ATI-P ATI Pharmacology - Set 2 - Part 2

Correct Answer: Monitor blood pressure continuously

Nitroprusside lowers blood pressure rapidly and can cause severe hypotension. The nurse should monitor blood pressure continuously during the infusion so the rate can be titrated safely and a dangerous drop in pressure is caught quickly. Option a is incorrect because the nitroprusside solution must be protected from light, not exposed to it, because light degrades the drug. Bright light would break it down, so this action is unsafe; the essential nursing measure is continuous blood pressure monitoring. Option b is incorrect because nitroprusside is given as a controlled, titrated infusion, never as a rapid push, which would cause the pressure to plummet. The action that keeps the client safe is watching blood pressure closely, not delivering the drug quickly. Option d is incorrect because the prepared solution is discarded after a limited time and is not kept for days, since it deteriorates. Storing it that long is unsafe, and it does nothing to support the close hemodynamic watching t

Correct Answer: Improved tolerance of activity

Digoxin increases the force of myocardial contraction and improves cardiac output, which relieves heart failure symptoms. The nurse should identify improved tolerance of activity as a therapeutic effect, reflecting better perfusion and reduced congestion. Option a is incorrect because worsening shortness of breath signals that heart failure is not controlled, the opposite of a therapeutic response. Digoxin strengthens the heart's pumping, so the nurse expects easier breathing and better activity tolerance rather than increasing dyspnea. Option c is incorrect because steady weight gain suggests fluid retention and failing therapy, not success. Because digoxin improves cardiac output and helps clear congestion, the expected benefit is reduced fluid backup, making weight gain a warning sign instead of a goal. Option d is incorrect because digoxin slows the heart rate through its negative chronotropic action, so a faster rate is not the therapeutic effect. The nurse anticipates a stro

Correct Answer: Yellow-green halos around objects

Digoxin toxicity causes visual disturbances, classically yellow-green or white halos around objects, along with anorexia, nausea, and dysrhythmias. The nurse should report halos because they are a recognized sign that the digoxin level may be toxic. Option b is incorrect because a pink chest rash is not associated with digoxin toxicity and points more toward a hypersensitivity reaction to another drug. The visual halos, paired with GI upset, are the hallmark that signals digoxin has reached a toxic level. Option c is incorrect because increased appetite is not a sign of toxicity; in fact, anorexia is usually the first GI manifestation when digoxin becomes toxic. The nurse should report the visual halos, which reflect the drug's toxic effect on the client. Option d is incorrect because a dry cough is linked to ACE inhibitors through bradykinin, not to digoxin. The toxic picture for digoxin features anorexia, nausea, dysrhythmias, and yellow-green halos, so the visual change is the

Correct Answer: Measure the client's apical pulse

Digoxin slows the heart rate and is withheld when the pulse is too low. The nurse should measure the apical pulse before administration and hold the dose for a slow heart rate, then notify the provider. Option a is incorrect because urine output guides diuretic therapy, not digoxin administration. The vital action before this dose is checking the apical pulse, because digoxin can drop an already slow heart rate to an unsafe level. Option b is incorrect because blood glucose monitoring fits insulin and some other drugs, not digoxin. Before giving digoxin, the nurse counts the apical heart rate, since bradycardia is the parameter that determines whether the dose is safe to give. Option d is incorrect because pupil size is not a parameter for digoxin, although vision changes can signal toxicity. The required pre-dose assessment is the apical pulse, which the nurse uses to decide whether to administer or hold the medication.

Correct Answer: Withhold the next dose of digoxin

Nausea, fatigue, and halos around lights are classic signs of digoxin toxicity. The nurse's first action is to withhold the next dose so no additional drug is added, then notify the provider and check the digoxin and potassium levels. Option b is incorrect because encouraging rest does nothing to stop ongoing absorption of a drug the client may already have in excess. The priority is to hold the next digoxin dose, because continuing the medication would deepen the toxicity the client is showing. Option c is incorrect because a snack may ease nausea but ignores the underlying danger of accumulating digoxin. The first and most protective step is to withhold the next dose, since the symptoms point to toxicity rather than simple hunger or stomach upset. Option d is incorrect because antacids actually reduce digoxin absorption and are not a treatment for toxicity. Rather than adding another drug, the nurse should first withhold the digoxin dose, because preventing more drug from enteri

Correct Answer: Place the tablet under your tongue to dissolve

Sublingual nitroglycerin is absorbed through the oral mucosa and is ineffective if swallowed. The nurse should instruct the client to place the tablet under the tongue and let it dissolve at the first sign of chest pain. Option a is incorrect because swallowing the tablet sends it through the digestive tract, where it is inactivated before it can relieve angina. For the drug to work quickly, it must dissolve under the tongue and absorb directly into the bloodstream. Option c is incorrect because chewing and swallowing destroys the benefit of the sublingual route, which depends on absorption through the mucosa. The tablet should be placed under the tongue, not chewed, so it can act rapidly on the chest pain. Option d is incorrect because waiting until pain is severe delays relief; the client should use nitroglycerin at the first indication of chest pain. The correct technique is to let the tablet dissolve under the tongue promptly rather than holding off until pain peaks.

Correct Answer: I will remove the patch for several hours daily

A daily nitrate-free interval prevents tolerance to nitroglycerin. Removing the patch for part of each day shows the client understands how to keep the medication effective and avoid losing its ability to prevent anginal attacks. Option a is incorrect because cutting a transdermal patch can release the drug unevenly and deliver an unreliable dose, so it is never advised. The statement that reflects correct understanding is allowing a patch-free period each day to prevent tolerance. Option b is incorrect because wearing the patch continuously day and night leads to tolerance, blunting the drug's effect over time. The client demonstrates understanding by removing it for several hours daily, which is the opposite of leaving it on around the clock. Option d is incorrect because applying the patch to the same site repeatedly can irritate the skin, so sites should be rotated. More importantly, the teaching point that prevents tolerance is the daily drug-free interval, not where the patc

Correct Answer: A throbbing headache

Nitroglycerin dilates blood vessels, including those in the head, which commonly produces a throbbing headache. The nurse should monitor for this adverse effect and can teach the client that acetaminophen may relieve the discomfort. Option b is incorrect because nitroglycerin tends to cause reflex tachycardia rather than a slow heart rate, because vasodilation drops blood pressure. The vascular dilation that triggers the heart to speed up is also what produces the headache the nurse anticipates. Option c is incorrect because constipation is linked to verapamil, not to nitroglycerin. As a vasodilator, nitroglycerin instead causes headache and orthostatic hypotension, so a pounding headache is the adverse effect the nurse watches for here. Option d is incorrect because ringing in the ears suggests aspirin or loop diuretic effects, not nitroglycerin. The widespread vasodilation from this drug commonly produces a headache, which is the effect the nurse should monitor the client for.

Correct Answer: I will take this medication twice each day

Ranolazine is an extended-release tablet taken twice daily to prevent anginal attacks over time. Stating that it is taken twice each day shows the client understands the medication is for ongoing prevention rather than for acute relief. Option a is incorrect because ranolazine is not effective for an acute anginal attack; a fast-acting nitrate is used for sudden chest pain. Believing this drug aborts an attack reflects a misunderstanding, so the client would need further teaching about its purpose. Option c is incorrect because grapefruit juice raises ranolazine levels and increases the risk of a dangerous rhythm disturbance, so it should be avoided. This statement signals a need for correction rather than the understanding the nurse is looking for. Option d is incorrect because ranolazine is extended-release and must be swallowed whole; crushing it would release the dose too quickly. Because this statement describes unsafe use, it does not indicate that the client has grasped the teac

Correct Answer: Shortness of breath and a dry cough

Amiodarone can cause serious pulmonary toxicity. The nurse should report shortness of breath and a dry cough, because these may signal lung injury, and the client needs evaluation with a chest x-ray and pulmonary function testing. Option a is incorrect because a craving for salt is not related to amiodarone's effect on the lungs. Pulmonary toxicity from this drug shows itself through respiratory complaints such as dyspnea and cough, which are what the nurse must report to the provider. Option b is incorrect because an increased appetite does not signal lung injury and is not a concern with amiodarone. The respiratory warning signs the nurse watches for are shortness of breath and a dry cough, which point to the drug's serious pulmonary effects. Option c is incorrect because bluish skin can occur with amiodarone as a blue-gray discoloration, but that is a skin change, not a sign of lung toxicity. The findings that reflect pulmonary injury are dyspnea and dry cough, which requi

Correct Answer: Wear sunscreen and protective clothing outdoors

Amiodarone causes photosensitivity, increasing the risk of severe sunburn. The nurse should instruct the client to wear sunscreen and protective clothing and to avoid sun lamps, which protects the skin during therapy with this medication. Option b is incorrect because grapefruit juice raises amiodarone levels and risks toxicity, so it should be avoided rather than taken with the drug. This instruction does not address sun sensitivity and would actually create a new danger for the client. Option c is incorrect because limiting green vegetables matters for warfarin because of vitamin K, not for amiodarone's skin effects. The teaching that protects against photosensitivity centers on sun protection, so dietary greens are not the focus here. Option d is incorrect because avoiding potassium is relevant to potassium-sparing diuretics, not to amiodarone-related photosensitivity. To guard against the drug's skin reaction, the client should use sunscreen and cover up, not change their

Correct Answer: A butterfly-shaped rash on the face

Procainamide can produce a lupus-like syndrome with fever, joint pain, and a butterfly-shaped facial rash. The nurse should report this rash so antinuclear antibody titers can be checked and the drug discontinued if the reaction is confirmed. Option a is incorrect because a blue-gray skin discoloration is associated with amiodarone, not procainamide. The lupus-like reaction tied to procainamide is recognized by joint pain and the butterfly rash across the face, which is the finding the nurse reports. Option c is incorrect because yellow-green halos point to digoxin toxicity, not to a procainamide reaction. The hallmark of procainamide's lupus-like syndrome is the facial butterfly rash with fever and aching joints, so the rash is what the nurse escalates. Option d is incorrect because a dry cough suggests an ACE inhibitor effect rather than a reaction to procainamide. The lupus-like syndrome this antidysrhythmic can cause features a butterfly-shaped facial rash, which is the manife

Correct Answer: Take the medication in the evening

The body produces most cholesterol at night, so statins work best with evening dosing. The nurse should instruct the client to take atorvastatin in the evening to gain the greatest effect on lowering cholesterol levels. Option a is incorrect because morning dosing before breakfast is less effective for a statin, since cholesterol synthesis peaks overnight. The nurse instead directs the client to take atorvastatin in the evening so it acts when the body is making the most cholesterol. Option b is incorrect because grapefruit juice raises statin levels and increases the risk of muscle injury, so it must be avoided, not encouraged. The correct teaching is to take the drug in the evening, while steering clear of grapefruit entirely. Option d is incorrect because fatigue alone is not a reason to stop a statin, and abruptly stopping is not part of correct teaching. The client should take the medication in the evening and report muscle pain, rather than discontinuing the drug for tiredness.

Correct Answer: Muscle aches and tenderness

Statins can cause myopathy, which may progress to rhabdomyolysis. The nurse should report muscle aches and tenderness to the provider, who may check the creatine kinase level and consider discontinuing the medication to prevent muscle damage. Option b is incorrect because a mild morning headache is not the concerning effect of a statin and is not specific to it. The adverse finding the nurse must report is unexplained muscle pain and tenderness, which can warn of serious muscle breakdown. Option c is incorrect because occasional dry skin is not associated with statin therapy and does not require reporting. The two effects the nurse watches for with atorvastatin are muscle pain, signaling myopathy, and signs of liver dysfunction. Option d is incorrect because a slight rise in appetite is not a recognized statin adverse effect. The finding that demands attention is muscle aching and tenderness, because it may reflect myopathy that could advance to rhabdomyolysis if missed.

Correct Answer: A current pregnancy

Statins are contraindicated in pregnancy because they can cause fetal malformation. The nurse should report a current pregnancy before starting atorvastatin so the provider can discontinue the drug and protect the developing fetus. Option a is incorrect because seasonal allergies do not interact with statin therapy and would not delay starting the drug. The finding that must be reported is the pregnancy, because atorvastatin can harm fetal development and should not be used. Option c is incorrect because well-controlled asthma is a concern with nonselective beta blockers, not with statins. The factor that must be reported before atorvastatin is begun is the pregnancy, since the drug poses a clear risk to the fetus. Option d is incorrect because a blood pressure in the expected range is unrelated to statin safety and is not a reason to withhold the drug. The critical finding to report here is the pregnancy, which contraindicates atorvastatin because of fetal harm.

Correct Answer: Right upper abdominal pain and bloating

Gemfibrozil increases the risk of gallstones. The nurse should report right upper abdominal pain and bloating, which can indicate gallbladder disease, so the provider can evaluate the client for this complication of fibrate therapy. Option a is incorrect because a craving for sweets is not a recognized effect of gemfibrozil and does not signal a complication. The finding that warrants reporting is right upper quadrant pain with bloating, which can point to the gallstones this drug may cause. Option b is incorrect because increased morning energy is not an adverse effect and would not be reported as a concern. The nurse instead watches for right upper abdominal pain and bloating, signs that may reveal gallbladder disease linked to fibrate use. Option c is incorrect because a decreased appetite is vague and not specific to gemfibrozil's main risks. The reportable problem here is gallbladder pain under the right ribs, which suggests the stones this fibrate can promote.

Correct Answer: Increase fiber and fluids in your diet

Bile-acid sequestrants such as colesevelam commonly cause constipation. The nurse should instruct the client to increase dietary fiber and fluids, which promote regular bowel movements and help relieve this frequent adverse effect of the medication. Option b is incorrect because reducing fluids would worsen constipation, the very problem this teaching aims to prevent. Because colesevelam slows the bowel, the client needs more fluid and fiber, not less, to keep stool moving comfortably. Option c is incorrect because avoiding calcium is unrelated to this drug's bowel effect and is not part of correct teaching. To manage the constipation that colesevelam often causes, the client should add fiber and fluids to the diet. Option d is incorrect because a bedtime-only schedule does not address constipation and is not how this drug is timed. The instruction that manages the common GI effect is to boost fiber and fluids, which help maintain regular bowel function.

Correct Answer: Separate the digoxin from the sequestrant by several hours

Bile-acid sequestrants bind other drugs, including digoxin, and reduce their absorption. The nurse should instruct the client to take digoxin separated from the sequestrant by several hours so the digoxin can be absorbed and remain effective. Option a is incorrect because taking both together lets the sequestrant bind the digoxin in the gut, lowering how much is absorbed. To preserve the digoxin's effect, the doses must be spaced apart rather than swallowed at the same time. Option b is incorrect because crushing digoxin into the sequestrant would maximize binding and waste the dose, the opposite of what is needed. The correct approach is to separate the two medications by several hours so the digoxin is properly absorbed. Option d is incorrect because stopping digoxin is not appropriate and could worsen the client's heart condition. The safe solution is to keep taking both drugs but space them several hours apart so the sequestrant does not block digoxin absorption.

Correct Answer: Rotate the subcutaneous injection sites

Alirocumab is a subcutaneous injection, and rotating sites helps prevent local injection-site reactions. The nurse should instruct the client to rotate sites and avoid areas of inflammation or injured skin when giving this medication. Option a is incorrect because alirocumab is not an oral tablet; it is injected under the skin, so swallowing does not apply. The teaching that fits this injectable cholesterol medication is to rotate the subcutaneous injection sites to reduce local skin reactions. Option b is incorrect because grapefruit juice cautions apply to certain statins and other drugs, not to this injectable monoclonal antibody. The correct administration teaching for alirocumab is to rotate subcutaneous sites and avoid irritated skin. Option c is incorrect because placing a tablet under the tongue describes the sublingual route used for nitroglycerin, not for alirocumab. This medication is given by subcutaneous injection, so the relevant instruction is to rotate the injection sit

Correct Answer: Protamine

Protamine binds heparin and forms a complex that has no anticoagulant activity, reversing its effect. The nurse should have protamine available as the antidote for a client receiving a heparin infusion in case bleeding occurs. Option a is incorrect because vitamin K reverses warfarin by restoring synthesis of clotting factors, but it has no effect on heparin. Because heparin works through antithrombin rather than vitamin K, the correct reversal agent for this infusion is protamine. Option b is incorrect because aminocaproic acid is used to control excessive bleeding after a thrombolytic such as alteplase, not to reverse heparin. The drug that neutralizes heparin specifically is protamine, which the nurse keeps on hand during the infusion. Option d is incorrect because idarucizumab is the reversal agent for dabigatran, a direct thrombin inhibitor, and does not counteract heparin. For a client on a heparin infusion, the antidote the nurse must have available is protamine.