Chapter 43,44,45
The nurse provides dietary teaching to the patient with hypertension and determines the patient understood the information when what meal is selected?
Grilled chicken, green salad with dressing, and baked apple
The nurse is caring for a patient newly prescribed iloprost (Ventavis). What is the nurse's priority teaching point about this medication?
Inhale this drug six to nine times a day during waking hours.
When a drug is said to increase the force of contraction of the heart muscle, the nurse appropriately uses what term?
Positive inotropic
The nurse is caring for a patient who reports insomnia since starting the antiarrhythmic agent prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking?
Propranolol (Inderal)
The nurse is caring for a patient who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the patient is taking?
Propranolol (Inderal)
What order for a digitalizing dose of digoxin (Lanoxin) for a 62-year-old man would the nurse consider appropriate and safe to administer?
0.75 mg orally now
A 6-year-old child weighing 60 pounds has been prescribed oral digoxin (Lanoxin) 30 mcg/kg as a loading dose. How many milligram will she be given?
0.818 mg
The nurse administers a bolus of lidocaine and follows it with a continuous infusion at what rate?
1 to 4 mg/min
The nurse is caring for a patient who has been noncompliant with treatment for hypertension. The nurse explains that untreated hypertension increases the risk of what? (Select all that apply.) A) Renal disease B) Cerebral infarction C) Heart failure D) Cholecystitis E) Migraine headache
A) Renal disease B) Cerebral infarction C) Heart failure
The nurse is preparing to administer a digitalizing dosage of digoxin to a geriatric patient. What factors will the nurse assess for first to avoid digoxin toxicity? (Select all that apply.) A) Renal function B) Low body mass C) Hydration D) Assessment of pulse E) Cognitive function
A) Renal function B) Low body mass C) Hydration
The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patient's prescription to losartan with hydrochlorothiazide (Hyzaar). What benefits does the nurse anticipate this patient will receive from this drug therapy? (Select all that apply.) A) Slows progression of diabetic nephropathy in type 2 diabetes B) Increases excretion of fluid and sodium resulting in lower blood volume C) Alters electrolyte and acidbase balance D) Improves control of blood pressure due to combination therapy E) Produces far fewer adverse effects resulting from the combination
A) Slows progression of diabetic nephropathy in type 2 diabetes B) Increases excretion of fluid and sodium resulting in lower blood volume
A patient has had sotalol (Betapace) ordered for treatment of a ventricular arrhythmia. What will the nurse consider when administering the drug?
Absorption of sotalol is decreased by the presence of food
The nurse administers what drug to terminate supraventricular tachycardia?
Adenosine (Adenocard)
The patient is diagnosed with secondary hypertension. What will be the focus of nursing care to treat this patient?
Administering epinephrine
The nurse is caring for a pediatric patient who has been diagnosed with paroxysmal atrial tachycardia. The order reads digoxin 10 mcg/kg orally. The child weighs 44 pounds. How many mcg will the nurse administer?
200 mcg
After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time?
5 to 30 minutes
The patient was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2 of the stepped-care management of hypertension plan, an angiotensin-converting enzyme inhibitor was ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the provider will order what?
A diuretic
What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension?
A diuretic
The nurse works in a clinic that has many African American patients. What would the nurse need to consider when caring for patients with hypertension? (Select all that apply.) A) African American men are at highest risk for hypertension. B) African Americans respond best to single-drug therapy. C) African Americans are most responsive to angiotensin-converting enzyme inhibitors. D) Increased adverse effects occur when using thiazide and thiazide-like diuretics. E) First-line use of a calcium channel blocker with changes to lifestyle is best in African Americans.
A) African American men are at highest risk for hypertension. B) African Americans respond best to single-drug therapy. D) Increased adverse effects occur when using thiazide and thiazide-like diuretics.
The nurse is teaching a class for newly hired cardiac care nurses and is discussing dronedarone (Multaq). What statement, if made by the nurse, is accurate? (Select all that apply.) A) Dronedarone has properties of all four classes of antiarrhythmics. B) Dronedarone reduces the risk of hospitalization in patients in atrial fibrillation. C) Dronedarone has many drugdrug interactions that need to be reviewed. D) It is an oral drug taken once a day. E) Common adverse effects of dronedarone include ventricular arrhythmias.
A) Dronedarone has properties of all four classes of antiarrhythmics. B) Dronedarone reduces the risk of hospitalization in patients in atrial fibrillation. C) Dronedarone has many drugdrug interactions that need to be reviewed.
While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Select all that apply.) A) Heart rate B) Stroke volume C) Preload D) Total peripheral resistance E) Pulse pressure
A) Heart rate B) Stroke volume D) Total peripheral resistance
The patient does not want to take medication to treat his or her hypertension if he or she can avoid it and asks the nurse if there is anything else he or she can do? What lifestyle changes will the nurse recommend? (Select all that apply.) A) Increase time spent exercising. B) Eliminate all salt from your diet. C) Reduce intake of fluids. D) Lose some weight. E) Try meditation.
A) Increase time spent exercising. D) Lose some weight. E) Try meditation.
The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? (Select all that apply.) A) Irregular heart rhythms B) Nausea C) Anorexia D) Headache E) Peripheral edema
A) Irregular heart rhythms B) Nausea C) Anorexia
The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered?
Anticoagulant
The nurse is providing drug teaching about quinidine in preparation for the patient's discharge. The nurse discusses drugfood interactions and advises the patient to drink what?
Apple juice
You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug?
Assess pulses and blood pressure.
What nursing assessment will the nurse perform to determine the hemodynamic effect of the patient's arrhythmia?
Assess the patient's blood pressure (BP) and pulse rate.
The nurse reviews the patient's medical history and determines class II antiarrhythmics are contraindicated due to the patient's history of what condition?
Asthma
The patient has just been prescribed milrinone (Primacor). The nurse recognizes the drug is contraindicated due to the patient's allergy to what?
Bisulfites
The nurse is caring for a patient receiving propranolol. What problems, reported by the patient, does the nurse suspect is caused by the drug? (Select all that apply.) A) Seizures B) Rash C) Atrioventricular (AV) block D) Bronchospasm E) Dreams
C) Atrioventricular (AV) block D) Bronchospasm E) Dreams
What electrolyte inactivates troponin and allows actin and myosin to form a bridge enabling the muscle fibers to contract?
Calcium
No antihypertensive medication is safe during pregnancy but if the benefit for the mother outweighs the risk to the fetus, what classification of medication can the nurse administer to the hypertensive pregnant woman?
Calcium channel blocker
The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the patient complains of a headache and nausea. What will the nurse do first?
Check her laboratory values and vital signs.
A patient with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. What is the nurse's priority assessment before administering the drug?
Check the patient's creatinine level.
The nurse is providing drug teaching for a patient who is to be discharged taking dofetilide (Tikosyn). What drug will the nurse teach the patient to avoid due to a drug-drug interaction?
Cimetidine
What class of antiarrhythmic agent would the nurse be most likely to administer to a lactating new mother?
Class II
What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential?
Class III
What class of antiarrhythmic agents does the nurse administer to depress generation of the action potentials and delaying phases 1 and 2 of repolarization?
Class IV
What class of antiarrhythmics will the nurse administer to the patient in symptomatic paroxysmal tachycardia because it markedly depresses phase 0 with extreme slowing of conduction?
Class Ic
The nurse admits a patient to the constant care unit with a digoxin level of 11 ng/mL and a serum potassium level of 5.2 mEq/L. Digoxin immune Fab is administered. The next day, the patient's digoxin level remains elevated. What action does the nurse anticipate?
Continue to monitor the patient's digoxin level daily.
The nurse expects the patient's heart failure (HF) is caused by what diagnosis that is responsible for 95% of the cases diagnosed?
Coronary artery disease (CAD)
The nurse teaches the patient receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia to monitor what parameter?
Daily blood pressure
The nurse sees a patient in an outpatient setting who is given a new prescription for an antiarrhythmic medication to treat premature atrial contractions (PAC). The nurse has limited time with the patient and addresses what priority nursing diagnosis?
Deficient knowledge
A triage nurse in the emergency department is assessing a 78-year-old man. It is determined that the patient is experiencing severe digoxin toxicity. What drug will the nurse administer immediately?
Digoxin immune Fab (Digibind)
The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug might the nurse administer that will both treat his hypertension and reduce myocardial oxygen consumption?
Diltiazem
What drug is a safe and effective calcium channel blocker only if the nurse administers them as sustained-release or extended-release preparations to treat hypertension?
Diltiazem (Cardizem)
The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of lidocaine therapy should the nurse assess for?
Dizziness
The pediatric nurse examines a child with mildly elevated blood pressure who is 10% above the upper weight limits for his or her age. What is the nurse's priority teaching point?
Encourage activity and begin weight loss diet.
A patient who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is the nurse's priority assessment?
Excessive sweating on the job
The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial hypertension. What single indicator would the nurse use to evaluate the effectiveness of this medication?
Exercise tolerance
The nurse evaluates the patient's lifestyle for factors that are contributing to his or her diagnosis of hypertension and then addresses the need to change what factor?
Exposure to high-frequency noise
The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing?
Furosemide (Lasix)
The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse warn the patient to avoid taking with digoxin?
Ginseng
A patient has been started on losartan (Cozaar), an angiotensin IIreceptor blocker (ARB), for hypertension. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the patient's hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this patient's hypertension?
Hydrochlorothiazide (Hyzaar)
The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances?
Hypertensive emergencies
What would the nurse teach the diabetic patient to monitor for when beginning a class II antidysrhythmic drug regimen in addition to insulin?
Hypoglycemia
The nurse reviews the patient's lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance?
Hypokalemia
When administering milrinone (Primacor), the nurse will assess the patient for what common adverse effect?
Hypotension
The nurse provides drug teaching to the patient prescribed captopril (Capoten). What statement made by the patient does the nurse interpret to mean teaching has been effective?
I will call my doctor if I bruise easily or become extremely tired.
The nurse prepares to administer a phosphodiesterase inhibitor by what route?
IV
The patient has been prescribed inamrinone (Inocor). Before administering the drug the nurse needs to know the drug has what pharmacokinetic effect?
Increase in cAMP
What assessment finding would indicate the patient's left-sided heart failure is worsening?
Increased crackles in lung fields
After administering digoxin, what assessment finding would indicate to the nurse that the drug was having the desired effect?
Increased urinary output
What common action do both cardiac glycosides and phosphodiesterase inhibitors have in common related to therapeutic action?
Increasing cellular calcium
A patient is admitted to the intensive care unit in shock with hypotension. What is an appropriate nursing diagnosis for this patient?
Ineffective peripheral tissue perfusion
The nurse is caring for a patient who takes ramipril (Altace) to treat hypertension. What would be an appropriate nursing diagnosis to include in this patient's care plan?
Ineffective tissue perfusion related to changes in cardiac output
What is the priority nursing assessment for a patient who is about to begin digoxin therapy?
Kidney function
The nurse, caring for a patient who is receiving cardiac glycosides to treat heart failure, will teach the patient to follow what diet?
Low sodium, high potassium, low fat
The nurse works with the patient, diagnosed with hypertension, and the patient's family to determine the goal of drug therapy for the patient taking an antihypertensive medication is what?
Maintaining the blood pressure within normal limits
A patient newly diagnosed with hypertension has just been given a prescription for medication. Along with promoting safety, what is the other goal of the nurse's teaching plan?
Medication compliance
The nurse is caring for an obese child with hypertension and slightly elevated serum glucose levels. What would the nurse anticipate will be ordered if lifestyle changes do not return blood pressure to an acceptable limit?
Mild diuretic
For what condition would the nurse expect to administer lidocaine via IV drip?
Multiple premature ventricular contractions (PVCs)
Which drug is in the class of drugs called human B-type natriuretic peptides?
Nesiritide (Natrecor)
A 62-year-old African American man diagnosed with congestive heart failure and hypertension has BiDil included in his drug therapy. What nursing assessment finding would indicate the patient is developing a complication from this drug?
Orthostatic hypotension
A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for?
Peripheral edema and bradycardia
The nurse recognizes blood pressure is determined by three elements including what?
Peripheral resistance
The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug specific adverse effect will the nurse include in the drug teaching?
Persistent cough
A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What does the nurse recognize that these symptoms indicate?
Pulmonary edema
The nurse assesses the patient before administering digoxin (Lanoxin) and withholds the drug and notifies the physician with what finding?
Pulse is 44 beats/min
A patient with a history of atrial fibrillation has had a worsening of his or her condition. The nurse knows that the drug of choice for long-term stabilization of atrial fibrillation following electrocardioversion is what?
Quinidine (generic)
A nurse is caring for a patient who has had disopyramide (Norpace), ordered. Before administering disopyramide (Norpace) what is the nurse's priority action to maintain safety?
Raise all side rails.
The nurse administers a human B-type natriuretic peptide with the expectation it will have what action?
Reduce venous return
The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the priority nursing assessment related to this drug?
Renal disease
What patient factor would result in the nurse administering a reduced dosage of disopyramide (Norpace)?
Renal impairment
A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include?
Report onset of a cough or fever to health care provider.
A 92-year-old patient is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. He asks the nurse why he must continue to take this drug. The nurse's best response would be that failure to treat a ventricular arrhythmia may what?
Result in death
The nurse suspects drug toxicity in the patient who has been receiving lidocaine by infusion over the past 2 days to control a ventricular arrhythmia. What assessment would the nurse perform to determine the accuracy of the suspicion of toxicity?
Serum lidocaine level
A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. In which step of a stepped-care management approach will the nurse teach about these changes in lifestyle?
Steps 1, 2, 3, and 4
The nurse assesses the patient's rhythm strip and notes several premature ventricular contractions, which the nurse recognizes is caused by what?
Stimulation of the ventricles from an ectopic focus in the ventricles
An older adult patient is taking a sustained-release antihypertensive drug. What is the nurse's priority teaching point about this medication?
Swallow the drug whole and do not to cut, crush, or chew it.
The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient understanding and determines further teaching is needed when the patient says she will do what?
Take the medication with a meal
The patient asks the nurse, Will I have to take this antiarrhythmic agent for the rest of my life? The nurse, having reviewed the CAST study, responds by saying what?
The drug is indicated for short-term treatment of life-threatening ventricular arrhythmias.
A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?
The ingestion of grapefruit juice
The nurse is caring for a patient who has digoxin toxicity. As the nurse assesses the changes in the patient's daily activities, what finding could indicate the cause of the toxic level?
The patient's daughter brought her a bag of licorice that she has been enjoying.
The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse be aware of?
The possible development of very serious cardiac arrhythmias
A patient asks the nurse what cardiac glycosides do to improve his condition. What is the nurse's best response?
They help renal blood flow and increase urine output.
When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic would the nurse expect to administer?
Thiazide
The nurse is preparing digoxin for an infant. What is the nurse's priority intervention?
To have another nurse check dosage calculations
The nurse administers a cardiac glycoside for what therapeutic effect?
To increase the force of the contraction of the heart
When the nurse is caring for a patient with a cardiac arrhythmia, the priority goal for the patient is what?
To maintain cardiac output
The nurse evaluates an improvement in the patient's heart failure (HF) status based on what assessment finding?
Using fewer pillows to sleep
The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, would the nurse question?
Verapamil
What is the nurse's priority to assess before giving a female patient her prescription for an angiotensin IIreceptor blocker (ARB)?
When was your last menstrual period (LMP)?
The patient taking digoxin (Lanoxin) has developed an infection. What antibiotic can the nurse safely administer to this patient?
Zithromax
What class of antiarrhythmics drug blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart?
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