Cardiovascular Meds

A nurse is reviewing the medical record of a pt who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further?

A history of left-sided heart failure - The nurse should further investigate the client's history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider.

A nurse is caring for a pt who has congestive heart failure and is taking digoxin daily. The pt refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

Check the pt's vital signs - It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.

A nurse is assessing a pt prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?

Heart rate 46/min -The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction.

A nurse is providing teaching to a pt who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the pt indicates an understanding of the teaching?

I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 min apart while waiting.

A nurse is providing discharge teaching to a pt who has a new prescription for warfarin. Which of the following statements by the pt indicates an understanding of the teaching?

I'll use my electric razor for shaving

A nurse is providing discharge teaching to a pt who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include?

Increase your daily intake of dietary fiber

A nurse is caring for a pt who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

Prothrombin time (PT) - This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation

A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?

Take one tablet at the first indication of chest pain - do not wait until chest pain is severe

A nurse is providing discharge teaching for a pt who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication

A nurse is caring for a pt who is on warfarin therapy for atrial fibrillation. The pt's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin K - reverses the effects of warfarin

A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching?

Apply the transdermal patch in the morning -The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening.

A nurse is providing teaching to a pt who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the pt to avoid while taking this medication?

Grapefruit juice - Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

A nurse is caring for a pt who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take?

Measure the pt's apical pulse

A nurse is teaching a pt who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

You might have to stop taking this medication 5 days before any planned surgeries

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?

2

A nurse is teaching a pt who takes warfarin daily. Which of the following statements by the pt indicates a need for further teaching?

I have started taking ginger root to treat my joint stiffness

A nurse in the emergency department is caring for a pt who took 3 nitroglycerin tablets sublingually for chest pain. The pt reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make?

A headache is an expected adverse effect of the medication - The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache.

A nurse is providing teaching to a pt who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide?

Do not use salt substitutes while taking this medication - Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.

A nurse is reviewing the medication list for a pt who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin?

Vitamin K - These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.

A nurse is caring for a pt who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication?

Decreased blood pressure - Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.

A nurse is caring for a pt who is taking digoxin for HF and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer?

Fab antibody fragments - Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A nurse is caring for a pt who has heart failure and a prescription for digoxin. Which of the following statements by the pt indicate an adverse effect of the medication?

I feel nauseated and have no appetite - Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is completing a medical interview with a pt who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the pt can potentiate the effect of warfarin?

The pt uses garlic to lower cholesterol levels

A nurse is providing teaching to a pt who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the pt indicates the need for further teaching?

I should leave the patch on until it is time for the next dose. - Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance.

A nurse is providing teaching to a pt who has a new prescription for lisinopril. Which of the following statements by the nurse indicates an understanding of the teaching?

I should report a cough to my provider.

A nurse is assessing an older adult pt who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity?

Anorexia - vomiting, confusion, headache, and vision changes are also manifestations of digoxin toxicity

A nurse is caring for a pt who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

Protamine

A nurse is preparing to administer enoxaparin to a pt. Which of the following actions should the nurse plan to take?

The nurse should not expel the air bubble in the profiled syringe

A nurse on a telemetry unit is caring for a pt who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the pt states that his chest pain is now a severity of 2. Which of the following actions should the nurse take?

Administer another nitroglycerin tablet -

A nurse is teaching a pt who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?

Bradycardia -Atenolol is a beta-blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia.

A nurse is caring for a pt who has thrombophlebitis and is receiving heparin by continuous IV infusion. The pt asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

Heparin does not dissolve clots. It stops new clots from forming

A nurse is teaching a pt who has a new prescription for captopril. Which of the following instructions should the nurse included in the teaching?

Monitor for a cough - Captopril is an ACE inhibitor used to treat hypertension. The client should monitor and report a cough and dyspnea.

A nurse in a provider's clinic is assessing a pt who takes sublingual nitroglycerin for stable angina. The pt reports getting a headache each time he takes the medication. Which of the following statements should the nurse make?

Try taking a mild analgesic to relieve the headache

A nurse is providing teaching for a pt who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the pt indicates an understanding of the teaching?

With the new medication, I should experience fewer side effects. - The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages.

A nurse is preparing to administer metoprolol 5 mg IV bolus to a client for heart rate control. Available is metoprolol injection 1 mg/mL. How many mL should the nurse administer per dose?

5

A nurse is teaching a pt who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include?

Monitor for leg cramps - Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.

A nurse is assessing a pt who has hypercholesterolemia and is receiving sivaststin. Which of the following findings should the nurse recognize as a potential adverse effect?

Muscle weakness - Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.

A nurse is caring for a pt who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to revere heparin's effects?

Protamine sulfate

A nurse is caring for a pt who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The pt asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level

A nurse is teaching a pt who has a new prescription for simvastatin. Which of the following instructions should the nurse include?

You should avoid grapefruit juice - Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. Potential adverse effects include elevated liver enzymes, and rhabdomyolysis.