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While reviewing a client's medication list, the nurse understands which prescribed medication(s) is/are classified as calcium channel blockers. Select all that apply.
- A. Nifedipine
- B. Propranolol
- C. Verapamil
- D. Hydralazine
- E. Digoxin
Correct Answer: A,C
Rationale: Nifedipine and verapamil are calcium channel blockers used to treat hypertension and angina. Propranolol is a beta-blocker, hydralazine is a vasodilator, and digoxin is a cardiac glycoside.
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The nurse is caring for a client with infective endocarditis. The nurse anticipates a prescription for which medication?
- A. Nitroglycerin
- B. Vancomycin
- C. Atorvastatin
- D. Aspirin
Correct Answer: B
Rationale: Vancomycin, an antibiotic, is used to treat infective endocarditis caused by bacterial infection. Nitroglycerin, atorvastatin, and aspirin are not indicated for this condition.
The clinic nurse is caring for a 38-year-old male
Item 5 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.
Physician Orders
• 12-lead electrocardiogram (ECG)
• atenolol 25 mg by mouth daily
• pitavastatin 1 mg by mouth daily
• fenofibrate 45 mg by mouth daily with food
The nurse receives, reviews, and implements the physician orders. Complete the sentences below by choosing from the list of options. The nurse needs to obtain baseline ___ prior to administering atenolol because atenolol would be contraindicated if the client ___. The nurse understands that the prescribed fenofibrate is intended to ___. Prior to administering the prescribed pitavastatin, the nurse needs to obtain baseline ___.
- A. electrocardiogram
- B. had low liver enzymes.
- C. had atrioventricular block.
- D. reduce triglycerides.
- E. urine analysis.
- F. liver function tests.
- G. c-reactive protein.
Correct Answer: A,C,D,F
Rationale: The nurse needs a baseline ECG (A) to check for atrioventricular block (C), a contraindication for atenolol. Fenofibrate is intended to reduce triglycerides (D). Baseline liver function tests (F) are needed for pitavastatin due to potential hepatotoxicity.
The nurse is answering phones in the general practice clinic and receives a call from a client who is experiencing leg pain after starting atorvastatin. Which of the following should the nurse advise the client to do?
- A. Continue taking the medication as this is an expected side effect.
- B. Discontinue the medication and schedule an appointment for the next week.
- C. Stretch for 20 minutes or take a warm shower.
- D. Discontinue the medication and go to the emergency room as soon as possible.
Correct Answer: D
Rationale: Leg pain with atorvastatin may indicate myopathy or rhabdomyolysis, a serious side effect requiring immediate discontinuation and emergency evaluation.
The nurse in the emergency department (ED) is caring for a client with a myocardial infarction. The nurse anticipates a prescription for which medications? Select all that apply.
- A. labetalol
- B. morphine sulfate
- C. nitroglycerin
- D. enalapril
- E. isosorbide
- F. diltiazem
Correct Answer: B,C,E
Rationale: Morphine sulfate (for pain), nitroglycerin (for vasodilation), and isosorbide (for preload reduction) are used in myocardial infarction. Labetalol, enalapril, and diltiazem are not first-line treatments.
The nurse is teaching a client who is receiving newly prescribed enalapril. Which of the following information should be a priority for the nurse to include?
- A. This medication may cause you to develop a dry cough.
- B. If you notice swelling of your face, lips, or eyes, report this to your doctor.
- C. You may notice that the taste of foods is different.
- D. You will need to obtain periodic lab work while taking this medication.
Correct Answer: B
Rationale: Enalapril, an ACE inhibitor, can cause angioedema, a potentially life-threatening swelling of the face, lips, or eyes, making this the priority teaching point. Dry cough, taste changes, and lab monitoring are relevant but less urgent.