Question

A nurse is reviewing the medication list of a client who has heart failure and a prescription for hydrochlorothiazide. The nurse should advise the client to avoid taking which of the following over-the-counter medications that can decrease the effects of hydrochlorothiazide?

Answer 1

Correct Answers:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Rationale :

🔹 Hydrochlorothiazide (HCTZ) is a thiazide diuretic commonly prescribed to treat heart failure, hypertension, and edema by promoting the excretion of sodium and water through the kidneys.

🔹 NSAIDs (such as ibuprofen, naproxen, and ketoprofen) can decrease the diuretic and antihypertensive effects of hydrochlorothiazide by reducing renal blood flow through inhibition of prostaglandin synthesis.

🔹 This interaction can lead to fluid retention, worsening edema, increased blood pressure, and exacerbation of heart failure, making NSAIDs particularly unsafe for clients with heart failure.

🔹 Concurrent use of NSAIDs may also increase the risk of acute kidney injury, especially in older adults and clients taking diuretics or ACE inhibitors.

🔹 The nurse should advise the client to avoid taking over-the-counter NSAIDs unless specifically approved by the healthcare provider.

🔹 For mild pain or fever, acetaminophen is generally considered the preferred over-the-counter analgesic for clients with heart failure because it does not significantly interfere with the action of hydrochlorothiazide.

🔹 The nurse should educate the client to read OTC medication labels carefully, as many cold and pain medications contain NSAIDs.

🔹 Clients should also monitor for signs of worsening heart failure, including rapid weight gain, increasing edema, shortness of breath, and decreased urine output, and report these findings promptly.

🔹 Medication reconciliation and patient education are essential to prevent harmful drug interactions.

🔹 Avoiding NSAIDs helps maintain the therapeutic effectiveness of hydrochlorothiazide and supports optimal management of heart failure.

👉 Key Point: NSAIDs reduce the effectiveness of hydrochlorothiazide and can worsen heart failure.

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Answer 2

Correct Answers:

Severe hepatic impairment
Hyperkalemia

Rationale :

✅ Severe hepatic impairment ✔️

🌻 Losartan is an angiotensin II receptor blocker (ARB) that is extensively metabolized by the liver.

🌻 In clients with hepatic impairment, blood concentrations of losartan can become significantly elevated because hepatic clearance is reduced.

🌻 For mild-to-moderate hepatic impairment, a lower starting dose is recommended, but losartan has not been adequately studied in severe hepatic impairment.

🌻 Because drug exposure may be substantially increased, severe hepatic impairment is considered a major reason to avoid or use alternative therapy in exam-style questions.

🌻 The nurse should notify the provider before initiating therapy in a client with severe liver dysfunction.

👉 Key Point: Severe liver impairment can markedly increase losartan exposure.

✅ Hyperkalemia ✔️

🌸 Losartan blocks the effects of angiotensin II, which decreases secretion of aldosterone.

🌸 Lower aldosterone levels reduce renal potassium excretion, which can cause potassium retention and hyperkalemia.

🌸 A client who already has hyperkalemia is at increased risk for the potassium level becoming dangerously high after starting losartan.

🌸 Severe hyperkalemia can cause muscle weakness, conduction abnormalities, and life-threatening cardiac dysrhythmias.

🌸 Serum potassium should therefore be assessed before and during therapy, and dosage reduction or discontinuation may be required if hyperkalemia develops.

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Answer 3

Correct Answers:

2

Rationale :

✍️ Step 1: Identify the prescribed dose

Prescribed dose = 0.25 mg

✍️ Step 2: Identify the available dose

Available dose = 0.125 mg per tablet

✍️ Step 3: Use the formula

Tablets to administer = Prescribed dose ÷ Available dose

✍️ Step 4: Substitute the values

0.25 mg ÷ 0.125 mg = 2 tablets

✍️ Step 5: Round as instructed

Nearest whole number = 2 tablets

✅ Final Answer: 2 tablets

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Answer 4

Correct Answers:

Vitamin D
Vitamin K
Vitamin E
Vitamin A

Rationale :

✅ Vitamin A ✔️ Correct

🌻 Vitamin A is a fat-soluble vitamin that requires normal fat absorption in the small intestine for adequate uptake.

🌻 Clients with malabsorption disorders, such as celiac disease, cystic fibrosis, Crohn's disease, chronic pancreatitis, or short bowel syndrome, have difficulty absorbing dietary fats and are therefore at risk for vitamin A deficiency.

🌻 Deficiency can lead to night blindness, dry eyes (xerophthalmia), dry skin, impaired immune function, and delayed wound healing.

🌻 The nurse should monitor for visual changes, assess nutritional status, and reinforce adherence to prescribed vitamin supplementation.

🌻 Maintaining adequate vitamin A levels is essential for vision, epithelial tissue integrity, immune function, and normal growth.

👉 Key Point: Vitamin A deficiency commonly occurs with fat malabsorption.

✅ Vitamin D ✔️ Correct

🌸 Vitamin D is a fat-soluble vitamin that depends on normal fat absorption for intestinal uptake.

🌸 Deficiency results in decreased calcium and phosphorus absorption, leading to poor bone mineralization.

🌸 Children may develop rickets, while adults are at risk for osteomalacia or osteoporosis.

🌸 The nurse should monitor calcium, phosphorus, vitamin D levels, and bone health, and encourage prescribed supplementation.

🌸 Adequate vitamin D is essential for healthy bones, teeth, and neuromuscular function.

👉 Key Point: Vitamin D deficiency causes impaired calcium absorption and bone disease.

✅ Vitamin E ✔️ Correct

🧿 Vitamin E is a fat-soluble antioxidant that protects cell membranes from oxidative damage.

🧿 Malabsorption disorders decrease vitamin E absorption, increasing the risk of deficiency.

🧿 Deficiency may cause peripheral neuropathy, muscle weakness, ataxia, decreased reflexes, and hemolytic anemia, particularly in children.

🧿 The nurse should monitor neurological function and encourage prescribed supplementation if indicated.

🧿 Adequate vitamin E supports neurological health, red blood cell integrity, and immune function.

👉 Key Point: Vitamin E deficiency can lead to neurological and hematologic problems.

✅ Vitamin K ✔️ Correct

🏵️ Vitamin K is a fat-soluble vitamin required for the liver to synthesize clotting factors II, VII, IX, and X.

🏵️ Fat malabsorption can reduce vitamin K absorption, increasing the risk of bleeding and prolonged clotting times.

🏵️ Deficiency may present with easy bruising, bleeding gums, epistaxis, prolonged PT/INR, or excessive bleeding after injury.

🏵️ The nurse should monitor coagulation studies and assess for signs of bleeding.

🏵️ Adequate vitamin K is necessary for normal blood coagulation and bone metabolism.

👉 Key Point: Vitamin K deficiency increases bleeding risk.

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Answer 5

Correct Answers:

Orange juice

Rationale :

🔹 Vitamin C (ascorbic acid) is a water-soluble vitamin that plays a vital role in collagen synthesis, wound healing, immune function, and antioxidant protection.

🔹 Adults 19 to 50 years require approximately 75 mg/day for women and 90 mg/day for men of vitamin C according to the Recommended Dietary Allowance (RDA).

🔹 Orange juice is one of the richest natural dietary sources of vitamin C, with 1 cup (240 mL) providing approximately 90–120 mg, enough to meet or exceed the daily requirement for most adults.

🔹 Vitamin C also enhances the absorption of non-heme iron from plant-based foods, helping reduce the risk of iron-deficiency anemia.

🔹 Regular consumption of vitamin C-rich foods supports healthy skin, blood vessels, cartilage, bones, gums, and immune function.

🔹 Other excellent sources include oranges, strawberries, kiwi, grapefruit, broccoli, Brussels sprouts, tomatoes, bell peppers, and cantaloupe.

🔹 Because vitamin C is water-soluble and not stored in large amounts, it should be consumed daily through diet.

🔹 Deficiency of vitamin C can lead to scurvy, characterized by bleeding gums, easy bruising, poor wound healing, fatigue, and petechiae.

🔹 The nurse should encourage clients to obtain vitamin C primarily from fresh fruits and vegetables as part of a balanced diet.

🔹 Choosing vitamin C-rich foods promotes overall health and supports normal body functions.

👉 Key Point: Orange juice is an excellent source of vitamin C and easily meets the daily requirement.

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Answer 6

Correct Answers:

"Fibrates are indicated for clients with very elevated serum triglyceride levels who are at higher risk for coronary artery disease."
"These medications may be prescribed for clients who have not seen sufficient improvement in HDL-C or triglyceride levels with statin therapy alone."
"Fibrates are indicated for clients who have made lifestyle changes, such as dietary modifications and increased exercise, without sufficient lipid level improvement."

Rationale :

✅ Very elevated triglyceride levels ✔️ Correct

🔹 Fibrates, such as fenofibrate and gemfibrozil, are especially effective at lowering serum triglycerides.

🔹 They work primarily by activating PPAR-alpha, which increases the breakdown of triglyceride-rich lipoproteins and decreases hepatic triglyceride production.

🔹 Fibrates are particularly useful when triglyceride levels are markedly elevated, because severe hypertriglyceridemia increases the risk of pancreatitis and contributes to cardiovascular risk.

🔹 They can also produce a modest increase in HDL-C, which may be beneficial in selected clients.

🔹 Therefore, a client with significantly elevated triglycerides is an appropriate candidate for fibrate therapy.

👉 Key Point: Think fibrates when triglycerides are very high.

✅ Insufficient improvement in HDL-C or triglycerides with statin therapy alone ✔️ Correct

🔹 Statins are primarily used to lower LDL cholesterol, but they may not adequately correct persistent hypertriglyceridemia or low HDL-C.

🔹 In selected clients, a fibrate may be added when triglycerides remain elevated despite appropriate statin therapy and lifestyle modification.

🔹 This combination requires caution because concurrent use, especially with gemfibrozil, can increase the risk of myopathy and rhabdomyolysis.

🔹 If combination therapy is needed, fenofibrate is generally preferred over gemfibrozil because it has fewer interactions with statins.

🔹 The nurse should monitor for muscle pain, weakness, and elevated creatine kinase if a fibrate and statin are used together.

👉 Key Point: Fibrates may be added when triglycerides remain high despite statin therapy.

✅ Lifestyle changes without sufficient improvement ✔️ Correct

🔹 Lifestyle modification is an important first step in treating hyperlipidemia and includes dietary changes, regular exercise, weight management, smoking cessation, and reduced alcohol intake.

🔹 If triglyceride or lipid levels remain significantly abnormal despite these measures, medication therapy may be necessary.

🔹 Fibrates may be prescribed when lifestyle interventions have not adequately reduced triglycerides.

🔹 This is especially appropriate when persistent hypertriglyceridemia places the client at increased risk for pancreatitis or cardiovascular disease.

🔹 Medication therapy should complement, not replace, ongoing lifestyle modification.

👉 Key Point: If lifestyle changes are not enough and triglycerides remain elevated, fibrates may be indicated.

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Answer 7

Correct Answers:

“This medication will force the liver to pull more cholesterol from your bloodstream."

Rationale :

🔹 Bile acid sequestrants (such as cholestyramine, colestipol, and colesevelam) work by binding bile acids in the intestine, preventing their reabsorption through the enterohepatic circulation.

🔹 Because bile acids are excreted in the stool instead of being recycled, the liver must produce new bile acids to replace those that were lost.

🔹 To make new bile acids, the liver uses cholesterol from the bloodstream, increasing the number of LDL receptors on hepatocytes and removing more LDL cholesterol (LDL-C) from the blood.

🔹 As a result, serum LDL cholesterol levels decrease, helping reduce the risk of atherosclerotic cardiovascular disease.

🔹 These medications are not absorbed systemically, so they work entirely within the gastrointestinal tract.

🔹 Bile acid sequestrants are often prescribed for clients with elevated LDL-C, particularly when statins are contraindicated or require additional LDL lowering.

🔹 Common adverse effects include constipation, bloating, flatulence, nausea, and abdominal discomfort because the medication remains in the intestines.

🔹 They can also decrease the absorption of fat-soluble vitamins (A, D, E, and K) and many oral medications. Therefore, other medications should generally be taken 1 hour before or 4 to 6 hours after the bile acid sequestrant.

🔹 Clients should increase fluid intake and dietary fiber to help prevent constipation.

🔹 Understanding the medication's mechanism helps improve adherence and encourages appropriate lifestyle modifications alongside therapy.

👉 Key Point: Bile acid sequestrants lower LDL by forcing the liver to use circulating cholesterol to produce new bile acids.

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Answer 8

Correct Answers:

"I will contact my health care provider If I experience visual changes."

Rationale :

🔹 Digoxin is a cardiac glycoside used to improve cardiac output in clients with heart failure and to control ventricular rate in certain dysrhythmias.

🔹 Visual disturbances, such as blurred vision, yellow or green halos around lights, or changes in color perception, are classic manifestations of digoxin toxicity.

🔹 Other signs of toxicity include anorexia, nausea, vomiting, fatigue, confusion, weakness, and bradycardia.

🔹 If these symptoms occur, the client should hold the medication and contact the healthcare provider immediately because toxicity can progress to life-threatening cardiac dysrhythmias.

🔹 The nurse should teach the client to check their apical pulse for a full 1 minute before taking digoxin and to withhold the medication if the pulse is below the prescribed parameter (commonly less than 60/min in adults) and notify the provider.

🔹 Clients should also have their serum digoxin level, potassium, magnesium, and renal function monitored because electrolyte imbalances and renal impairment increase the risk of toxicity.

🔹 Maintaining a diet with adequate potassium (unless contraindicated) is important because hypokalemia increases the effects and toxicity of digoxin.

🔹 Early recognition of toxicity allows prompt treatment and helps prevent serious complications.

🔹 Client education is essential because digoxin has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small.

🔹 Prompt reporting of visual changes improves medication safety and patient outcomes.

👉 Key Point: Visual changes are a hallmark sign of digoxin toxicity and require immediate provider notification.

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Answer 9

Correct Answers:

"Avoid foods that contain high levels of potassium."

Rationale :

🔹 Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, heart failure, and diabetic kidney disease.

🔹 ACE inhibitors decrease aldosterone secretion, causing the kidneys to retain potassium while excreting less of it.

🔹 As a result, clients are at risk for hyperkalemia, especially if they consume large amounts of potassium-rich foods or potassium supplements.

🔹 The nurse should instruct the client to avoid potassium supplements, potassium-containing salt substitutes, and excessive intake of high-potassium foods such as bananas, oranges, tomatoes, potatoes, spinach, and avocados unless directed otherwise by the provider.

🔹 The client should have serum potassium and renal function (BUN and creatinine) monitored regularly because ACE inhibitors can impair kidney function and increase potassium levels.

🔹 Signs of hyperkalemia include muscle weakness, numbness, tingling, and irregular heart rhythms, which should be reported immediately.

🔹 Clients should also be informed that a persistent dry cough may occur and should notify the provider if it becomes bothersome.

🔹 Another important adverse effect is angioedema, characterized by swelling of the lips, tongue, face, or throat, which requires immediate emergency care.

🔹 The nurse should advise the client to change positions slowly because orthostatic hypotension may occur, particularly when therapy is first initiated.

🔹 Following these teaching points helps improve medication safety and reduces the risk of serious complications.

👉 Key Point: ACE inhibitors increase potassium levels—avoid excessive potassium intake.

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Answer 10

Correct Answers:

Recommend vitamin D supplementation

Rationale :

🔹 Vitamin D is produced in the skin when it is exposed to ultraviolet B (UVB) radiation from sunlight.

🔹 People who live in northern latitudes often receive much less UVB exposure during winter, which reduces the body's ability to synthesize adequate vitamin D.

🔹 Because sunlight is limited seasonally, vitamin D supplementation is a reliable and safe way to prevent deficiency.

🔹 Adequate vitamin D helps maintain calcium and phosphorus absorption, supporting normal bone mineralization and muscle function.

🔹 Deficiency can contribute to osteomalacia in adults, rickets in children, bone pain, muscle weakness, and increased fracture risk.

🔹 The nurse should also encourage dietary sources of vitamin D such as fortified milk, fortified cereals, egg yolks, and fatty fish.

🔹 Supplementation is especially important for people with additional risk factors such as limited outdoor exposure, darker skin pigmentation, older age, obesity, or malabsorption disorders.

🔹 The exact dose should be based on the client's age, diet, risk factors, and laboratory findings if vitamin D levels have been checked.

👉 Key Point: When winter sunlight is limited, vitamin D supplementation is the most dependable prevention strategy.

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Custom: NURA_303 Exam #2 Summer 2026

No.

1 :
A nurse is reviewing the medication list of a client who has heart failure and a prescription for hydrochlorothiazide. The nurse should advise the client to avoid taking which of the following over-the-counter medications that can decrease the effects of hydrochlorothiazide?

2 :
A nurse is reviewing the medical history of a client who has been prescribed losartan for hypertension. Which of the following conditions should the nurse identify as contraindications for the use of losartan? (Select All that Apply.)

3 :
A nurse is preparing to administer digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

4 :
A patient with a malabsorption disorder is at risk for deficiencies in fat-soluble vitamins due to impaired absorption of dietary fats. Which of the following vitamins should the nurse monitor closely for potential deficiency in this patient? (Select all that apply)

5 :
A nurse is planning a health education session for a group of adults aged 19 to 50 years. Which of the following foods should the nurse recommend to meet the Recommended Daily Allowance (RDA) for vitamin C?

6 :
A nurse is reviewing treatment options with a client who has hyperlipidemia. Which of the following are indications for initiating fibrate therapy? (Select All that Apply.)

7 :
A nurse is educating a client on the action of bile-acid sequestrants prescribed for lowering cholesterol levels. Which of the following client outcomes should the nurse explain is a result of taking this medication?

8 :
A nurse is teaching about the management of heart failure with a client who has a prescription for digoxin. Which of the following statements by the client indicates an understanding of the teaching?

9 :
A nurse is educating a client who has been prescribed lisinopril for hypertension. Which of the following statements should the nurse include?

10 :
A nurse is evaluating a client's risk factors for vitamin D deficiency. Considering the client's geographic location in a northern latitude with limited sunlight during winter, which of the following interventions should the nurse suggest to prevent low vitamin D levels?

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Custom: NURA_303 Exam #2 Summer 2026

No.

1 : A nurse is reviewing the medication list of a client who has heart failure and a prescription for hydrochlorothiazide. The nurse should advise the client to avoid taking which of the following over-the-counter medications that can decrease the effects of hydrochlorothiazide?

2 : A nurse is reviewing the medical history of a client who has been prescribed losartan for hypertension. Which of the following conditions should the nurse identify as contraindications for the use of losartan? (Select All that Apply.)

3 : A nurse is preparing to administer digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

4 : A patient with a malabsorption disorder is at risk for deficiencies in fat-soluble vitamins due to impaired absorption of dietary fats. Which of the following vitamins should the nurse monitor closely for potential deficiency in this patient? (Select all that apply)

5 : A nurse is planning a health education session for a group of adults aged 19 to 50 years. Which of the following foods should the nurse recommend to meet the Recommended Daily Allowance (RDA) for vitamin C?

6 : A nurse is reviewing treatment options with a client who has hyperlipidemia. Which of the following are indications for initiating fibrate therapy? (Select All that Apply.)

7 : A nurse is educating a client on the action of bile-acid sequestrants prescribed for lowering cholesterol levels. Which of the following client outcomes should the nurse explain is a result of taking this medication?

8 : A nurse is teaching about the management of heart failure with a client who has a prescription for digoxin. Which of the following statements by the client indicates an understanding of the teaching?

9 : A nurse is educating a client who has been prescribed lisinopril for hypertension. Which of the following statements should the nurse include?

10 : A nurse is evaluating a client's risk factors for vitamin D deficiency. Considering the client's geographic location in a northern latitude with limited sunlight during winter, which of the following interventions should the nurse suggest to prevent low vitamin D levels?

1 :
A nurse is reviewing the medication list of a client who has heart failure and a prescription for hydrochlorothiazide. The nurse should advise the client to avoid taking which of the following over-the-counter medications that can decrease the effects of hydrochlorothiazide?

2 :
A nurse is reviewing the medical history of a client who has been prescribed losartan for hypertension. Which of the following conditions should the nurse identify as contraindications for the use of losartan? (Select All that Apply.)

3 :
A nurse is preparing to administer digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

4 :
A patient with a malabsorption disorder is at risk for deficiencies in fat-soluble vitamins due to impaired absorption of dietary fats. Which of the following vitamins should the nurse monitor closely for potential deficiency in this patient? (Select all that apply)

5 :
A nurse is planning a health education session for a group of adults aged 19 to 50 years. Which of the following foods should the nurse recommend to meet the Recommended Daily Allowance (RDA) for vitamin C?

6 :
A nurse is reviewing treatment options with a client who has hyperlipidemia. Which of the following are indications for initiating fibrate therapy? (Select All that Apply.)

7 :
A nurse is educating a client on the action of bile-acid sequestrants prescribed for lowering cholesterol levels. Which of the following client outcomes should the nurse explain is a result of taking this medication?

8 :
A nurse is teaching about the management of heart failure with a client who has a prescription for digoxin. Which of the following statements by the client indicates an understanding of the teaching?

9 :
A nurse is educating a client who has been prescribed lisinopril for hypertension. Which of the following statements should the nurse include?

10 :
A nurse is evaluating a client's risk factors for vitamin D deficiency. Considering the client's geographic location in a northern latitude with limited sunlight during winter, which of the following interventions should the nurse suggest to prevent low vitamin D levels?