Exam 3
Which needle length and gauge should the nurse choose to administer subcutaneous heparin? 1½ inch; 20 gauge ⅝ inch; 25 gauge 1½ inch; 18 gauge 1 inch; 26 gauge
⅝ inch; 25 gauge Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to ⅝-inch needle, 25 or 26 gauge. The other options have needle sizes that are larger, which would cause unnecessary discomfort and potential bruising and hematoma formation.
The nurse determines that the patient is experiencing an adverse effect of enalapril if which effect is noted? Patient has a dry, hacking cough Patient's serum sodium is 140 mEq/L Patient's serum potassium is 4.2 mEq/L Patient complains of persistent dry mouth
Patient has a dry, hacking cough One of the major side effects of angiotensin-converting enzyme (ACE) inhibitors such as enalapril is a dry, irritating, nonproductive cough. This cough is a major reason for the discontinuation of ACE inhibitors. The cough is a result of increased bradykinin in the lungs, which induces increased prostaglandin and nitric oxide production and causes the cough. The patient's sodium level is normal; ACE inhibitors are more likely to decrease the serum sodium level. The patient's potassium level is normal; ACE inhibitors are more likely to increase the serum potassium level. Persistent dry mouth is an adverse effect of adrenergic medications.
A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? Select all that apply. Platelets Vitamin K Prothrombin time (PT) International normalized ratio (INR) Activated partial thromboplastin time (aPTT)
Platelets Activated partial thromboplastin time (aPTT) To reduce the risk of heparin-induced thrombocytopenia, platelet counts should be monitored. Heparin therapy is monitored by measuring aPTT. Warfarin therapy is monitored by measuring PT and results are expressed as an INR. Vitamin K is not monitored for a heparin infusion.
Which statement indicates the nurse understands the action of calcium channel blockers? "These medications increase automaticity." "These medications increase repolarization." "These medications slow cardiac conduction." "These medications shorten the action potential."
"These medications slow cardiac conduction" The calcium channel blockers verapamil and diltiazem are used as antidysrhythmics to slow cardiac conduction. Calcium channel blockade has the same impact on cardiac action as does beta blockade. They reduce myocardial contractility, decrease automaticity in the sinoatrial node, and delay conduction through the atrioventricular node.
The nurse is caring for a patient prescribed digoxin for heart failure. Which finding would require immediate attention by the nurse? Vomiting and diarrhea Heart rate of 68 beats/min Digoxin level of 0.7 ng/mL Potassium level of 3.7 mEq/L
Vomiting and diarrhea Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. A heart rate of 68 beats/min, potassium level of 3.7 mEq/L, and digoxin level of 0.7 ng/mL (0.5-0.8 being the optimal range) are within the normal range.
A patient is being discharged from the hospital on warfarin for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply. Wear a medical alert bracelet. Check all urine and stools for discoloration. Do not start any new medication without first talking to the healthcare provider. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer.
Wear a medical alert bracelet. Check all urine and stools for discoloration. Do not start any new medication without first talking to the healthcare provider. Advise the patient to wear some form of identification (e.g., Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. Aspirin and aspirin products should be avoided because aspirin can increase the effects of warfarin to promote bleeding and can act on the gastrointestinal tract to cause ulcers, thereby initiating bleeding. The INR should be determined frequently: daily during the first 5 days, twice a week for the next 1 to 2 weeks, once a week for the next 1 to 2 months, and every 2 to 4 weeks thereafter for the duration of treatment.
After being taught about digoxin, which statement from the staff indicates more teaching is needed? "Digoxin has a positive inotropic effect." "Digoxin is a first-line drug for heart failure." "Digoxin when used by women may actually shorten life." "Digoxin can help with heart failure, but it does not prolong life."
"Digoxin is a first-line drug for heart failure." The statement that digoxin is a first-line drug for heart failure is incorrect and needs to be clarified. Used widely in the past, digoxin is considered a second-line agent today for heart failure. Digoxin does have a positive inotropic effect, it can shorten women's lives, and it can help with heart failure but does not prolong life.
A patient with deep vein thrombosis receiving an intravenous heparin infusion asks the nurse how this medication works. What is the nurse's best response? "Heparin converts plasminogen to plasmin, which in turn dissolves the clot matrix" "Heparin suppresses coagulation by helping antithrombin perform its natural functions." "Heparin prevents activation of vitamin K and thus blocks synthesis of some clotting factors." "Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels."
"Heparin suppresses coagulation by helping antithrombin perform its natural functions." Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots. Thrombolytics (e.g., alteplase) dissolve existing clots. Blocking vitamin k-dependent clotting factors occurs with warfarin, not heparin. Platelet aggregation is blocked with antiplatelets such as aspirin, not with anticoagulants such as heparin.
A patient is started on warfarin therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? "Your concern is valid. I will call the doctor to discontinue the heparin." "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications." "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." "Because of your valve replacement, it is especially important for you to be given anticoagulant therapy. The heparin and warfarin together are more effective than one alone."
"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until the anticoagulant effect is achieved. Walking decreases the risk of blood clots. Heparin and warfarin are both effective individually; the heparin will be discontinued once the warfarin is fully effective, as evidenced by prothrombin time and international normalized ratio levels within the therapeutic range.
The nurse is reviewing medication records of several different patients. Which patients should the nurse closely monitor for hyperkalemia? Select all that apply. A patient taking amiloride and furosemide A patient taking triamterene and a direct renin inhibitor A patient taking spironolactone and hydrochlorothiazide A patient taking spironolactone and angiotensin receptor blocker A patient taking amiloride and an angiotensin-converting enzyme (ACE) inhibitor
A patient taking triamterene and a direct renin inhibitor A patient taking spironolactone and angiotensin receptor blocker A patient taking amiloride and an angiotensin-converting enzyme (ACE) inhibitor Three groups of drugs—ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors—can elevate potassium levels and thus should be combined with spironolactone, amiloride, and triamterene only when clearly necessary. Although they can be employed alone as diuretics, spironolactone and amiloride are used primarily to counteract potassium loss caused by more powerful diuretics (thiazides, loop diuretics) and do not have to be monitored as closely.
The nurse is working with a student to care for a patient with heart failure who is experiencing an arrhythmia secondary to digoxin toxicity. Which action by the student does the nurse correct in the care of this patient? Holding digoxin Holding diuretics Administering quinidine Administering fab fragments
Administering quinidine The patient with digoxin toxicity should not be administered quinidine because this can increase serum levels of digoxin. Digoxin would be held for toxicity, and diuretics would be held to correct potassium levels. Fab fragment administration is the immunoglobulin antidote for digoxin toxicity.
Which patient assessment would assist the nurse in evaluating the therapeutic effects of a calcium channel blocker? Absence of chest pain Patient denies dizziness Patient states that she feels stronger Decreased swelling in the ankles and feet
Absence of chest pain The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased. Diuretics are used to decrease edema in the ankles and feet. Dizziness may be a side effect of the medication. Calcium channel blockers may cause fatigue.
A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? Platelet count of 150,000 mm 3 International normalized ratio (INR) of 1.0 Blood urea nitrogen (BUN) level of 12 mg/dL Activated partial thromboplastin time (aPTT) of 120 seconds
Activated partial thromboplastin time (aPTT) of 120 seconds The aPTT value of 120 seconds is too prolonged. The heparin drip should be stopped per the provider order. The typical aPTT normal values for a patient on anticoagulant therapy are between 1.5 and 2.5 times the control value, with normal control values being between 25 and 35 seconds. The normal range for BUN is 7 to 20 mg/dL, and the normal platelet range is 150,000 to 400,000. Normal range for INR is 0.8 to 1.1. Note that heparin does not affect the INR or the BUN level.
A patient has reduced cardiac output. Which compensatory response would the nurse expect to occur in this patient? Shrinkage of cardiac muscle Excretion of water and blood volume Suppression of the sympathetic nervous system (SNS) Activation of the renin-angiotensin-aldosterone system (RAAS)
Activation of the renin-angiotensin-aldosterone system (RAAS) Reduced cardiac output leads to the following compensatory responses: activation of the RAAS, activation of the SNS, retention of water and expansion of blood volume, and cardiac dilation. Although these responses represent the body's attempt to compensate for reduced cardiac output, they can actually make matters worse.
A bleeding patient receiving warfarin has an international normalized ratio (INR) of 6. What is the nurse's best course of action? Administer phytonadione. Stop the intravenous drip. Wait for the INR to decrease. Administer protamine sulfate.
Administer phytonadione The nurse should administer phytonadione to the bleeding patient who is on warfarin and has an extremely elevated INR. This medication will block the vitamin K-dependent clotting factors. Increasing vitamin K can hasten the return to normal coagulation. Warfarin is given orally, not intravenously. Protamine sulfate is an antidote to heparin therapy, not warfarin.
A nurse is preparing to administer enoxaparin sodium to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? Rub the administration site after injecting. Use the Z-track method to inject the medication. Administer the medication into subcutaneous tissue of the abdomen. Draw up the medication in a syringe with a 22-gauge, 1½-inch needle.
Administer the medication into subcutaneous tissue of the abdomen. Enoxaparin is a low-molecular-weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method should never be used to administer enoxaparin sodium. The use of a 22-gauge, 1½-inch needle is more appropriate for administration of an intramuscular injection.
When observing a new staff nurse preparing to administer diltiazem, the charge nurse should approve which action? Administering the drug via an infusion pump. Drawing up the medication in a heparin flush. Pushing the medication intravenously over 30 seconds. Hanging the medication secondary to a free-hanging dextrose solution.
Administering the drug via an infusion pump. It is recommended that an infusion pump be used for intravenous (IV) dosing of any of the classes of antidysrhythmics, with proper solution and dilution. A diltiazem drip should be hung as a primary IV drip. IV incompatibilities should be checked before administration. Dextrose is incompatible with many medications. Diltiazem should not be injected quickly; it should be pushed over at least one minute.
The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising blood pressure? Renin Angiotensin I Angiotensin II Angiotensin III
Angiotensin II Angiotensin II is a potent vasoconstrictor. It participates in all the pathways regulated by the renin-angiotensin-aldosterone system. Angiotensin I is a precursor to angiotensin II; angiotensin III is formed by degradation of angiotensin II and is less potent. Renin catalyzes the conversion of angiotensinogen to angiotensin I.
A patient is taking hydrochlorothiazide. On assessment, the nurse notes that the patient has muscle weakness, cramping, and leg discomfort. What should be the nurse's first intervention? Reduce salt in the patient's diet Administer calcium supplements Assess the serum potassium level Give a lower dose of the medication
Assess the serum potassium level Hydrochlorothiazide can cause hypokalemia, characterized by muscle weakness, cramping, and leg discomfort. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements does not reduce the symptoms caused by potassium deficiency. The patient is experiencing hypokalemia, not hypernatremia; reducing salt is for hypernatremia. Reducing the dose of the medication will not help restore the electrolyte balance.
The nurse is administering captopril to a patient with heart failure. Which best describes the effects of this drug? Constricts arterioles and veins Increases release of aldosterone Blocks production of angiotensin II Increases production of angiotensin II
Blocks production of angiotensin II Captopril, an angiotensin-converting enzyme (ACE) inhibitor, blocks production of angiotensin II, decreases release of aldosterone, and suppresses degradation of kinins. By suppressing production of angiotensin II, ACE inhibitors cause dilation of arterioles and veins.
The nurse administers candesartan to a patient. Which assessment finding should the nurse use as a clinical indicator of the therapeutic effectiveness of the medication? Blood pressure reduction Serum potassium retention Peripheral perfusion reduction Pulmonary congestion retention
Blood pressure reduction All angiotensin receptor blockers (ARBs), such as candesartan, are approved for hypertension. Reduction in blood pressure equals those seen with angiotensin-converting enzyme (ACE) inhibitors. ARBs will decrease pulmonary congestion. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink from increased perfusion. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia.
A patient is prescribed digoxin for heart failure. The nurse instructs the patient to avoid consuming bran. What is the reason behind this instruction? Bran decreases digoxin absorption. Bran and digoxin cause constipation. Bran and digoxin cause urinary retention. Bran increases the digoxin concentration in body.
Bran decreases digoxin absorption. Meals high in bran can decrease absorption significantly. Bran is a high-fiber food, and fiber treats constipation. Bran does not produce an additive effect and thus does not increase the digoxin concentration in the body. Bran and digoxin do not affect urinary tract function and therefore do not cause urinary retention.
Which medication works by preventing angiotensin II from binding with its receptor sites? Quinapril Aliskiren Eplerenone Candesartan
Candesartan Candesartan is an angiotensin II receptor blocker and thus prevents the binding of angiotensin II at its receptor sites. Quinapril is an angiotensin-converting enzyme inhibitor, aliskiren is a direct renin inhibitor, and eplerenone is a selective aldosterone receptor blocker.
When a patient's renin-angiotensin-aldosterone system is activated, which responses would the nurse expect? Select all that apply. Dilation of veins Diuresis by the kidneys Constriction of arterioles Retention of water by the kidneys Constriction of renal blood vessels
Constriction of arterioles Retention of water by the kidneys Constriction of renal blood vessels The renin-angiotensin-aldosterone system supports arterial pressure by causing constriction of arterioles and veins, and retention of water by the kidneys. Angiotensin II, a hormone, causes constriction of renal blood vessels. Dilation and diuresis do not occur.
A patient is prescribed lisinopril 40 mg by mouth once a day for hypertension. For which therapeutic effect should the nurse monitor? Slowing of the heart rate Decrease in blood pressure Symptoms such as dizziness and fainting Pulse oximetry oxygen saturation of 100%
Decrease in blood pressure The therapeutic effect of angiotensin-converting enzyme (ACE) inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.
The nurse should plan to monitor closely for which clinical manifestation after administering furosemide? Decreased pulse Decreased temperature Decreased blood pressure Decreased respiratory rate
Decreased blood pressure High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Furosemide should not affect temperature or respirations. The nurse also should closely monitor the patient's potassium level.
The nurse reviews a patient's laboratory values and observes a digoxin level of 2.5 ng/mL and a potassium level of 5.9 mEq/L. Upon physical assessment, the patient begins to experience changes in heart rate and rhythm (dysrhythmias). Which drug should the nurse be prepared to administer? Digoxin Quinidine Potassium supplements Digoxin immune Fab antibody fragments
Digoxin immune Fab antibody fragments When digoxin overdose is especially severe (normal range is 0.5-0.8 ng/mL), digoxin levels can be lowered using digoxin immune Fab antibody fragments. Potassium supplements are helpful when hypokalemia is present, not hyperkalemia. Giving digoxin would make the situation worse. Although the patient has dysrhythmias, quinidine should not be used because it causes plasma levels of digoxin to rise. Rather, phenytoin and lidocaine are most effective.
The nurse should monitor for which adverse effect after administering hydrochlorothiazide and digoxin to a patient? Dehydration Heart failure Digoxin toxicity Decreased diuretic effect
Digoxin toxicity Digoxin levels have an inverse relationship with potassium levels. Because hydrochlorothiazide can lower potassium levels, combined use of hydrochlorothiazide and digoxin poses a risk for elevated digoxin levels and ensuing digoxin toxicity.
Verapamil has been administered to a patient. The nurse should closely monitor for which adverse effects of this drug? Select all that apply. Dizziness Headache Ankle edema Reflex tachycardia Heart block evidence on cardiac monitor
Dizziness Headache Ankle edema Heart block evidence on cardiac monitor Verapamil is a calcium channel blocker (CCB). It is associated with dizziness, headache, ankle edema, and heart block. Verapamil does not cause reflex tachycardia; reflex tachycardia occurs with the dihydropyridine family of CCBs.
The nurse is administering several different diuretics. Which drug will produce the most diuresis in a patient? Furosemide Triamterene Spironolactone Hydrochlorothiazide
Furosemide Furosemide is the most potent diuretic. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. Furosemide works at the loop of Henle; as a result, furosemide produces the greatest diuresis. Hydrochlorothiazide works on the early distal convoluted tubule so does not have the capacity to excrete as much sodium and water as a loop diuretic and is less effective. Triamterene and spironolactone work at the distal nephron so do not have the ability to excrete as much sodium and water as loop diuretics.
The nurse is caring for a pregnant patient with a history of thrombosis. Which prophylactic treatment does the nurse anticipate the health care provider will prescribe for this patient? Warfarin Alteplase Enoxaparin Clopidogrel
Enoxaparin Enoxaparin is a low molecular weight heparin that can be used in pregnancy to prevent thrombosis. Warfarin can prevent thrombosis, but in pregnant women, it can cross the placenta and affect the developing fetus, causing fetal hemorrhage and death. Additionally, it can cause gross malformations, central nervous system defects, and optic atrophy, so warfarin will not be prescribed to this patient. Alteplase is a fibrinolytic drug that digests the fibrin meshwork of clots and degrades fibrinogen as well as other clotting factors, so it would not be used prophylactically. Clopidogrel is used to prevent stenosis of coronary stents, and for secondary prevention of myocardial infarction, ischemic stroke, and other vascular events.
The nurse is administering 8:00 a.m. medications for hypertension. Which drugs should the nurse identify as aldosterone antagonists? Select all that apply. Losartan Aliskiren Benazepril Eplerenone Spironolactone
Eplerenone Spironolactone Eplerenone and spironolactone are both aldosterone antagonists. Aliskiren is a direct renin inhibitor. Losartan is an angiotensin II receptor blocker (ARB), and benazepril is an angiotensin-converting enzyme (ACE) inhibitor.
The nurse is teaching a patient prescribed captopril for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. Expect a persistent dry cough. Take the medication with food. Expect a sore throat and fever. Avoid potassium salt substitutes. Report difficulty in breathing immediately.
Expect a persistent dry cough. Avoid potassium salt substitutes. Report difficulty in breathing immediately. Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril must be taken at least 1 hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.
Which patient symptoms should alert the nurse to be concerned about digoxin toxicity? Select all that apply. Fatigue Vomiting Constipation Blurred vision Muscle weakness
Fatigue Vomiting Blurred Vision Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Constipation is not a symptom of digoxin toxicity.
The nurse is caring for a patient who has congestive heart failure. The patient's medical history indicates that the patient has a history of chronic kidney disease with a low glomerular filtration rate (GFR). Which drug would the nurse anticipate being prescribed for the patient? Furosemide Metolazone Methyclothiazide Hydrochlorothiazide
Furosemide Furosemide is especially useful in patients with severe renal impairment, because, unlike the thiazides, the drug can promote diuresis even when renal blood flow and GFR are low. The use of thiazides (metolazone, hydrochlorothiazide, or methyclothiazide) is not effective with a low GFR.
A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply. Heart failure Hypertension Angina pectoris Sinus bradycardia Cardiogenic shock Chronic obstructive pulmonary disease
Heart failure Hypertension Angina pectoris Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade also has been shown to reduce mortality in patients with heart failure.
A nurse discovers that a patient has a cardiac output of 5 L/min. What else should the nurse assess to determine cardiac output besides stroke volume? Heart rate Blood pressure Cardiac preload Cardiac afterload
Heart rate The basic equation for cardiac output is CO = HR × SV, where CO is cardiac output, HR is heart rate, and SV is stroke volume. Cardiac preload and after load help determine stroke volume. Blood pressure is affected by cardiac output.
Which assessment finding in a patient with cardiac risk factors should be reported immediately if the patient is taking a nonselective beta blocker? Chest pain Weight loss History of asthma History of alcohol abuse
History of asthma Beta blockers must be used cautiously in patients with a history of asthma because the drugs induce bronchoconstriction and increased airway resistance, which may further cause dyspnea and wheezing. Weight loss is not a concern for patients with cardiac risk factors who are taking nonselective beta blockers; however, weight gain may indicate edema. Beta blockers are effective in the treatment of angina or chest pain. Although beta blockers can interact with alcohol and cause adverse effects, such as hypotension, a history of alcohol abuse is not a concern if the patient no longer engages in such behavior.
The nurse caring for a patient taking furosemide is reviewing the patient's most recent laboratory results, which are sodium, 136 mEq/L; potassium, 3.2 mEq/L; chloride, 100 mEq/L; and blood urea nitrogen, 15 mg/dL. What would be the nurse's best action? Begin a 24-hour urine collection. Administer furosemide as ordered. Place the patient on a cardiac monitor. Hold the furosemide and notify the physician.
Hold the furosemide and notify the physician. The nurse's best action is to hold the furosemide and notify the physician. Loop diuretics, such as furosemide, can cause significant potassium loss. Normal potassium level is 3.5 to 5 mEq/L. The other listed electrolyte levels are normal. Administering the furosemide could result in a critically low potassium level. Effects of low potassium include cardiac dysrhythmias. Placing a patient on a cardiac monitor requires a physician's order and would warrant further assessment first, such as taking vital signs and asking the patient whether he or she is having any cardiac-related symptoms. Collecting a 24-hour urine specimen is not appropriate in this case.
When monitoring patients receiving antihypertensive agents, the nurse realizes which medication could have a side effect similar to those of systemic lupus erythematosus? Lisinopril Valsartan Aliskiren Hydralazine
Hydralazine Hydralazine can cause a syndrome resembling systemic lupus erythematosus. This reaction is rare. If the reaction occurs, the medication must be withdrawn. This medication is a third-line drug for therapy.
Which side effects should the nurse monitor for in a patient who takes enalapril? Select all that apply. Bradycardia Hyperkalemia Intractable cough Visual disturbances Systemic lupus erythematosus-like syndrome
Hyperkalemia Intractable cough Enalapril is an angiotensin-converting enzyme (ACE) inhibitor. Intractable cough and hyperkalemia are side effects of ACE inhibitors. The drug does not cause bradycardia, visual disturbances, or systemic lupus erythematosus-like syndrome.
The nurse is caring for a patient who takes warfarin for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. How should the nurse interpret this finding? INR is too high; vitamin K may be needed. INR is within normal limits; no action is indicated. INR is too low; the dose may need to be increased. INR is too high; intravenous protamine may be needed.
INR is too low; the dose may need to be increased. An INR in the range of 2 to 3 is considered the therapeutic level for warfarin therapy; however, it may take several days to obtain peak effects. For a level of 1.2, the nurse should contact the healthcare provider, who will determine whether a dose adjustment is needed. Reversal with vitamin K would occur if the INR is greater than 8 or the patient is actively bleeding. Protamine sulfate reverses heparin, not warfarin.
A patient with hypertension has been prescribed furosemide. On reviewing the patient's medical history, the nurse learns that the patient is also taking a nonsteroidal anti-inflammatory drug (NSAID) for rheumatoid arthritis. What would the nurse anticipate the healthcare provider would prescribe? Serum blood level for pH Serum blood level of calcium Decreased dose of the NSAID Increased dose of furosemide
Increased dose of furosemide When furosemide is used with NSAIDs, the diuretic activity of the drug is decreased due to the inhibition of prostaglandin synthesis. The nurse should expect the provider to increase the dose of furosemide to produce effective diuresis. When furosemide is given with an NSAID, there is no impact on the serum calcium level or pH. Decreasing the dose of the NSAID may not be effective in relieving the patient's pain.
The patient with diabetes is diagnosed with hypertension. The nurse would instruct the patient to increase frequency of blood glucose monitoring if which medication(s) are prescribed for the patient? Select all that apply. Enalapril Diltiazem Metoprolol Furosemide Hydrochlorothiazide
Metoprolol Furosemide Hydrochlorothiazide Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. Diltiazem and enalapril do not cause either of these effects.
The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe? Deep vein thrombosis Reduced risk of bruising Increased platelet aggregation Increased prothrombin time/international normalized ratio (PT/INR) levels
Increased prothrombin time/international normalized ratio (PT/INR) levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased PT/INR. Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet medication.
A patient of African American heritage with heart failure is unable to tolerate angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Which medication is an appropriate alternative for this patient? Eplerenone Triamterene Hydrochlorothiazide Isosorbide dinitrate and hydralazine
Isosorbide dinitrate and hydralazine BiDil is a fixed-dose combination of isosorbide dinitrate plus hydralazine that is approved specifically for African American patients with heart failure. Triamterene and hydrochlorothiazide are diuretics. Eplerenone is an aldosterone antagonist and is not recommended in this situation.
The nurse who administers spironolactone to a patient with heart failure should recognize that it promotes improvement by what mechanism? It is a strong diuretic. It promotes fluid retention. It blocks the action of aldosterone. It promotes elimination of excess potassium.
It blocks the action of aldosterone. One potassium-sparing diuretic—spironolactone—prolongs survival in patients with heart failure primarily by blocking receptors for aldosterone, not by causing diuresis. Spironolactone spares potassium; in fact, its side effect is hyperkalemia. Furosemide is a strong water/diuretic pill.
The nurse is caring for a patient with bipolar disorder treated with lithium. The patient has a new prescription for captopril for hypertension. The combination of these two drugs makes which assessment particularly important? Lithium level Blood pressure Potassium level Creatinine level
Lithium level Lithium levels should be monitored on a regular basis. Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, can cause lithium accumulation. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects.
The patient who takes insulin has just been prescribed a beta blocker drug. The nurse recognizes that the interaction of the beta blocker and the insulin may have which result? Masked signs of hypoglycemia Masked signs of hyperglycemia Enhanced activity of the beta blocker drug Decreased activity of the beta blocker drug
Masked signs of hypoglycemia The interaction of insulin and a beta blocker drug is known to result in masking of the signs of hypoglycemia. Insulin neither enhances nor decreases the activity of beta blockers.
A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. The nurse will immediately notify the healthcare provider of which findings? Select all that apply. Nosebleeds aPTT of 40 seconds aPTT of 100 seconds Platelet count of 300,000/µL Activated partial thromboplastin time (aPTT) of 65 seconds
Nosebleeds aPTT of 40 seconds aPTT of 100 seconds Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/µL is within normal limits, indicating no evidence of thrombocytopenia.
What is the most appropriate nursing consideration for a patient who is prescribed verapamil and digoxin? Restrict intake of oral fluids and high-fiber food. Take an apical pulse for 30 seconds before administration. Hold the medications if the heart rate is greater than 110 beats/min. Notify the healthcare provider of nausea, vomiting, and visual changes.
Notify the healthcare provider of nausea, vomiting, and visual changes. Verapamil can raise digoxin blood serum levels, increasing the risk of digoxin toxicity. Symptoms of digoxin toxicity may include nausea, vomiting, and visual changes. Increase intake of oral fluids and high-fiber food to decrease the adverse effect of constipation. An apical pulse should be taken for a full minute before administering digoxin. Verapamil and digoxin can cause bradycardia, not tachycardia.
The laboratory calls to report a drop in the platelet count to 90,000/mm 3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? Obtain vitamin K and prepare to administer it by intramuscular injection. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level.
Notify the healthcare provider to discuss the reduction or withdrawal of heparin. The nurse should notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm 3 would warrant discontinuation of the heparin. Vitamin k is used for reversal of warfarin, not heparin. Increasing the dose would worsen the platelet count. Monitoring the aPTT will not decrease the risks associated with thrombocytopenia.
The nurse is caring for a patient who takes an angiotensin-converting enzyme (ACE) inhibitor. If the patient develops a persistent nonproductive cough, what should the nurse do? Notify the provider of the new development. Tell the patient that the cough will subside in a few days. Assess the patient for other symptoms of upper respiratory tract infection. Instruct the patient to take antitussive medication until the symptoms subside.
Notify the provider of the new development. ACE inhibitors prevent the breakdown of bradykinins, frequently causing a nonproductive cough. The patient should be switched to a different medication if the side effect cannot be tolerated. The cough will not subside in a few days. This is not a sign of infection but is a known side effect of ACE inhibitors. Medications will not make the cough subside.
A patient is ordered furosemide to be given via intravenous push. Which interventions should the nurse perform? Select all that apply. Obtain weight Assess lung sounds Administer slowly over 1 to 2 minutes Monitor electrocardiogram continuously Maintain accurate intake and output record Insert an arterial line for continuous blood pressure monitoring
Obtain weight Assess lung sounds Administer slowly over 1 to 2 minutes Maintain accurate intake and output record Furosemide can be infused via intravenous push slowly over 1 to 2 minutes. For all patients, obtain baseline values for weight, blood pressure (sitting and supine), pulse, respirations, and electrolytes (sodium, potassium, chloride). It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure. Also, there is no need to continuously monitor an electrocardiogram.
Which assessment findings indicate the patient is experiencing adverse effects from furosemide? Select all that apply. Oliguria Dry mouth Clear lungs Unusual thirst Clear yellow urine
Oliguria Dry mouth Unusual thirst Furosemide can produce dehydration. Signs of evolving dehydration include dry mouth, unusual thirst, and oliguria (urine output less than 25 mL/hr). Therapeutic effects of furosemide include clear lungs and an increased amount of clear yellow urine.
Which assessment is most important for the nurse to obtain before administering digoxin to a patient with heart failure? Pulse Blood pressure Respiratory rate Weight in kilograms
Pulse It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.
The nurse is educating a patient who will begin taking a new calcium channel blocker. Which instruction provided by the nurse is most appropriate? Consume a low-calorie diet. Restrict the intake of grapefruit. It is safe to use herbal medications. Start with a low dose of the prescribed medicine.
Restrict the intake of grapefruit. Grapefruit can cause food-drug interactions and decrease the metabolism of some drugs, including calcium channel blockers. The decreased metabolism of drugs causes an accumulation of the drug in the body and leads to toxic effects. So, consumption of grapefruit should be avoided. Herbal medications also have some side effects, so consumption of herbal medications should be avoided. The metabolism of drugs is not affected by high- or low-calorie foods. The prescribed medicine should be taken in the appropriate quantity because low doses do not give the desired therapeutic effect.
A patient has been prescribed furosemide for pulmonary edema secondary to congestive heart failure. Which instructions will the nurse include in the patient teaching? Select all that apply. Weigh yourself weekly. Take the medication before bed. Rise slowly from sitting or reclining positions. Monitor your blood glucose diligently for hypoglycemia. Report any irregular heartbeat, muscle weakness, or cramping. Report any tenderness or swelling of the joints to your health care provider.
Rise slowly from sitting or reclining positions. Report any irregular heartbeat, muscle weakness, or cramping. Report any tenderness or swelling of the joints to your health care provider. Furosemide, a loop diuretic, can cause dehydration, so the nurse should teach the patient to monitor him or herself for any side effects. The nurse should tell the patient to rise slowly from sitting or reclining positions in order to minimize the risk of falls secondary to orthostatic hypotension that can occur as a side effect of the furosemide. The nurse should teach the patient to report any irregular heartbeat, muscle weakness, or cramping, since these can be signs of hypokalemia caused by the potassium-wasting properties of furosemide. The patient should also report any tenderness or swelling of the joints, because this can indicate gout caused by hyperuricemia that can occur as a side effect of furosemide. The nurse should teach the patient to weigh him or herself daily in order to monitor the therapeutic effects of the drug. The nurse should tell the patient to avoid taking furosemide later in the day, since it increases urine volume and may make the patient have to urinate frequently at night, disrupting sleep and therefore potentially compromising adherence. The patient should be taught to monitor his or her blood glucose regularly, but this is done for signs of hyperglycemia, not hypoglycemia.
The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril. Which laboratory result indicates an adverse effect of this drug? Uric acid level of 10 mg/dL Potassium level of 3.2 mEq/L Blood glucose level of 180 mg/dL Serum creatinine level of 2.3 mg/dL
Serum creatinine level of 2.3 mg/dL Patients with bilateral renal artery stenosis are at increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia, hyperglycemia, or hyperuricemia.
The nurse is caring for a patient receiving hydralazine. The health care provider prescribes propranolol. A drug such as propranolol is often combined with hydralazine for which purpose? To prevent heart failure To reduce the risk of headache To improve hypotensive effects To protect against reflex tachycardia
To protect against reflex tachycardia Hydralazine is a vasodilator that lowers blood pressure, but it can also trigger reflex tachycardia. Beta blockers, such as propranolol, are often added to the regimen to normalize the heart rate.
Which hemodynamic system serves as a reservoir for circulating blood? Heart Veins Lungs Arteries
Veins Most of the circulating blood is in the veins, venules, and venous sinuses. The venous system serves as a reservoir for circulating blood. The heart pumps the blood. The lungs partake in gas exchange. The arteries carry the oxygenated blood to the body.
A patient who has been taking warfarin is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? Vitamin E Vitamin K Protamine sulfate Calcium gluconate
Vitamin K Vitamin K is the antagonist for warfarin. If a heparin overdose occurs, the antidote is protamine sulfate. Vitamin E and calcium gluconate are not used to counteract the effects of warfarin.