Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has hypertension and is prescribed metoprolol, a beta blocker. The nurse should monitor the client for which of the following adverse effects?
A. Tachycardia
Choice A is wrong because tachycardia, or fast heart rate, is not an adverse effect of metoprolol. In fact, metoprolol can lower the heart rate by blocking the beta-1 receptors in the heart. A normal resting heart rate for adults ranges from 60 to 100 beats per minute (bpm). Metoprolol can cause bradycardia, or slow heart rate, which can be a serious side effect if it is too low.
B. Hyperglycemia
Choice B is wrong because hyperglycemia, or high blood sugar, is not an adverse effect of metoprolol. Metoprolol does not affect the insulin secretion or glucose metabolism in the body. A normal blood sugar level for adults without diabetes is less than 140 mg/dL (7.8 mmol/L) two hours after eating. Metoprolol can cause hypoglycemia, or low blood sugar, in people who have diabetes and take insulin or other glucose-lowering medications. This is because metoprolol can mask the symptoms of hypoglycemia, such as palpitations and tremors.
C. Bronchospasm
This is because metoprolol is a beta blocker, which can block the beta-2 receptors in the lungs and cause constriction of the airways. This can lead to breathing problems such as shortness of breath, cough, and wheezing. Bronchospasm is more likely to occur in people who have asthma or chronic obstructive pulmonary disease (COPD).
D. Hyperkalemia.
Choice D is wrong because hyperkalemia, or high potassium, is not an adverse effect of metoprolol. Metoprolol does not affect the potassium balance in the body.
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Full Explanation
This is because metoprolol is a beta blocker, which can block the beta-2 receptors in the lungs and cause constriction of the airways. This can lead to breathing problems such as shortness of breath, cough, and wheezing. Bronchospasm is more likely to occur in people who have asthma or chronic obstructive pulmonary disease (COPD).
Choice A is wrong because tachycardia, or fast heart rate, is not an adverse effect of metoprolol. In fact, metoprolol can lower the heart rate by blocking the beta-1 receptors in the heart. A normal resting heart rate for adults ranges from 60 to 100 beats per minute (bpm). Metoprolol can cause bradycardia, or slow heart rate, which can be a serious side effect if it is too low.
Choice B is wrong because hyperglycemia, or high blood sugar, is not an adverse effect of metoprolol. Metoprolol does not affect the insulin secretion or glucose metabolism in the body. A normal blood sugar level for adults without diabetes is less than 140 mg/dL (7.8 mmol/L) two hours after eating. Metoprolol can cause hypoglycemia, or low blood sugar, in people who have diabetes and take insulin or other glucose-lowering medications. This is because metoprolol can mask the symptoms of hypoglycemia, such as palpitations and tremors.
Choice D is wrong because hyperkalemia, or high potassium, is not an adverse effect of metoprolol. Metoprolol does not affect the potassium balance in the body.
A normal blood potassium level for adults is 3.6 to 5.2 millimoles per liter (mmol/L)
Similar Questions
A nurse is evaluating a client who has hypertension and is taking lisinopril, an angiotensin II receptor blocker (ARB). Which of the following outcomes indicates that the medication is effective?
A. The client has no edema in the lower extremities.
Choice A is wrong because the client has no edema in the lower extremities. This is not a specific outcome of lisinopril, an angiotensin II receptor blocker (ARB). Edema can be caused by many factors, such as heart failure, kidney disease, or venous insufficiency. Lisinopril does not directly affect fluid retention or edema.
B. The client has a urine output of 30 mL/hr.
Choice B is wrong because the client has a urine output of 30 mL/hr. This is a low urine output that may indicate dehydration, kidney impairment, or urinary obstruction. Lisinopril is expected to increase urine output by reducing the blood pressure and improving the renal blood flow.
C. The client has a blood pressure of 120/78 mm Hg.
The client has a blood pressure of 120/78 mm Hg. This indicates that the medication is effective because it lowers the blood pressure below the hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
D. The client has a serum creatinine level of 1.2 mg/dL.
Choice D is wrong because the client has a serum creatinine level of 1.2 mg/dL. This is a high serum creatinine level that may indicate kidney damage or reduced kidney function. Lisinopril is expected to lower the serum creatinine level by preventing the progression of kidney disease and protecting the kidney from further injury.
Full Explanation
The client has a blood pressure of 120/78 mm Hg. This indicates that the medication is effective because it lowers the blood pressure below the hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
Choice A is wrong because the client has no edema in the lower extremities. This is not a specific outcome of lisinopril, an angiotensin II receptor blocker (ARB). Edema can be caused by many factors, such as heart failure, kidney disease, or venous insufficiency. Lisinopril does not directly affect fluid retention or edema.
Choice B is wrong because the client has a urine output of 30 mL/hr. This is a low urine output that may indicate dehydration, kidney impairment, or urinary obstruction. Lisinopril is expected to increase urine output by reducing the blood pressure and improving the renal blood flow.
Choice D is wrong because the client has a serum creatinine level of 1.2 mg/dL. This is a high serum creatinine level that may indicate kidney damage or reduced kidney function. Lisinopril is expected to lower the serum creatinine level by preventing the progression of kidney disease and protecting the kidney from further injury.
Normal ranges of urine output, blood pressure, and serum creatinine are:
• Urine output: 800 to 2000 mL/day or 40 to 80 mL/hr
• Blood pressure: less than 120/80 mm Hg for adults
• Serum creatinine: 0.6 to 1.2 mg/dL for males and 0.5 to 1.1 mg/dL for females
A nurse is teaching a client who has hypertension and is prescribed nifedipine, a calcium channel blocker, about self-care measures. Which of the following instructions should the nurse include? (Select all that apply.)
A. Avoid drinking alcohol while taking this medication.
Alcohol can increase the risk of side effects such as dizziness, flushing, headache, and low blood pressure.
B. Monitor your blood pressure and pulse regularly.
This will help to evaluate the effectiveness of the medication and detect any abnormal changes.Normal blood pressure for adults is less than 130/80 mm Hg and normal pulse rate is 60 to 100 beats per minute.
C. Report any swelling in your ankles or feet to your provider.
This can be a sign of fluid retention or heart failure, which are possible complications of nifedipine.
D. Do not stop taking this medication abruptly.
This can cause a rebound increase in blood pressure and chest pain.The dose should be tapered gradually under the supervision of the provider.
E. Chew or crush the sustained-release tablet for faster action.
Chewing or crushing the sustained-release tablet can cause too much of the drug to be released at once, which can lead to overdose or severe side effects. The tablet should be swallowed whole with a glass of water.
Full Explanation
Nifedipine is a calcium channel blocker that lowers blood pressure by relaxing the blood vessels and reducing the workload of the heart.
The following instructions should be included in the teaching:
• Avoid drinking alcohol while taking this medication. Alcohol can increase the risk of side effects such as dizziness, flushing, headache, and low blood pressure.
• Monitor your blood pressure and pulse regularly. This will help to evaluate the effectiveness of the medication and detect any abnormal changes. Normal blood pressure for adults is less than 130/80 mm Hg and normal pulse rate is 60 to 100 beats per minute.
• Report any swelling in your ankles or feet to your provider. This can be a sign of fluid retention or heart failure, which are possible complications of nifedipine.
• Do not stop taking this medication abruptly. This can cause a rebound increase in blood pressure and chest pain. The dose should be tapered gradually under the supervision of the provider.
Choice E is wrong because chewing or crushing the sustained-release tablet can cause too much of the drug to be released at once, which can lead to overdose or severe side effects.
The tablet should be swallowed whole with a glass of water.
Which drug blocks the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects?
A. Beta blockers
Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system. Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline
B. Calcium channel blockers
Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells. Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells
C. Angiotensin II receptor blockers (ARBs)
Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects
D. Direct acting vasodilators.
Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate. Direct acting vasodilators lower blood pressure by decreasing peripheral resistance
Full Explanation
Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects
Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system. Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline
Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells. Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells
Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate. Direct acting vasodilators lower blood pressure by decreasing peripheral resistance