular hypertrophy occurs as a co"pensatory "echanis" to heart failure. ationa!e 2% :ne of the fastest ho"eostatic responses to di"inished cardiac output is activation of the sy"pathetic nervous syste" 7S(S8. The increased heart rate resultin# fro" sy"pathetic activation is a nor"al co"pensatory "echanis" that serves to increase cardiac output. ationa!e 3% When cardiac output in a patient with HC is di"inished blood flow to the kidneys is reduced. ationa!e 4% ?asopressin 7antidiuretic hor"one8 which is elevated in HC patients causes fluid retention and worsens this condition. ationa!e ,% Two pro/infla""atory substances tu"or necrosis factor 7T(C8 and interleukin are found in hi#h levels in patients with HC and are associated with a poor pro#nosis. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: 5eduction of 5isk &otential 'ursin$/)nte$rated Concepts: (ursin# &rocess% +valuation &earnin$ *utcome: ,./0 Question 26 Type: MCMA The nurse is carin# for a patient with heart failure. Which assess"ent findin#s indicate the patient is currently e6periencin# class , heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Cati#ue with physical activity 2. &alpitations with physical activity 3. (o sy"pto"s with physical activity 4. =yspnea with physical activity ,. An#ina at rest Correct Answer: $ , ) ationa!e 1% &atients e6periencin# class , heart failure often e6perience fati#ue.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 2% &atients e6periencin# class , heart failure often e6perience palpitations. ationa!e 3% &atients e6periencin# no sy"pto"s with physical activity are classified as havin# class $ heart failure. ationa!e 4% &atients e6periencin# class , heart failure often e6perience dyspnea. ationa!e ,% &atients e6periencin# class ) heart failure are unable to perfor" physical activity and have sy"pto"s at rest. "!o#a! ationa!e: Co$niti%e &e%e!: Analy;in# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: &hysiolo#ical Adaptation 'ursin$/)nte$rated Concepts: (ursin# &rocess% Assess"ent &earnin$ *utcome: ,./) Question 2Type: MCMA The nurse is carin# for a patient who is bein# treated phar"acolo#ically for the sy"pto"s of heart failure. What would be included in the nurse1s role of phar"acolo#ic "ana#e"ent of this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Teachin# the patient how to space "edications to decrease adverse effects 2. Teachin# the patient the lon#/ter" benefits of beta blockers 3. Continually "onitorin# the patient durin# '? infusions 4. =ecreasin# "edication dosa#es when the patient co"plains of adverse effects ,. Chan#in# a "edication that is no lon#er workin# to decrease the patient1s sy"pto"s Correct Answer: $ , 0 ationa!e 1% :ne role of the nurse is patient teachin#. The nurse should teach the patient how to space "edications to decrease the hypotensive effects that can occur durin# treat"ent for heart failure. ationa!e 2% >eta blockers can have "any adverse effects that can affect adherence. The nurse should teach the patient the lon#/ter" benefits in order to increase "edication adherence.

Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 3% &atients who are receivin# "edications used to treat heart failure by '? re2uire continual "onitorin# by the nurse. ationa!e 4% The nurse cannot chan#e a dose of a "edication without a health care provider1s order. This is outside the nurse1s scope of practice. ationa!e ,% The nurse cannot prescribe "edications! it is outside the nurse1s scope of practice to chan#e a "edication with a health care provider1s order. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: &har"acolo#ical and &arenteral Therapies 'ursin$/)nte$rated Concepts: (ursin# &rocess% '"ple"entation &earnin$ *utcome: ,./3 Question 2. Type: MCMA The nurse is carin# for a patient bein# treated phar"acolo#ically for heart failure. Which laboratory values is the nurse careful to "onitor durin# treat"ent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. &otassiu" levels 2. >H( 3. Creatinine 4. 4iver function tests ,. Seru" dru# levels Correct Answer: $ , 0 3 ationa!e 1% 't is i"portant to "onitor electrolyte levels especially potassiu" when a patient is bein# treated phar"acolo#ically for heart failure. ationa!e 2% 't is i"portant to "onitor renal function while a patient is bein# treated phar"acolo#ically for heart failure. ationa!e 3% 't is i"portant to "onitor renal function while a patient is bein# treated phar"acolo#ically for heart failure.
Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.

ationa!e 4% 't is not necessary to "onitor liver function while a patient is bein# treated phar"acolo#ically for heart failure. ationa!e ,% 't is i"portant to "onitor seru" dru# levels while a patient is bein# treated phar"acolo#ically for heart failure. "!o#a! ationa!e: Co$niti%e &e%e!: Applyin# C!ient 'eed: &hysiolo#ical 'nte#rity C!ient 'eed (u#: &har"acolo#ical and &arenteral Therapies 'ursin$/)nte$rated Concepts: (ursin# &rocess% &lannin# &earnin$ *utcome: ,./A

Ada"s, Pharmacology for Nurse: A Pathophysiologic Approach, )*+ Copyri#ht ,-$) by &earson +ducation 'nc.