Question

1. The patient was prescribed lisinopril to treat his hypertension. RN is ready to educate patients about this medication which of the most common adverse effects can the patient expect? a. Bradycardia b. Severe tachycardia C. Cardiac arrhythmia d. None productive cough 2. Which of the following anti-hypertensive medications is contraindicated for patients with bronchial asthma? a. Atenolol b. Lisinopril c. Nitroprusside d. Losartan 3. Following are the medications for treatment of coronary heart disease. Which of those medications is a lipid lowering drug? a. Propranolol b. Verapamil C. Nifedipine d. Atorvastatin 4. All of the following are the medications that influence on blood coagulations. Which medication prevents clot formation? a. All thrombolytics b. Warfarin C. Protamine sulfate d. Vitamin K 5. The nurse is observing a coworker who is about to give an injection of insulin. Which of the following actions by the coworker would require the nurse to intervene? a. Injecting the insulin medication 15 degrees using an insulin syringe b. Cleaning the injection site with an alcohol before injecting the medication C. Checking the clients blood sugar level before injecting the medication d. Injecting the insulin in the abdominal area away from the umbilicus

Answer 1

Answer:1

Correct answer - d

Non- productive cough

1. 5 -35 % of patients have a dry cough.
2. Lisinopril is an ACE inhibitor.
3. It inhibits kininase II activity.
4. This leads to accumulation of bradykinin, substance P and prostaglandins.
5. They promote cough.

option a: Incorrect - Lisinopril has no effect on heart rate

b: Incorrect - Severe tachycardia - Lisinopril has no effect on heart rate.

c: Incorrect -Cardiac arrhythmia - Arrthymia does not occur with lisinopril

Answer 2

Option: b - Linisopril

ACE inhibitors increase cough and airway responsiveness

a: Incorrect - Atenolol

1. Atenolol is cardio-selective B1 antagonist
2. It has more affinity for beta 1 receptor than beta 2 adrenergic receptors
3. Beta 2 adrenergic receptors are located in the smooth muscle of bronchioles.
4. On the contrary, cardio-selective beta 1 antagonist up-regulate the beta receptors. This improves the airway responsiveness to beta-2-agonists.
5. Non-selective beta-agonist caused stimulation of beta-2-receptors and induces bronchospasm

option c: Incorrect - Nitroprusside - this drug does not cause bronchospasm

option d: Incorrect -losartan - this drug increases cough

Answer : 3

Correct: d - Atorvastatin

1. Atorvastatin belongs to the statin group of drugs
2. It is a lipid-lowering agent ( Cholesterol)
3. It inhibits 3 - hydroxy - 3 Methy -glutaryl Co-A reductase
4. It is prescribed when LDL levels are >100mg/dl or > 70mg/dl if the patient has a history of cardiac disease.

Option a: Incorrect - Propanolol

1. It reduces heart rate
2. Reduce the myocardial oxygen demand
3. Reduce the risk of death
4. Reduces intrinsic sympathetic activity
5. NO effect on serum lipids

Option b: Incorrect -Verapamil

1. Causes coronary vasodilation
2. Reduces myocardial oxygen demand
3. Reduces angina
4. No effect on serum lipids

Option- Incorrect - Nifedipine

1. Causes coronary vasodilation
2. Reduces myocardial oxygen demand
3. Reduces angina
4. No effect on serum lipids

Answer 4:

Correct: b: Warfarin

1. Warfarin is an anticoagulant drug
2. It is Vitamin K antagonist
3. It reduces the levels of Vitamin K dependant clotting factors 2, 7,9,10,
4. It prevents clot formation

Option a: Incorrect - All thrombolytics

1. Thrombolytic drugs increase the break down of clot
2. They do so by converting plasminogen to plasmin
3. Plasmin acts on the fibrin stand present in the clots and increases their break down
4. Eg streptokinase, alteplase

Option c: Incorrect - Protamine sulfate

1. It is an antidote for heparin
2. It is used to reverse the anticoagulant effects of heparin
3. It is a basic compound and binds with heparin.
4. This complex reduces the anticoagulant effects of heparin

Option d: Incorrect -Vitamin K

1. Vitamin K is required for the formation of clotting factors
2. Vitamin K depended clotting factors are 2,7,9,10
3. Anticoagulant factors that are dependent on Vitamin K are protein C and protein S.

Answer: 5

Correct: a: angle of 15 degrees

1. Insulin injection is given Subcutaneously
2. Subcut injection is given at a 45-degree angle.
3. 15 degree is for intradermal

Option b: Incorrect: It is a good clinical practice to clean the injection site with alcohol before injection. This will reduce the chance of an injection site abscess.

Option c: Incorrect: It is a good clinical practice to check the patient's blood sugar level before injecting insulin. This will help you to adjust the insulin done and prevent iatrogenic hypoglycemia.

Option d: Incorrect :

1. Insulin injections are commonly given in the abdomen.
2. The absorption of insulin is faster, more predictable from this site.
3. It is also easy for patients to learn