Pharm Exam 2 prt1

A patient with a history of hypertension and chronic kidney disease is prescribed lisinopril. Which of the following nursing actions is most appropriate to prevent complications related to this medication?

• Encourage increased potassium intake.

• Monitor for signs of hyperkalemia and assess renal function.

• Administer the medication with antacids.

• Discontinue the medication if blood pressure is within normal limits.

Answer explanation

Monitoring for signs of hyperkalemia and assessing renal function is crucial when administering lisinopril, as it can increase potassium levels and affect kidney function, especially in patients with chronic kidney disease.

A patient receiving warfarin therapy presents with an INR of 5.0 and minor gum bleeding. What is the most appropriate nursing intervention?

• Double the next dose of warfarin.

• Hold the next dose and notify the healthcare provider.

• Administer vitamin K immediately.

• Instruct the patient to continue the current dose.

Answer explanation

Holding the next dose and notifying the healthcare provider is appropriate due to the elevated INR of 5.0, indicating a risk of bleeding. Immediate action is necessary to prevent complications.

A patient is prescribed piperacillin/tazobactam for a severe infection. The patient reports a history of penicillin allergy. What should the nurse do first?

• Administer the medication as ordered.

• Notify the healthcare provider before administration.

• Monitor the patient closely after administration.

• Document the allergy in the chart and proceed.

Answer explanation

Notifying the healthcare provider is crucial due to the patient's penicillin allergy. Piperacillin/tazobactam contains a penicillin derivative, which may trigger an allergic reaction. Safety must be prioritized.

A patient on furosemide develops muscle weakness and irregular heart rhythm. Which laboratory value should the nurse assess to determine the cause?

• Serum sodium

• Serum potassium

• Serum calcium

• Serum creatinine

Answer explanation

Furosemide can cause hypokalemia, leading to muscle weakness and irregular heart rhythms. Assessing serum potassium levels is crucial to determine if low potassium is the cause of these symptoms.

A patient is prescribed enoxaparin for DVT prophylaxis after surgery. Which assessment finding would require immediate action by the nurse?

• Mild bruising at the injection site

• Hematuria and sudden onset of back pain

• Slight swelling in the lower extremity

• Mild headache

Answer explanation

Hematuria and sudden onset of back pain may indicate a serious complication such as a bleeding disorder or retroperitoneal hemorrhage, requiring immediate nursing intervention. Other findings are less urgent.

A patient taking nifedipine for hypertension reports swelling in the ankles. What is the most appropriate nursing action?

• Advise the patient to stop the medication.

• Assess for signs of heart failure and notify the provider.

• Instruct the patient to elevate their legs.

• Increase the dose of nifedipine.

Answer explanation

Swelling in the ankles may indicate fluid retention, which can be a sign of heart failure. The most appropriate action is to assess for signs of heart failure and notify the provider for further evaluation.

A patient is receiving heparin therapy for a pulmonary embolism. The nurse notes that the patient’s aPTT is significantly above the therapeutic range. What is the best nursing intervention?

• Continue the current dose and recheck in 24 hours.

• Stop the infusion and notify the healthcare provider.

• Administer an additional dose of heparin.

• Encourage the patient to ambulate.

Answer explanation

Stopping the infusion and notifying the healthcare provider is crucial when aPTT is significantly above the therapeutic range to prevent complications such as bleeding.

A patient on atenolol for hypertension complains of feeling dizzy when standing up quickly. What should the nurse do to address this issue?

• Instruct the patient to increase salt intake.

• Teach the patient to rise slowly from a sitting or lying position.

• Discontinue the medication immediately.

• Advise the patient to take the medication at night.

Answer explanation

The patient is likely experiencing orthostatic hypotension due to atenolol. Teaching the patient to rise slowly helps prevent dizziness by allowing the body to adjust to changes in position.

A patient is prescribed losartan for hypertension. Which patient history would require the nurse to question this order?

• History of asthma

• Pregnancy

• Diabetes mellitus

• Osteoarthritis

Answer explanation

Losartan is contraindicated in pregnancy due to potential harm to the fetus. Therefore, a history of pregnancy would require the nurse to question the order.

A patient is receiving rivaroxaban for atrial fibrillation. Which of the following should the nurse include in the discharge teaching?

• Routine blood monitoring is required.

• Report any signs of unusual bleeding immediately.

• Take the medication only when symptoms occur.

• Avoid all green leafy vegetables.

Answer explanation

Rivaroxaban increases bleeding risk; thus, patients must report any unusual bleeding immediately. Routine blood monitoring is not required, and the medication should be taken consistently, not just when symptoms occur. Green leafy vegetables can be consumed.