BODY TISSUE SYMPATHETIC RESPONSE PARASYMPATHETIC

RESPONSE

EYE 1. DILATE PUPILS 2. CONSTRICT PUPILS

LUNGS 3. DILATE/ 4. – 5.
BRONCHODILATION BRONCHOCONSTRICTIO
N/ INCREASE
SECRETIONS
HEART [Link] HEART 7. DECREASE HEART RATE
RATE
BLOOD VESSELS 8. CONSTRICT BLOOD 9. DILATE BLOOD VESSELS
VESSELS
GASTROINTESTINAL 10. RELAXES GI 11. CONSTRICT/ INCREASE GI
MOTILITY
BLADDER 12. RELAXES BLADDER 13. CONSTRICT BLADDER
UTERUS 14. RELAXES UTERUS
SALIVARY GLAND 15. INCREASE SALIVATION

TEST III
1. D5 LR 1L x 10hrs using drop factor of 20gtts/ml – flow rate
- 100ml/hr
- 33-34gtts/min

1L = 100ml

2. D5 NR 1L x 100cc/hr DF of 60ugtts/ml – flow rate

- 100 ugtts/mins.

3. MgSO4 4.5 gms IM STAT on each buttock. How many ml will you administer on each
buttock if the stock on hand is 250mg/ml, 1 vial contains 10ml.
- 18 ml per buttock
 1,000 mg 1 ml
4.5gms X = 4,500 mg 4,500 mg X = 18 ml per buttock
1 gms 250 mg
4. When the nurse on duty received the IVF of D5 LR 1L at the level of 500ml at
7am and the regulation is at 125ml/hr, what time will the IVF be consumed?
- 11 am
500 ml
= 4 hr 7am + 4 = 11 am
125 ml/hr
[Link] doctors order is to give a loading dose of 1.5 gm of cefuroxime thru IV, how many
vials will the nurse purchase if the availability is 750mg/vial cefuroxime powder to be
diluted in 5ml of NSS?
- 2 vials
100 mg 1 vial
1.5 gm X 1 gm = 1,500 mg 1,500mg X 750 mg = 2 vials

A patient has angina pectoris. The patient’s BP is 100/60 mm Hg. The nurse administers
nitroglycerin 0.4 mg sublingual (SL). It is most important for the nurse to assess the
patient for the development of
HYPOTENSION An intense side effect of nitroglycerin is hypotension because it causes
vasodilation.

A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will
the nurse implement? (Select all that apply.)
CHECKING THE APICAL PULSE RATE BEFORE ADMINISTRATION.
MONITORING THE PATIENT’S SERUM DIGOXIN LEVEL.
INSTRUCTING PATIENT TO REPORT PULSE RATE LESS THAN 60.
The apical pulse should be taken before digoxin administration and the drug withheld if
the heart rate is less than 60. The patient’s serum digoxin level should be monitored and
withheld if in toxic range. Therapeutic level is 0.5 to 2 ng/mL. Patient should be advised to
eat foods high in potassium. Patient should be advised to avoid taking antacids with
digoxin because they decrease absorption.

A patient is ordered to receive digoxin to treat congestive heart failure. The nurse is most
concerned about which assessment finding?
HEART RATE 56 BEATS/MIN A baseline pulse rate for the patient should be obtained for
future comparisons. Apical pulse should be taken for a full minute and should be greater
than 60 beats/min. The prescriber should be notified if the patient’s pulse is less than 60
beats per minute.

A nurse is preparing to administer digoxin to a patient. Which laboratory result is the nurse
most concerned about?
POTASSIUM 3.0 MEQ/L A low serum potassium level enhances the action of digoxin and
can cause digitalis toxicity.
When administering antianginal drugs, the nurse identifies which as the most common
response?
HYPOTENSION The most common side effect of antianginal drugs is hypotension.

The nurse should teach the patient to report which of the following to the health care
provider immediately if experienced after taking nitroglycerin?
PERSISTENT PAIN Dizziness, faintness, and headache can occur when taking
nitroglycerin. It is important to teach the patient about avoiding complications related to
orthostatic hypotension. Persistent pain indicates the possibility of acute coronary
syndrome.

The nurse identifies which drug as a calcium channel blocker used for the treatment of
dysrhythmias?
DILTIAZEM Diltiazem (Cardizem) is a calcium channel blocker used to treat dysrhythmias.
Esmolol (Brevibloc) is a beta blocker. Flecainide (Tambocor) is a sodium channel blocker.
Sotalol HCl (Betapace) is a beta blocker.

A patient with angina and a long history of severe chronic obstructive pulmonary disease
is ordered beta blocker therapy. Which beta blocker would be most effective for this
patient?
ATENOLOL Cardioselective beta blockers act more strongly on the beta 1 receptor, which
decreases the heart rate but avoids bronchoconstriction. Examples of selective beta
blockers are atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL). Examples of
nonselective beta blockers are propranolol (Inderal), nadolol (Corgard), and pindolol
(Visken). These drugs decrease the heart rate and can cause bronchoconstriction.

A patient is taking furosemide 40 mg daily for heart failure and hypertension. It is most
important for the nurse to assess the patient for the development of
LOW SERUM POTASSIUM, SODIUM, MAGNESIUM, AND CALCIUM. Loop diuretics
cause a loss of potassium, sodium, magnesium, and calcium.

Which statement will the nurse include when teaching a patient about loop diuretics?
RISE SLOWLY FROM A LYING OR SITTING TO STANDING POSITION TO PREVENT
DIZZINESS. The medication should be taken in the morning, not at bedtime, to prevent
sleep disturbances and nocturia; taking the medication at mealtime or with a snack, not on
an empty stomach, can prevent nausea from developing, and patients receiving this
medication should eat a diet high in fruits and vegetables to prevent hypokalemia.

A patient is admitted to the intensive care unit with increased intracranial pressure. The
nurse would anticipate administering
MANNITOL. Osmotic diuretics such as mannitol (Osmitrol) increase the osmolality and
sodium reabsorption in the proximal tubule and loop of Henle. Sodium, chloride,
potassium, and water are excreted. This group of drugs is used to prevent kidney failure,
to decrease intracranial pressure, and to decrease intraocular pressure. Mannitol is a
potent osmotic potassium-wasting diuretic frequently used in emergency situations such
as ICP and IOP.
A patient is receiving furosemide. It is most important for the nurse to monitor the patient
for the development of
HYPOKALEMIA is the most common electrolyte balance associated with furosemide
(Lasix) therapy

A patient with congestive heart failure gains 5 pounds in 1 week. This most likely indicates
a fluid weight gain of
2 L. Weight gain of 2.2 pounds is equivalent to an excess liter of body fluids.

Before administering triamterene, it is most important for the nurse to determine if the
patient is also receiving
POTASSIUM CHLORIDE. Triamterene (Dyrenium) is a potassium-sparing diuretic.
Potassium supplementation is not indicated unless the patient’s serum potassium level is
very low.

Which statement about aldosterone does the nurse identify as being true? Aldosterone
IS A MINERALOCORTICOID HORMONE. Aldosterone is a mineralocorticoid hormone
that promotes sodium retention, and potassium excretion is not secreted by the pancreas.

A patient with chronic glaucoma is most likely to receive which drug?

A CARBONIC ANHYDRASE INHIBITOR Carbonic anhydrase inhibitors are primarily used
to decrease IOP in patients with open-angle (chronic) glaucoma. Thiazides and loop
diuretics are used to treat hypertension and peripheral edema. Potassium-sparing diuretics
are used as mild diuretics in combination with other diuretics.

A patient’s blood pressure (BP) is 142/82 mm Hg. The health care provider prescribed a
diuretic to lower this BP. The nurse knows that this BP is
INDICATING STAGE 1 HYPERTENSION. A BP of 142/82 indicates stage 1 hypertension.
The systolic range for stage 1 is 140 to 159, and the diastolic range for stage 1 is 90 to 99.

A patient is receiving an angiotensin II receptor blocker. Which does the nurse recognize
as an angiotensin II receptor blocker?
VALSARTAN ARBs have a suffix of -sartan. Valsartan (Diovan) is an ARB. Amlodipine is a
calcium channel blocker; captopril is an ACE inhibitor with a common suffix of -pril.
Metoprolol is a beta blocker with a common suffix of -lol.

A patient is receiving an angiotensin II receptor blocker. It is most important for the nurse
to assess the patient for
DIZZINESS. Side effects/adverse effects of ARBs include dizziness, diarrhea, insomnia,
occasional cough, and upper respiratory infection.

An African-American patient is to be treated with initial monotherapy to control

hypertension. The nurse expects the patient to receive
ALPHA-ADRENERGIC BLOCKERS. African Americans do not respond well to diuretics as
the initial monotherapy for controlling hypertension. This group is susceptible to low-renin
hypertension; therefore, they do not respond well to beta blockers and ACE inhibitors. The
antihypertensive drugs that are effective for African Americans are alpha 1 blockers and
calcium channel blockers.
The nurse should instruct a patient to not suddenly stop taking antihypertensives in order
to avoid
REBOUND HYPERTENSION. Abrupt discontinuation of antihypertensive drugs may cause
rebound hypertension.

A patient with hypertension is ordered to receive an angiotensin-converting enzyme

inhibitor. The nurse identifies a common benign side effect of this class of medications as
A DRY COUGH. The primary side effect of ACE inhibitors is a constant, irritated cough.
Other side effects include nausea, vomiting, diarrhea, headache, dizziness, fatigue,
insomnia, serum potassium excess, and tachycardia.

Before administering the alpha-adrenergic blocker prazosin, it is most important for the
nurse to assess the patient for a history of
RENAL DISEASE. Prazosin (Minipress) is used to treat refractory heart failure,
hypertension, and benign prostatic hypertrophy. Contraindication to use of the drug is
renal disease.

When administering antihypertensive medications to Asian Americans, it is most important

for the nurse to
MONITOR BLOOD PRESSURE CAREFULLY. Asian Americans are twice as sensitive as
whites to beta blockers and other antihypertensives. A reduction in antihypertensive
dosing is frequently needed. Native Americans have a reduced or lower response to beta
blockers compared with whites. Monitoring blood pressure and drug dosing should be an
ongoing assessment for these cultural groups.

A patient is prescribed aspirin, 81 mg, and clopidogrel. The nurse identifies the drug
classification of clopidogrel as
ANTIPLATELET. Clopidogrel is an antiplatelet drug.

A patient arrived in the emergency department 2 hours after an acute ischemic stroke.
The patient is given an intravenous (IV) injection of alteplase tPA. It is most important for
the nurse to monitor what? (Select all that apply.)
BLEEDING
VITAL SIGNS
ALLERGIC REACTIONS
ELECTROCARDIOGRAM
The nurse should monitor the patient receiving thrombolytics for adverse effects, such as
bleeding, allergic reactions, and cardiac dysrhythmias. An increased heart rate with a
decreased BP usually indicates blood loss from bleeding.

Which information will the nurse include when teaching a patient about warfarin therapy?
FOLLOW UP WITH LABORATORY TESTS SUCH AS PT OR INR TO REGULATE
WARFARIN DOSE. Laboratory tests such as PT or INR are performed to regulate warfarin
(Coumadin) dose. The patient should avoid consuming large amounts of green, leafy
vegetables; broccoli; legumes; soybean oil; coffee; tea; cola; excessive alcohol, and certain
nutritional supplements such as coenzyme Q10. Patients are encouraged to perform oral
hygiene and use a soft tooth brush to prevent gums from bleeding. Patients should be
instructed to use an electric razor when shaving.

A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which
medication on hand as an antidote in case it is needed?
PROTAMINE SULFATE Vitamin K is the antidote for warfarin (Coumadin), not heparin,
therapy; warfarin (Coumadin) is an anticoagulant, and aminocaproic acid (Amicar) is a
plasminogen inactivator used to control excessive bleeding from hyperfibrinolysis.

Four patients are considered as potential candidates for thrombolytic therapy. Which
patient is most likely to receive thrombolytic therapy?
THE PATIENT WHO RECENTLY USED ACETAMINOPHEN Acetaminophen (Tylenol) does
not interfere with the coagulation system. Contraindications for use of thrombolytics
include a recent CVA, active bleeding, severe hypertension, recent history of traumatic
injury, especially head injury, and anticoagulant therapy. The nurse should report if the
patient takes aspirin or NSAIDs.

The nurse is caring for a patient who received alteplase tPA for treatment of acute
coronary syndrome. The patient starts to bleed. The nurse anticipates administration of
which medication?
AMINOCAPROIC ACID Aminocaproic acid (Amicar) is used to stop bleeding by inhibiting
plasminogen activation, which inhibits thrombolysis.

A patient visits an outpatient clinic. The patient has been noncompliant with
anticoagulation therapy and states, “I don’t like having to have blood work all of the time.”
The nurse anticipates prescription of which medication?
RIVAROXABAN Two oral anticoagulants form a new anticoagulant category called Xa
inhibitors. Rivaroxaban (Xarelto) was FDA-approved in July 2011, and apixaban (Eliquis)
was FDA-approved in December 2012. These drugs do not require routine coagulation
monitoring and are given q.d. or b.i.d. The other medications are administered
intravenously.

A patient is recovering from surgery to replace her right hip. In the early postoperative
phase, the nurse anticipates administration of which drug to prevent deep vein
thrombosis?
LOW-MOLECULAR-WEIGHT HEPARIN Low-molecular-weight heparins are derivatives of
standard heparin and were introduced to prevent venous thromboembolism. The other
drugs are platelet inhibitors. Antiplatelets are used to prevent thrombosis in the arteries
by suppressing platelet aggregation.

The patient develops a deep vein thrombosis. The nurse anticipates administration of
which medication?
INTRAVENOUS HEPARIN Intravenous heparin is indicated for rapid anticoagulant effect
when a thrombosis occurs because of a deep vein thrombosis (DVT), pulmonary embolism
(PE), or an evolving stroke. The effects of subcutaneous heparin take longer to occur.
Clopidogrel (Plavix) is an antiplatelet drug that is mainly for prophylactic use in prevention
of myocardial infarction or stroke. Vitamin K is the antidote for warfarin, and protamine is
the antidote for heparin.