Pharm II Quiz 2 Multiple Choice Identify the choice that best completes the statement or answers the question.

____1. A patient with a body mass index (BMI) of 25 would be considered to be in which weight category? a. Underweight b. Normal weight c. Overweight d. Obese ____2. What is the most critical approach to the treatment of metabolic syndrome? a. Psychotherapy b. Pharmacotherapy c. Lifestyle management d. Patient education ____3. Healthy diets should include no more than which percentage of saturated fat based on total calories? a. 30 b. 10 c. 7 d. 2 ____4. Which ethnic group or gender is at greatest risk for developing metabolic syndrome? a. Hispanic women b. Asian men c. African American men d. White women ____5.

What is the incidence of metabolic syndrome in the United States? a. 1 in 4000 b. 1 in 400 c. 1 in 40 d. 1 in 4 ____6. Which is the mechanism of action demonstrated by exercise in managing blood glucose levels? a. Exercise causes release of glucose and promotes a reduced blood glucose level. b. Exercise on a regular basis causes a reduction in lean body mass, which helpsregulate blood glucose levels. c. Increased muscle mass and less fat tends to normalize blood glucose levels because glucose is used by muscle cells when exercising. d. Exercise stimulates the liver, the primary storage and utilization site of glucose, torelease glucose. ____7. Which instruction by the nurse is accurate to include in a patients care to manage metabolicsyndrome? a. Encourage the client to exercise 20 minutes every day. b. Eliminate alcohol intake. c. Increase simple carbohydrates in the diet. d. Reduce stress. ____8. Which medication combinations may be beneficial in treating angina pectoris? a. Antidysrhythmics and platelet-active agents b. ACE inhibitors and statins c. Vasoconstrictors and diuretics d. Analgesics and thrombolytics ____9.

A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The healthcare provider has prescribed HMG-CoA reductase inhibitor. What is the primary indication in usingthis medication? a Reduce coronary vessel spasm . b. Simplify oxygen requirements of the cardiac cells c. Lower cholesterol levels d. Dilate the coronary arteries ____10. What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin? a. Use the sublingual form only. b. Administer subsequent doses parenterally. c. Allow for a daily 8- to 12-hour nitrate-free period. d. Store the drug in a dark container, free from light and moisture. ____11. Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina? a. Take a dose routinely at bedtime. b. Place the tablet under the tongue and swallow immediately. c. Take one tablet and then seek medical attention if the pain is not relieved within 5minutes. d. Take one tablet every 2 to 3 minutes until relief is obtained. ____12. How frequently are nitroglycerin tablets discarded and prescriptions refilled? a. Monthly b. Every 3 months c. Every 6 months d. Yearly ____13. When are sustained-release nitroglycerin tablets administered? a.

Once a day b. At bedtime c. When symptoms of acute angina appear d. Every 8 to 12 hours ____14. Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray? a. Shake the container to disperse the medication evenly. b. Inhale the medication slowly over 1 to 2 minutes. c. Administer the medication under the tongue. d. Close the mouth and swallow the spray. ____15. Which statement is true regarding the pain associated with angina? a. It does not subside until treatment is initiated. b. It is highly variable in intensity and location. c. It typically subsides after 1 to 3 minutes. d. It is directly related to the degree of myocardial damage. ____16. How do beta-adrenergic blocking agents reduce myocardial oxygen demand? a. By inhibiting the stimulation of norepinephrine and epinephrine b. By increasing the production of dopamine and acetylcholine c. By delaying the destruction of acetylcholinesterase and cholinesterase d. By enhancing the sensitivity of alpha receptors and beta receptors ____17. The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction willthe nurse provide the patient? a. Report any headaches following self-administration to your health care provider. b. Carry the medication in a pocket directly next to the body. c.

Carry the medication with you at all times. d. Store nitroglycerin in a clear glass container with a tight lid. c. Coronary angioplasty d. Avoidance of caffeine and emotional stress e. Use of nitrates ____42. Which lifestyle modifications will the nurse include when educating the patient with angina pectoris? (Select all that apply.) a. Weight reduction therapy b. Low-potassium diet c. Smoking cessation d. Stress management e. Independent exercise ____43. Which will the nurse include in discharge teaching for patients on nitrate therapy? (Select all thatapply.) a. Increase caffeine in diet b. Relaxation techniques c. Proper storage of medications d. Pain assessment e. Isometric exercise program

____

44.

Which will the nurse include in the teaching plan for a patient with angina who is prescribed a beta-adrenergic blocking agent? (Select all that apply.) a. Goals include reduced frequency of attacks, reduced nitrate use, and improvedexercise tolerance. b. Only some beta blockers are effective in treating angina pectoris.

c. Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina. d. Cardioselective agents minimize pulmonary and peripheral vascular adverseeffects. e. Stress exercise is an effective way to determine the most appropriate dosage. f Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina. ____45. Which medications may safely be administered to a patient on ticlopidine? (Select all that apply.) a. Acetaminophen (Tylenol) b. Acetylsalicylic acid c. Propranolol (Inderal) d. Cimetidine (Tagamet) e. Furosemide (Lasix) ____46. Anticoagulant therapy may be used for which situations? (Select all that apply.) a. To prevent stroke in patients at high risk b. Following a myocardial infarction c. Following total hip or knee joint replacement surgery d. With deep vein thrombosis e. To prevent thrombosis in immobilized patients f. Peptic ulcer disease ____47. The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin)at home. Which important points will the nurse include? (Select all that apply.) a. Do not make any major changes to your diet without discussing it with your health care provider. b. Keep outpatient laboratory appointments for monitoring of therapy. c. Take the medication after meals.

d. Report signs of bleeding to your health care provider, including observing skinfor bruising, petechiae, blood in emesis, urine, or stools, bleeding gums, cold,clammy skin, faintness, or altered sensorium. e. Avoid aspirin products. ____48. Which are accurate nursing interventions when administering heparin subcutaneously? (Select allthat apply.) a Assessment of recent aPTT levels b. Massaging the site after injection of medication c. Aspirating after needle insertion d. Documentation of ecchymotic areas e. Monitoring of vital signs ____49. The pharmacologic agents used to treat deep vein thrombosis (DVT) may act in which of thefollowing ways? (Select all that apply.) a. Prevent platelet aggregation b. Prevent the extension of existing clots c. Inhibit steps in the fibrin clot formation cascade d. Prolong bleeding time e. Lower serum triglycerides Pharm II Quiz 2Answer Section MULTIPLE CHOICE 1 . A N S : C FeedbackA A BMI of less than 18.5 is considered underweight. B A BMI of 18.5 to 24.9 is considered normal weight. C A BMI of 25 to 29.9 is considered overweight. D A BMI of 30 to 34.9 is considered obesity, class I, 35 to 39.9 is consideredobesity, class II, and more than 40 is considered extreme obesity.

P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 3 3 6 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 2 . A N S : C FeedbackA Psychotherapy is not the most critical approach to treating metabolic syndrome. B Pharmacotherapy is not the most critical approach to treating metabolicsyndrome. C Lifestyle management is critical for managing metabolic syndrome; other approaches will not be effective without it. D Patient education is not the most critical approach to treating metabolicsyndrome. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 3 3 8 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 3 . A N S : C FeedbackA A diet with 30% saturated fat would not be considered a healthy diet. B A diet with 10% saturated fat would not be considered a healthy diet. C A healthy diet should have no more than 7% of calories from saturated fat. D A diet can have up to 7% saturated fat before it is considered unhealthy. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 3 3 8 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 4 . A N S : A FeedbackA Hispanic women have the highest incidence rate of metabolic syndrome at 27%. B Asian men are not at the highest risk for metabolic syndrome. C African American men are not at the highest risk for metabolic syndrome. D White women are not at the highest risk for metabolic syndrome. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 3 3 6 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 5 . A N S : D FeedbackA

One in 4000 is less than the incidence of metabolic syndrome in the UnitedStates. B One in 400 is less than the incidence of metabolic syndrome in the UnitedStates. C One in 40 is less than the incidence of metabolic syndrome in the United States. D The incidence of metabolic syndrome in the United States is 1 in 4, or about 50million adults. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 3 3 6 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 6 . A N S : C FeedbackA Exercise increases the rate of glucose uptake in the contracting skeletal muscles. B Exercise on a regular basis prevents reduction in lean body mass and proteinwasting. C Exercise leads to more muscle and less fat, so blood glucose levels tend to returnto normal. D The liver is not the primary storage and utilization site of glucose. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 3 3 8 TOP:Nursi ng Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological Integrity7 . A N S : D FeedbackA Twenty minutes of exercise is not adequate. B Alcohol intake needs to be restricted but does not have to be eliminated. C Complex carbohydrates are appropriate in the management of metabolicsyndrome. D Stress reduction is important in the management of metabolic syndrome P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 3 3 8 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity8 . A N S : B FeedbackA Antidysrhythmics and platelet-active agents are not used in combination to treatangina because angina does not typically result in rhythm disturbances. B ACE inhibitors and statins are often combined to treat angina pectoris. C Vasoconstrictors would exacerbate angina and are not used with diuretics. D

Analgesics and thrombolytics are not used in combination to treat angina because angina is not caused by a clot, so thrombolytics are not necessary. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 4 1 0 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity9 . A N S : C FeedbackA Statins do not affect vascular spasms. B Statins do not affect oxygen requirements of cells. C HMG-CoA reductase inhibitor, a statin, has become standard therapy to be usedwith elevated cholesterol levels. This medication prevents added atheroscleroticvessel buildup and further narrowing of the coronary arteries. D Statins do not dilate coronary arteries. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 0 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 1 0 . A N S : C FeedbackA Route of administration does not affect tolerance. B Route of administration does not affect tolerance. C An 8- to 12-hour nitrate-free period will eliminate the development of toleranceto nitroglycerin. D Medication storage method does not affect tolerance. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 3 TOP:Nursing Process Step: Implementation MSC:NCLEX Client Needs Category: Physiological Integrity1 1 . A N S : C FeedbackA Nitrates are taken at the indication of pain. B Sublingual nitrates are not swallowed. C The patient should seek medical attention if chest pain is not relieved by onetablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes. D Tablets should be taken every 5 minutes, for a total of three tablets in 15 minutesif pain is not relieved.

P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 3 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Health Promotion and Maintenance1 2 . A N S : C FeedbackA Nitroglycerin has a longer shelf life than 1 month. B Nitroglycerin has a longer shelf life than 3 months. C Every 6 months, the nitroglycerin prescription should be refilled and the oldtablets safely discarded. D Nitroglycerin does not have a shelf life this long. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 4 1 3 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Health Promotion and Maintenance1 3 . A N S : D FeedbackA To be effective, sustained-release nitroglycerin must be taken more often. B To be effective, sustained-release nitroglycerin must be taken more often. C Sustained-release nitroglycerin is taken to prevent angina; waiting untilsymptoms occur decreases its effectiveness. D Sustained-release nitroglycerin tablets are usually taken on an empty stomachevery 8 to 12 hours. If gastritis develops, it may be necessary to take thesetablets with food. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 4 1 3 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity 1 4 . A N S : C FeedbackA Shaking the container can cause bubbles that will slow the release of nitroglycerin. B The dose should not be inhaled. C Translingual nitroglycerin spray should be sprayed onto or under the tongue.The container should not be shaken because the bubbles formed may slow therelease of the medication. The spray should not be inhaled or swallowed. D The dose should not be swallowed. P T S : 1 D I F : C o g n i t i v e L e v e l :

C o m p r e h e n s i o n R E F : 4 1 5 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity1 5 . A N S : B FeedbackA Anginal pain usually does subside with rest. Sustained pain is usually indicativeof a myocardial infarction. B The presentation of angina pectoris is highly variable. The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness. Pain or discomfort may radiate to the neck, lower jaw,shoulder, and arm. Attacks can last from 30 seconds to 30 minutes. C Although angina pain may subside in this way, in general, it is highly variable inhow it is manifested. D Anginal pain may or may not correlate with the amount of myocardial damage. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 0 9 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 1 6 . A N S : A FeedbackA Beta-adrenergic blocking agents prevent the stimulation of epinephrine andnorepinephrine, which normally increase heart rate. B Dopamine and acetylcholine are not beta-adrenergic neurotransmitters. C Beta blockers do not delay the destruction of these enzymes. D Beta blockers do not enhance the sensitivity of alpha-adrenergic and betareceptor sites. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 6 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 1 7 . A N S : C FeedbackA Headache is an expected adverse effect. B Heat causes the medication to deteriorate, so being carried next to the bodywould cause it to become ineffective. C Nonhospitalized patients should carry nitroglycerin at all times. D Tablets are degraded by sunlight.

P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 3 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity1 8 . A N S : C FeedbackA Allergy to nitrates is highly unlikely. B Increasing dosages and frequency of nitrate use is more likely to reflectdeterioration of cardiac function than dependence on the medication. C Tolerance to nitrates can develop rapidly, particularly if large doses areadministered frequently. D Nausea is not a common adverse effect of nitrate treatment. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 6 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity1 9 . A N S : A FeedbackA Chronic stable angina is precipitated by physical exertion or stress, lasts only afew minutes, and is relieved by rest or nitroglycerin. B Nocturnal is not a designated classification. C Unstable angina is unpredictable. D Variant angina occurs at rest. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 4 0 9 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 2 0 . A N S : B FeedbackA Calcium channel blockers are not given to decrease heart rate in patients with angina. B By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow. Dilation of peripheralvessels reduces the workload of the heart. C Calcium channel blockers do not increase cardiac contractility. D Calcium channel blockers do not promote fluid excretion. P T S : 1 D I F : C o g n i t i v e L e v e l :

C o m p r e h e n s i o n R E F : 4 1 7 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 1 . A N S : B FeedbackA The ointment is not applied to the lower extremities, including the legs. B Covering the area where the patch is placed with a clear plastic wrap and tapingit in place is appropriate. C The ointment should not be rubbed into the skin. D Shaving is not recommended prior to application because of possible skinirritation. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 5 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 2 . A N S : A FeedbackA The most common adverse effect of nitrate therapy is headache. Analgesics,such as acetaminophen, may be used if needed. B The medication should not be discontinued. C When administered sublingually, this medication is taken as needed for chest pain. D Lying down will not prevent the occurrence of a headache. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 6 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 3 . A N S : C FeedbackA Increased coronary artery vasodilation is not an effect of this medication. B This medication causes gastrointestinal side effects such as abdominal pain. C Baseline and follow-up ECGs should be obtained to evaluate the effects on the patients QT incorrect interval. D This medication does not elevate LDL levels. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 8 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 4 . A N S : C FeedbackA

Warfarin is an anticoagulant and would not counteract hemorrhage. B Lovenox is chemically related to heparin and would not counteract hemorrhage. C Protamine sulfate is the antidote to heparin. With the patients risk of fluidvolume deficit as a result of trauma, the primary intervention would be tocounteract the effects of heparin to prevent hemorrhage. D Vitamin K is used to control the bleeding that results from use of warfarin(Coumadin), not heparin. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 2 9 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 5 . A N S : B FeedbackA It is inappropriate to tell a patient how long it will take to dissolve a clot. B Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formationof emboli. Heparin will minimize tissue damage by preventing it fromdeveloping into an insoluble, stable thrombus. C The patients question does not warrant notification of the health care provider. D Telling the patient that the health care provider will be starting the patient onticlopidine is inappropriate and inaccurate. P T S : 1 D I F : C o g n i t i v e L e v e l : A n a l y s i s R E F : 4 1 9 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity2 6 . A N S : C FeedbackA These results are not within the normal therapeutic range. B RBC count is not relevant in assessing therapeutic response to anticoagulation. C Heparin dosage is considered to be in the normal therapeutic range if the aPTTis 1.5 to 2.5 times the control value. The patients aPTT value is above thetherapeutic range, which puts her at risk for hemorrhage. The most appropriatenursing action would be to stop the heparin drip. D Mental status is not relevant in assessing therapeutic response toanticoagulation. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 8 TOP:Nursi n g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 2 7 . A N S : B

FeedbackA Air is not expelled from the prefilled syringe. B The needle is left in place for 10 seconds after injection C This medication is not administered intramuscularly. D The site should not be massaged to reduce local bleeding. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 6 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Safe, Effective Care Environment2 8 . A N S : D FeedbackA An increase of heparin is not indicated because the patient is in the therapeuticrange. B The range is not toxic. C An antidote to the anticoagulant is not indicated because the patient is within thetherapeutic range. D Therapeutic heparin values are 1.5 to 2.5 times the control value. Thetherapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour.Fifty-four is within the therapeutic range. P T S : 1 D I F : C o g n i t i v e L e v e l : A n a l y s i s R E F : 4 2 8 TOP:Nursin g P r o c e s s S t e p : P l a n n i n g MSC:NCLEX Client Needs Category: Safe, Effective Care Environment2 9 . A N S : B FeedbackA Fibrinolytic agents do not have an effect on myocardial oxygenation. B Fibrinolytic agents such as streptokinase dissolve or lyse recently formedthrombi. The goals of thrombolytic therapy are to lyse the thrombus during the early stages of clot formation, restore circulation to the areas distal to thethrombus, and reduce morbidity after thromboembolism formation. C Fibrinolytic agents do not promote platelet aggregation. D Fibrinolytic agents do not inhibit clotting mechanisms. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 3 2 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Safe, Effective Care Environment3 0 . A N S : D FeedbackA Thromboembolic medications do not dissolve clots.

B Thromboembolic medications do not make platelets more flexible. C Thromboembolic medications do not cause vasodilation. D The pharmacologic agents used to treat thromboembolic disease act to prevent platelet

aggregation or to inhibit a variety of steps in the fibrin clot formationcascade

P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 9 TOP:Nursi ng Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological Integrity3 1 . A N S : C FeedbackA Heparin is used to prevent clotting after myocardial infarction. B Transient ischemic attacks are often treated with aspirin. C Dipyridamole has been used extensively in combination with warfarin to prevent the formation of thromboembolism after cardiac valve replacement. D Transplant patients are treated postoperatively with immunosuppressantmedications. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 2 2 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity3 2 . A N S : B FeedbackA Assessing pulses is not a preventive measure. B Using active or passive leg exercises for a patient on bed rest will prevent clotformation. C Adequate hydration promotes fluidity of the blood and decreases the risk of clotformation. D Placing pressure against the popliteal space will increase the risk of clotformation. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 0 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity3 3 . A N S : D FeedbackA Fruit salad is not high in vitamin K. B

Pasta salad is not high in vitamin K. C Potato salad is not high in vitamin K. D Green leafy vegetables contain vitamin K. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 3 1 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity3 4 . A N S : D FeedbackA Medical alert bracelets should always be worn. B The health care provider needs to be consulted prior to taking any OTCmedications. C Caution must be used when cutting with knives or using any sharp objects. D Soft-bristled toothbrushes are acceptable to use for oral care. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 1 TOP:Nursi n g P r o c e s s S t e p : E v a l u a t i o n M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 3 5 . A N S : B FeedbackA Bradycardia is not indicative of bleeding. B Petechiae are indicative of bleeding. These pinpoint red spots on the skinindicate intradermal hemorrhage. C Increased urinary output is not indicative of bleeding. D Dry skin is not indicative of bleeding. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 3 1 TOP:Nursi n g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y MULTIPLE RESPONSE 3 6 . A N S : A , E FeedbackCorrect Smoking may aggravate metabolic syndrome.Excessive consumption of alcohol may aggravate metabolic syndrome. Incorrect Metabolic syndrome is not directly affected by inadequate hydration.Metabolic syndrome is directly affected by a sedentary lifestyle, notexcessive exercise.Metabolic syndrome is directly affected by increased, not inadequate,caloric intake.

P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 3 3 7 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 3 7 . A N S : A , C , D , F FeedbackCorrect Dementia is associated with metabolic syndrome.Renal disease is associated with metabolic syndrome.Obstructive sleep apnea is associated with metabolic syndrome.Polycystic ovary syndrome is associated with metabolic syndrome. Incorrect Insomnia is not associated with metabolic syndrome.Orthostatic hypotension is not associated with metabolic syndrome. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 3 3 7 TOP:Nursing P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 3 8 . A N S : B , C , E FeedbackCorrect Pharmacologic approaches to managing metabolic syndrome are targetedtoward controlling diabetes.Pharmacologic approaches to managing metabolic syndrome are targetedtoward controlling hypertension.Pharmacologic approaches to managing metabolic syndrome are targetedtoward controlling dyslipidemia. Incorrect There is no pharmacologic intervention for obstructive sleep apnea.Obesity should be addressed before pharmacologic therapy begins.Insulin resistance is not dealt with pharmacologically in the earlymanagement of metabolic syndrome. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 3 3 9 TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 3 9 . A N S : A , C FeedbackCorrect Angina pectoris is considered a coronary artery disease.Acute myocardial infarction is considered a coronary artery disease. Incorrect Pulmonary stenosis is a congenital heart disease.Pericarditis is inflammation of the tissue surrounding the heart.Venous stasis ulcers are not related to coronary artery disease. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 3 3 5 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 4 0 . A N S : A , B , C , D FeedbackCorrect

Metabolic syndrome is characterized by hyperglycemia.Metabolic syndrome is characterized by abdominal obesity.Metabolic syndrome is characterized by low high-density lipoproteins.Metabolic syndrome is characterized by hypertension. Incorrect Osteoporosis is not a characteristic of metabolic syndrome. P T S : 1 D I F : C o g n i t i v e L e v e l : A n a l y s i s R E F : 3 3 6 TOP:Nursin g P r o c e s s S t e p : A s s e s s m e n t M S C : N C L E X C l i e n t N e e d s C a t e g o r y: P h ys i o l o g i c a l I n t e g r i t y 4 1 . A N S : B , C , D , E FeedbackCorrect Coronary artery bypass may be standard treatment of angina pectoris, pending medical evaluation.Coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation.Avoiding caffeine and emotional stress is standard treatment of angina pectoris.Use of nitrates is standard treatment of angina pectoris. Incorrect An ECG is not a procedure for the treatment of angina. P T S : 1 D I F : C o g n i t i v e L e v e l : K n o w l e d g e R E F : 4 0 9 4 1 0 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 2 . A N S : A , C , D Feedback

Correct Although medications can control angina attacks, lifestyle changes suchas maintaining an ideal weight are important in managing the disease.Smoking cessation is a vital component to include when educating the patient with angina pectoris.Although medications can control angina attacks, lifestyle changes suchas managing stress are important in controlling the disease. Incorrect Limiting potassium is not a recommendation for treatment of angina pectoris.The patient should always consult the health care provider before participating in any exercise regimen. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 2 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 3 . A N S : B , C , D FeedbackCorrect Lifestyle modifications such as relaxation techniques, are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers.Pain assessment and rating is an important part of nitrate therapy. Incorrect Increasing caffeine in the diet should be discouraged.Participation in a regular, moderate exercise program is essential, butexercise should not be strenuous or isometric in patients with angina.

P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 2 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Health Promotion and Maintenance4 4 . A N S : A , C , D , E FeedbackCorrect Beta blockers are used to reduce the frequency of attacks, reduce nitrateuse, and improve exercise tolerance.Comorbidities influence product selection in the angina patient.Cardioselective agents have greater affinity for beta-1 adrenergicreceptors (cardiac) than beta-2 adrenergic receptors (bronchi, peripheral blood vessels), thereby reducing the possible pulmonary and vascular adverse effects.Stress exercise is an effective way to determine the most appropriatedosage. Incorrect All beta blockers are effective in treating angina pectoris.Divided doses are not necessary to provide effective control of angina.

P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 1 6 TOP:Nurs ing Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological Integrity4 5 . A N S : A , C , E FeedbackCorrect Acetaminophen is safe to administer to patients taking ticlopidine becauseit does not contribute to bleeding.Inderal is safe to administer to patients taking ticlopidine because it doesnot contribute to bleeding.Lasix is safe to administer to patients taking ticlopidine because it doesnot contribute to bleeding. Incorrect

Acetylsalicylic acid inhibits platelet aggregation, which prolongs bleedingtime. Patients on anticoagulant therapy should avoid aspirin.Cimetidine significantly reduces the metabolism of ticlopidine. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 4 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 6 . A N S : A , B , C , D , E FeedbackCorrect Anticoagulant therapy is used to treat patients at high risk for stroke.Anticoagulant therapy is used to treat patients with thromboembolicdiseases, such as myocardial infarction.Anticoagulant therapy is used to treat patients at risk of developingthrombus secondary to underlying medical conditions.Anticoagulant therapy is used to treat patients with thromboembolicdiseases, such as deep vein thrombosis.Anticoagulant therapy is used to treat patients at risk of developingthrombus secondary to underlying medical disease. Incorrect Anticoagulant therapy is not used to treat patients with peptic ulcer disease. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 2 4 4 3 1 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 7 . A N S : A , B , D , E FeedbackCorrect Although patients on anticoagulant therapy should have knowledge aboutfoods high in vitamin K (green leafy vegetables), they should not makeany major changes to their diet without consulting with their health care

provider, pharmacist, and/or nutritionist.Patients receiving anticoagulant therapy should maintain regular appointments for assessment of the drugs therapeutic effects and followup with the health care provider for regular review of laboratory valuesand dosage monitoring.Regular self-assessment for signs of bleeding is necessary for patients onanticoagulant therapy.Patients on anticoagulant therapy should avoid aspirin products. Incorrect Warfarin does not have to be taken after meals. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 3 1 4 3 2 TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 8 . A N S : D , E FeedbackCorrect Ecchymosis, or bruising, indicates bleeding below the dermis and should be assessed closely.Patients on heparin therapy are prone to bleeding, which would lead tohemorrhagic shock. Vital sign alterations would alert the nurse to internal bleeding. Incorrect

aPTT levels are required to be monitored for the intravenous route, but notfor subcutaneous injections.The injection site should not be massaged to reduce local bleeding.Aspiration may cause bruising when administering heparinsubcutaneously. P T S : 1 D I F : C o g n i t i v e L e v e l : A p p l i c a t i o n R E F : 4 2 8 TOP:Nursin g Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological Integrity4 9 . A N S : A , B , C , D FeedbackCorrect Agents used to treat DVT may prevent future clotting.Agents used to treat DVT may prevent the extension of clots.Agents used to treat DVT may inhibit steps in the formation of clots.Agents used to treat DVT act to prolong bleeding time. Incorrect Medications used to treat DVT do not lower serum triglyceride levels. P T S : 1 D I F : C o g n i t i v e L e v e l : C o m p r e h e n s i o n R E F : 4 1 9