NUR 2474 PHARMACOLOGY EXAM 2: NCLEX QUESTIONS WITH VERIFIED DETAILED ANSWERS, ALREADY GRADED A+. 2024 AUGUST UPDATE. NEW!
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Course
NUR 2474 PHARMACOLOGY
Institution
NUR 2474 PHARMACOLOGY
NUR 2474 PHARMACOLOGY EXAM 2: NCLEX
QUESTIONS WITH VERIFIED DETAILED
ANSWERS, ALREADY GRADED A+. 2024
AUGUST UPDATE.
NEW!
An older adult patient with congestive heart failure develops crackles in both lungs and
pitting edema of all extremities. The physician orders hydrochlorothiazide (Hyd...
NUR 2474 PHARMACOLOGY EXAM 2: NCLEX
QUESTIONS WITH VERIFIED DETAILED
ANSWERS, ALREADY GRADED A+. 2024
AUGUST UPDATE.
NEW!
An older adult patient with congestive heart failure develops crackles in both lungs and
pitting edema of all extremities. The physician orders hydrochlorothiazide (HydroDIURIL).
Before administering this medication, the nurse reviews the patient's chart. Which laboratory
value causes the nurse the most concern?
Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore,
an elevated creatinine clearance would cause the most concern. Thiazide diuretics are
potassium-wasting drugs and thus may actually improve the patient's potassium level.
Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL
cholesterol; however, this patient's levels are low, so this is not a risk.
A patient with chronic congestive heart failure has repeated hospitalizations in spite of
ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has
ordered spironolactone (Aldactone) to be added to this patient's drug regimen, and the nurse
provides education about this medication. Which statement by the patient indicates
understanding of the teaching?
a."I can expect improvement within a few hours after taking this drug."
b."I need to stop taking potassium supplements."
,c."I should use salt substitutes to prevent toxic side effects."
d."I should watch closely for dehydration." - ANS✔✔-b."I need to stop taking potassium
supplements."
Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting
effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for
hyperkalemia when taking this medication, so they should be advised to stop the
supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain
high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the
risk of dehydration is not increased.
A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor.
The nurse reviewing this patient's chart before administering the medication will be most
concerned about which other disease process?
ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery
stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary
artery disease, and diabetes mellitus are not comorbidities that are contraindications to
treatment with an ACE inhibitor.
A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time.
What will the nurse do?
a.Instruct the patient not to get up without assistance.
b.Make sure the patient takes a potassium supplement.
c.Report the presence of a dry cough to the prescriber.
d.Request an order for a diuretic to counter the side effects of the ACE inhibitor. - ANS✔✔-
a.Instruct the patient not to get up without assistance.
Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be
discouraged from getting up without assistance. Potassium supplements are
contraindicated. A dry cough is an expected side effect that eventually may cause a patient
to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can
,exacerbate hypotension and should be discontinued temporarily when a patient starts an
ACE inhibitor.
A patient who has been taking an antihypertensive medication for several years is recovering
from a myocardial infarction. The prescriber changes the patient's medication to an ACE
inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's
response?
a."ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."
b."ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol."
c."ACE inhibitors increase venous return to the heart, improving cardiac output."
d."ACE inhibitors regulate electrolytes that affect the cardiac rhythm." - ANS✔✔-a."ACE
inhibitors can prevent or reverse pathologic changes in the heart's structure."
ACE inhibitors have many advantages over other antihypertensive medications, the most
important of which is their ability to prevent or reverse pathologic changes in the heart and
reduce the risk of cardiac mortality caused by hypertension. They are useful in patients with
high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they
do not directly affect this comorbidity. They reduce venous return to the heart, thereby
reducing right heart size. They do not alter serum electrolyte levels
A prescriber orders ramipril (Altace) for an obese patient with type 2 diabetes mellitus who
has developed hypertension. The nurse provides teaching before dismissing the patient
home. Which statement by the patient indicates understanding of the teaching?
a."I am less likely to develop diabetic nephropathy when taking this medication."
b."I should check my blood sugar more often, because hyperglycemia is a side effect of this
drug."
c."Taking this medication helps reduce my risk of stroke and heart attack."
d."This medication will probably prevent the development of diabetic retinopathy." - ANS✔✔-
c."Taking this medication helps reduce my risk of stroke and heart attack."
Ramipril (Altace) is approved for reducing the risk of stroke and myocardial infarction (MI) in
patients at high risk for a major cardiovascular event because they have hypertension in
conjunction with a history of stroke or MI or because they have diabetes. ACE inhibitors
cannot be used for primary prevention of diabetic nephropathy, but they can delay the onset
of overt nephropathy in patients who already have less advanced nephropathy. ACE
inhibitors do not affect serum electrolytes or glucose. One ACE inhibitor, enalapril, can
reduce the risk of diabetic retinopathy in some patients with type 1 diabetes mellitus.
, A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse
correctly tell the patient about this symptom?
a.It indicates that a serious side effect has occurred.
b.It is a common side effect that occurs in almost all patients taking the drug.
c.It may be uncomfortable enough that the drug will need to be discontinued.
d.It occurs frequently in patients taking the drug but will subside over time. - ANS✔✔-c.It
may be uncomfortable enough that the drug will need to be discontinued.
A cough occurs in about 10% of patients taking ACE inhibitors and is the most common
reason for discontinuing therapy. It does not indicate a serious condition. It occurs in about
10% of all patients and is more common in women, older adults, and those of Asian
ancestry. It does not subside until the medication is discontinued.
A nurse is reviewing a patient's medications before administration. Which drug-to-drug
interactions should most concern the nurse in a patient with a history of heart failure and a
potassium level of 5.5 mEq/L?
a.Furosemide (Lasix) and enalapril (Vasotec)
b.Amlodipine (Norvasc) and spironolactone (Aldactone)
c.Eplerenone (Inspra) and spironolactone (Aldactone)
d.Metoprolol (Lopressor) and furosemide (Lasix) - ANS✔✔-c.Eplerenone (Inspra) and
spironolactone (Aldactone)
The greatest risk with eplerenone is hyperkalemia, and combining this drug with a
potassium-sparing diuretic creates a significant risk of hyperkalemia. Furosemide and
enalapril, an ACE inhibitor, would not be contraindicated in this patient. Amlodipine and
spironolactone would not cause hyperkalemia. The combination of metoprolol, a beta
blocker, and furosemide would not be contraindicated in this patient.
A patient who stops taking an ACE inhibitor because of its side effects will begin taking an
angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not
occur with an ARB medication?
a.Angioedema
b.Cancer
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