pharm final

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? Continue as planned, because the level is within normal limits. Tell the patient to hold today's dose and return to the clinic. Consult the prescriber to recommend an increased dose. Have the patient call 911 and meet him/her in the emergency department.

The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

You're teaching a patient about how angiotensin II receptor blockers (ARBs) work. Which statement below BEST describes how these medications work on the body?* A. "They prevent Angiotensin II Type I Receptors from binding with Angiotensin II." B. "These medications prevent the activation of Angiotensin II Type II Receptors from binding with Angiotensin II." C. "They inhibit angiotensin-converting-enzyme (ACE) from converting an Angiotensin I to Angiotensin II." D. "These medications prevent Angiotensin II Type I Receptors from binding with angiotensin-converting-enzyme (ACE)."

A ARBs prevent Angiotensin II Type I Receptors from binding with Angiotensin II. Remember ACE Inhibitors inhibit angiotensin-converting-enzyme (ACE) from converting Angiotensin I to Angiotensin II.

Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply:* A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II. C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I. D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart.

A and B. ACE inhibitors inhibits the renin-angiotensin-aldosterone system (RAAS), which will prevent the conversion of Angiotensin I to Angiotensin II.

Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply:* A. Inactivates bradykinin by breaking it down B. Dilates vessels C. Causes the kidneys to keep sodium and water D. Converts Angiotensin I to Angiotensin II

A and D. ACE inactivates bradykinin by breaking it down and converts Angiotensin I to Angiotensin II. Option C describes the role of aldosterone, which is influenced by Angiotensin II, and option D describes how ACE Inhibitors work....remember they block the actions of ACE.

A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply:* A. The patient reports seeing yellow-greenish halos and is vomiting. B. The patient reports flushing and has enlargement of the gums. C. The patient's heart rate is regular and 80 beats per minute. D. The patient's Digoxin level is 3 ng/mL.

A and D. Calcium channel blockers can increase Digoxin level. Therefore, the patient's Digoxin levels should be monitored closely. A normal Digoxin level is 0.5-2 ng/mL. Signs and symptoms of Digoxin Toxicity is nausea, vomiting, vision changes (seeing yellowish/green halos, blurred vision etc. Option B is an expected side effect from calcium channel blockers and option C is normal.

A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply:* A. Decreases SVR (systemic vascular resistance) and blood pressure B. Constriction of the vessels C. Kidneys will excrete water and sodium D. Kidneys will retain potassium. E. Increases SVR (systemic vascular resistance) and blood pressure

A, C, and D. ACE inhibitors will cause the opposite effects of Angiotensin II, which is a major vasoconstrictor and triggers the release of aldosterone (remember this substance will cause the kidneys to keep sodium and water and excrete potassium). However, ACE Inhibitors will perform the opposite effects by decreasing the blood pressure via vasodilation of vessels (which decreases SVR) and causes the kidneys to excrete water and sodium and retain potassium (hence the nurse must monitor for hyperkalemia).

A patient is prescribed Verapamil for treatment of a supraventricular arrhythmia. As the nurse you know that this calcium channel blocker will help control the heart rate and rhythm by causing which of the following changes in the heart? Select all that apply:* A. Negative inotropic effect B. Positive inotropic effect C. Negative chronotropic effect D. Positive chronotropic effect E. Negative dromotropic effect F. Positive dromotropic effect

A, C, and E. Verapamil is a calcium channel blocker that is a non-dihydropyridine (phenylalkylamine). It decreases the contractility of the heart muscle cells, which decreases the strength of heart contractions, and this causes a NEGATIVE inotropic effect. In addition, Verapamil decreases the contraction of nodal tissue cells, specifically the SA and AV nodal tissue. Therefore, by decreasing the SA node (pacemaker of the heart), the heart rate will decrease, and this causes a NEGATIVE chronotropic effect. And by decreasing the AV node (gatekeeper), the speed of conduction will decrease, which will cause a NEGATIVE dromotropic effect.

What conditions are Angiotensin II Receptor Blockers (ARBs) used to treat? Select all that apply:* A. Hypertension B. Renal stenosis C. Diabetic nephropathy in type 2 diabetics D. Atrial flutter E. Heart failure

A, C, and E. ARBs can treat hypertension, diabetic nephropathy in type 2 diabetics (which is kidney disease in type 2 diabetics), and heart failure.

Select all the pharmacodynamic effects of angiotensin II receptor blockers (ARBs):* A. Vasodilation B. Vasoconstriction C. Sodium conservation D. Sodium excretion E. Water conservation F. Water excretion

A, D, and F. ARBs prevent Angiotensin II Type I Receptors from binding with Angiotension II. This leads to vasodilation of vessels and decreases the release of aldosterone, which leads to sodium and water excretion (potassium is conserved...so watch out for hyperkalemia).

Which patient below would MOST benefit from an ACE Inhibitor? A. A 50-year-old female with systolic dysfunction heart failure. B. A 48-year-old male with severe renal failure. C. A 35-year-old female with chronic hepatitis. D. A 54-year-old male with hypovolemic shock.

A. ACE Inhibitors are used to treat patient with hypertension, systolic dysfunction heart failure (the left ventricle is too weak to pump blood forward out of the heart...ACE inhibitors will decrease afterload which will make it easier for the heart to pump blood), and after a myocardial infarction. Patients with renal failure or liver disease are not candidates for ACE inhibitors because of the effects of the drug on the kidneys and how it is cleared in the liver. In option D, the patient will be hypotensive and need fluids or vasopressors....NOT a medication that will lower the blood pressure.

A patient is taking Digoxin. What medication on the patient's medication list increases the patient's risk of experiencing Digoxin toxicity?* A. Furosemide B. Metformin C. Nitroglycerin D. Coumadin

A. Furosemide is a loop-diuretic and this medication wastes potassium. Remember hypokalemia (low potassium level) increases the risk of a patient developing Digoxin toxicity. Hypercalcemia and hypomagnesemia also increases Digoxin toxicity.

A patient is admitted with a dysrhythmia. The physician prescribes Propranolol. Which statement by the patient requires the nurse to hold the ordered dose and notify the physician for further orders?* A. "I use an inhaler at home for asthma." B. "My heart feels like it is racing, and I feel very weak." C. "I had caffeine this morning with breakfast." D. "I smoke 2 packs of cigarettes per day."

A. Propranolol is a nonselective beta blocker. Therefore, it affects beta 1 and beta 2 receptors. Beta 2 receptors are found in the lungs (specifically the bronchioles). This medication could cause bronchoconstriction in patients with asthma or COPD and should be avoided. Selective beta blockers (Atenolol, Esmolol, Metorprolol) block only beta 1 (which are found in the heart and kidneys). Therefore, they are less likely to cause bronchoconstriction.

A patient is prescribed Metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly?* A. "After I stop taking this medication I will let my physician know." B. "I take this medication with my breakfast every morning." C. "I will change positions slowly while I'm taking this medication." D. "While I'm taking this medication I will monitor my heart rate."

A. The patient should NOT just stop taking the medication. It must be tapered off over a period of time (usually about 2 weeks). This will prevent the development of rebound hypertension, myocardial ischemia, and angina.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? Tonic-clonic Absence Simple partial Complex partial

Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) Swollen, tender gums Measles-like rash Productive cough Unusual hair growth Nausea and vomiting

Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

Administration of dantrolene [Dantrium] for the treatment of muscle spasticity is contraindicated in which patient? A patient with a C6 spinal cord injury A patient with cerebral palsy A patient with multiple sclerosis and underlying cirrhosis A patient experiencing malignant hyperthermia

Although dantrolene is effective for treating spasticity in multiple sclerosis, it is contraindicated in this patient because of the underlying liver disease. Dantrolene is useful for relieving muscle spasticity associated with cerebral palsy and spinal cord injury and, in intravenous form, for managing life-threatening malignant hyperthermia.

A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient's scheduled medication list is an ARB?* A. Metoprolol B. Losartan C. Lisinopril D. Nicardipine

B

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? Take the medication on a full stomach. Change positions slowly. The drug may cause the urine to be very dilute. Carbidopa has many adverse effects.

B Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? "With proper treatment, we can completely eliminate your seizures." "Our goal is to reduce your seizures to an extent that helps you live a normal life." "Seizure medication does not reduce seizures in most patients." "These drugs will help control your seizures until you have surgery."

B Seizure disorders are often treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? Diarrhea Dyskinesia Wheezing Headache

B When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A patient is prescribed Diltiazem for the treatment of a cardiac disorder. Which findings below would require the nurse to hold the ordered dose of Diltiazem and notify the physician for further orders? Select all that apply:* A. Blood pressure 198/102 B. EKG shows 3rd Degree Atrioventricular Block C. EKG shows Atrial Fibrillation with Rapid Ventricular Response D. Heart Rate 46 beats per minute

B and D. Diltiazem is a calcium channel blocker that helps treat arrhythmias (supraventricular tachycardia and atrial fibrillation), hypertension, and angina. It is contraindicated if bradycardia or 2nd/3rd AV blocks occur. This is because this medication decreases the function of the SA and AV nodes (which is advantageous if a-fib with rapid ventricular response is occurring). However, if a 2nd degree AV block is presenting or bradycardia, the SA and AV nodes are not working properly and this medication could further impede their function.

You're providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply:* A. "If I feel unwell, it is okay that I miss a dose." B. "I will avoid using salt substitutes that contain potassium." C. "I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication". D. "I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor."

B and D. It is very important a patient does not miss a dose of this medication (even if they are unwell) because this medication can cause rebound hypertension. Also, the patient should avoid salt substitutes with potassium and AVOID consuming foods high in potassium (like the foods in option C) because this medication causes the kidneys to retain potassium. The patient should monitor their blood pressure and pulse rate regularly and report any significant changes to their doctor.

Which type of calcium channel blockers below are considered non-dihydropyridines and can provide anti-arrhythmic effects? Select all that apply:* A. Nifedipine B. Diltiazem C. Amlodipine D. Verapamil

B and D. Verapamil and Diltiazem are calcium channel blockers that are non-dihydropyridine. They are more selective to the myocardium when compared to dihydropyridine (Nifedipine and Amlodipine), which are more selective to the vascular system. Therefore, non-dihydropyridines can provide anti-arrhythmic effects.

Select all the beta blocker medications listed below that affect ONLY beta 1 receptors:* A. Timolol B. Atenolol C. Metoprolol D. Esmolol

B, C, D. Atenolol, Metoprolol, and Esmolol are selective and affect ONLY beta 1 receptors, which are found in the heart and kidneys. Timolol is a nonselective beta blocker and affects both beta 1 and beta 2 receptors.

Beta 2 receptors can be found in the? Select all that apply:* A. Heart B. Lungs C. GI system D. Kidneys E. Vascular smooth muscle F. Skeletal muscle

B, C, E, and F. Beta 2 receptors can be found in the lungs (bronchioles), GI system, vascular smooth muscle, skeletal muscle and even the ciliary body of the eye (not listed).

Your patient is prescribed a calcium channel blocker. As the nurse you know that these medication works to block calcium channels in what areas of the body? Select all that apply:* A. Vagal nerve cells B. Vascular smooth muscle C. Cardiac nodal tissue D. Peripheral nervous cells E. Cardiac myocytes

B, C, and E. Calcium channel blockers work to block the L-type calcium channels in the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue. When the calcium channels of these areas are blocked they will decrease contraction of these cells, which will provide vasodilation, decrease in heart rate, and decrease in strength of heart contractions. Remember there are different types of calcium channel blockers, and some are more selective to the vascular smooth muscle, while some are more selective to the myocardium.

Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply:* A. Verapamil B. Felodipine C. Nifedipine D. Diltiazem E. Amlodipine

B, C, and E. Remember the "dipine" medications are known as the dihydropyridines, and they are more vascular selective. This is why they are great at treating hypertension because they cause vasodilation due to inhibiting the calcium channels in the vascular smooth muscle. This leads to the relaxation of these vessels and in turn decreases arterial blood pressure.

What EARLY signs and symptoms should the nurse assess for in a patient taking Digoxin that could indicate toxicity of this drug? Select all that apply:* A. Dysrhythmias B. Anorexia C. Drowsiness D. Nausea E. Vomiting

B, D, and E. GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.

Digoxin helps the heart pump more efficiently by altering the inotropic, chronotropic, and dromotropic actions of the heart. Select all the options below that accurately describe these actions created by Digoxin:* A. Positive Chronotropic B. Positive Inotropic C. Negative Inotropic D. Negative Dromotropic E. Negative Chrontropic F. Positive Dromotropic

B, D, and E. Digoxin creates a positive inotropic, negative chronotropic, and negative dromotropic action on the heart. This helps the heart's contraction to be stronger while it pumps at a slower rate. Therefore, the heart will empty more efficiently (less back flow of blood) and this will increase stroke volume, which will increase cardiac output.

What signs and symptoms below would demonstrate a patient is experiencing an overdose of a beta blocker medication? Select all that apply:* A. Blood pressure 200/110 B. Heart rate 35 beats per minute C. EKG shows atrial fibrillation with rapid ventricular rate (RVR) D. Patient is maniac and agitated E. Dyspnea F. Patient is severely drowsy G. EKG shows 3rd degree AV block

B, E, F, and G. Signs and symptoms of beta blocker overdose would be the opposite of the effects of the sympathetic nervous system. Beta blockers slow down the heart rate (overdose: severe bradycardia...heart rate of 35 and heart block 2nd or 3rd degree), decrease blood pressure (overdose: severe hypotension), and severely drowsy (due to very slow heart rate and decreased cardiac output to the brain).

A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is?* A. Tell the patient to immediately stop taking the medication and seek medical treatment. B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication. C. Recommend the patient start taking the medication at night to decrease the coughing. D. Reassure the patient that the cough will disappear within 6 months of taking the medication.

B. A persistent, dry cough can occur in some patients taking ACE Inhibitors and is usually harmless. It is due to how ACE Inhibitors affect bradykinin (an inflammatory substance in the body). A patient should NEVER abruptly stop taking an ACE inhibitor because it can cause rebound hypertension. If the patient cannot tolerate the cough, they should speak with the MD about switching to another type of medication.

A patient is taking an ACE Inhibitor and Spironolactone. It is priority the nurse teaches the patient?* A. To avoid consuming alcoholic beverages B. To limit foods high in potassium C. To limit salt intake D. To take the medications with food

B. ACE Inhibitors and spironolactone (it's a potassium-sparing diuretic) will both cause the kidneys to retain potassium. Therefore, it is very important the nurse teaches the patient to limit foods high in potassium.

Your patient is prescribed an Angiotensin II Receptor Blocker (ARB) for the treatment of blood pressure management. Which statement below BEST describes how this medication will manage blood pressure in a patient?* A. "This medication will increase systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water." B. "This medication will decrease systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water." C. "ARBs will cause vasoconstriction and increase renal blood flow and volume." D. "ARBs will cause vasodilation and the kidneys to retain sodium and water."

B. ARBs will decrease systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water."

Which patient below is at MOST risk for developing Digoxin toxicity?* A. A 30-year-old male patient with heart failure and hyperglycemia. B. A 82-year-old male patient with atrial fibrillation and magnesium level of 1 mg/dL. C. A 45-year-old female with potassium level of 4.2 mEq/L. D. A 50-year-old female with a calcium level of 9 mg/dL.

B. Elderly patients are at a very high risk of Digoxin toxicity due to a decrease of function in the liver and renal system. Also, this patient in option B is experiencing hypomagnesemia (<1.5 mg/dL) which increases the risk of Digoxin toxicity even more.

Which category of beta blockers block beta 1 and beta 2 receptors?* A. Selective beta blockers B. Nonselective beta blockers

B. Nonselective beta blockers BLOCK beta 1 and beta 2...therefore they're not selective. Selective beta blockers block ONLY beta 1 receptors and are sometimes referred to as cardioselective.

You're providing discharge instructions to a patient who will be taking a calcium channel blocker at home. Which statement by the patient demonstrates they did NOT understand the teaching instructions and needs re-education?* A. "I will follow a low-fat and high-fiber diet." B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice." C. "This medication can enlarge my gums so I will maintain good oral hygiene." D. "I will monitor my blood pressure regularly because this medication can cause low blood pressure."

B. The patient should AVOID grapefruit juice while taking CCBs because this could lead to an increase in drug levels. The patient should follow a high-fiber diet due to constipation (especially with Verapamil). In addition, CCBs can enlarge the gums (gingival hyperplasia) and lower blood pressure.

As the nurse you know to tell the patient that the best way to PREVENT rebound hypertension while taking an Angiotensin II Receptor Blocker (ARB) is to?* A. assess the blood pressure daily with a self-monitoring device B. never abruptly stop taking the medication C. avoid taking the medication with milk or grapefruit juice D. avoid taking over-the-counter medications

B. The patient should NEVER just quit taking the medication because rebound hypertension can occur.

Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are?* A. Low in calcium B. High in fiber C. Low in potassium D. High in sodium

B. Verapamil can cause constipation. The patient should choose to eat foods that are high in fiber to help prevent this side effect.

A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor?* A. Metoprolol B. Benazepril C. Losartan D. Amlodipine

B. Benazepril >"lol" is beta blockers >"sartan" is ARBS >"dipines" CCB

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? To increase the amount of acetylcholine at the presynaptic neurons To reduce the amount of dopamine available in the substantia nigra To balance cholinergic and dopaminergic activity in the brain To block dopamine receptors in presynaptic and postsynaptic neurons

C Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? "You have apparently developed resistance to your current medication and will have to change to another drug." "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." "You should try to keep taking your medication at the current dose. These effects will go away with time."

C Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? Decaffeinated tea, gelatin cubes, and ginger ale when alert Docusate 100 mg orally daily Meperidine 50 mg IM every 4 hours as needed for pain Acetaminophen 650 mg every 6 hours as needed for temperature

C Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

An adult patient is being discharged home on Digoxin. Which statements below verbalized by the patient demonstrates they understand how to properly take this medication? Select all that apply:* A. "I will limit by intake of foods high in potassium." B. "I will not take this medication and notify the physician if my heart rate is less than 70 bpm." C. "I will measure my pulse rate before every dose I take." D. "It is important that I immediately report any vision changes I may experience while taking this medication."

C and D. The patient should always measure their pulse rate before taking each dose of Digoxin and hold the dose if it is less than 60 bpm (this is for adults). The patient should not restrict foods high in potassium because this could lead to hypokalemia, which can lead to Digoxin toxicity. Vision changes should be reported because this could indicate Digoxin toxicity.

Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply:* A. Hyperkalemia B. Persistent, dry cough C. Swelling in the face D. Thin and shiny skin in the lower extremities E. Difficulty breathing

C and E. Angioedema is swelling deep in the skin (dermis and subcutaneous tissue).....it's very dangerous! Signs and symptoms include: swelling in face (mouth, eyes, tongue, lips, dyspnea, swelling of extremities). It most commonly occurs in African American patients.

Beta 1 receptors can be found in the? Select all that apply:* A. GI tract B. Uterus C. Heart D. Lungs E. Kidneys F. Vascular smooth muscle

C and E. Beta 1 receptors can be found in the HEART and KIDNEYS.

A patient who developed a dry, persistent cough while taking an ACE Inhibitor is switched to an angiotensin II receptor blocker (ARB). The patient reports the cough is now gone, but asks you to explain how this medication helped alleviate the cough. What is the correct response?* A. "ARBs prevent ACE (angiotensin-converting-enzyme) from breaking down bradykinin so a dry, persistent cough is less likely." B. "ARBs increase ACE (angiotensin-converting-enzyme) which helps decrease bradykinin levels and helps alleviate the cough." C. "ARBs do not inhibit ACE (angiotensin-converting-enzyme), which is a substance that inactivates bradykinin by breaking it down; therefore, a cough is not likely with this medication." D. "ARBs prevent Angiotensin II Type I receptor sites from activating bradykinin in the lungs."

C. ACE Inhibitors can cause a dry, persistent cough in some patients because it inhibits ACE from inactivating bradykinin by breaking it down....therefore, levels of bradykinin increase and lead to coughing. ARBs do NOT inhibit ACE (angiotensin-converting-enzyme), which is a substance that inactivates bradykinin by breaking it down; therefore, a cough is not likely with this medication.

What is the therapeutic range of the drug Digoxin?* A. 2-3.5 ng/mL B. 0.1-2 ng/mL C. 0.5-2 ng/mL D. 3.5-5 ng/mL

C. A normal Digoxin level should be 0.5 - 2 ng/mL. Any levels greater than 2 ng/mL is considered toxic.

A patient is taking an Angiotensin II Receptor Blocker (ARB). What finding below is an adverse side effect of this medication and should be reported to the physician?* A. BUN 10 B. Creatinine 1 mg/dL C. Potassium 6.8 mEq/L D. ALT 20 U/L

C. ARBs can lead to hyperkalemia due to how they decrease the release of aldosterone and cause the kidneys to excrete sodium and water, but conserve potassium. A normal potassium level is 3.5-5 mEq/L.

Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________.* A. vasodilation; anti-diuretic hormone (ADH) B. vasodilation; aldosterone C. vasoconstriction; aldosterone D. vasoconstriction; anti-diuretic hormone (ADH)

C. Angiotensin II causes vasoconstriction of the vessels and triggers the release of aldosterone.

A patient is prescribed a beta blocker for a cardiac condition. You know this medication blocks the beta receptors in the body so ____________ and __________ cannot bind to the receptor site and elicit a _______ ________ _________ response.* A. angiotensin II and angiotensin I; sympathetic nervous system B. dopamine and norepinephrine; parasympathetic nervous system C. norepinephrine and epinephrine; sympathetic nervous system D. dopamine and acetylcholine; parasympathetic nervous system

C. Beta blockers block the beta receptors in the body so norepinephrine and epinephrine cannot bind to the receptor site and elicit a sympathetic nervous system response.

A patient with diabetes and hypertension is being discharged home. The patient will be taking Sotalol and insulin per sliding scale. Which statement by the patient demonstrates they did NOT understand your discharge instructions about the side effects of Sotalol?* A. "This medication can affect my blood glucose levels." B. "I will monitor my heart rate and blood pressure everyday while taking this medication." C. "While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low." D. "I will report to my physician if I develop shortness of breath, weight gain, or swelling in my feet."

C. Beta blockers can prevent tachycardia (increased heart rate). An increased heart rate is a sign for most diabetics that they are experiencing a low blood glucose level. Therefore, the patient who is taking beta blocker (especially a nonselective type) needs to be re-educated that a fast heart rate is NOT a reliable way of determining hypoglycemia and should check their blood glucose regularly.

At 1000 your patient is scheduled to take a dose of Atenolol. What finding below would require you to hold the scheduled dose and notify the physician?* A. The patient's heart rate is 120 beats per minute. B. The patient's blood pressure is 102/76. C. The patient has swelling in lower extremities, dyspnea, and crackles in lung fields.

C. In option C, the patient is showing signs and symptoms of uncompensated heart failure (beta blockers are not used when uncompensated heart failure presents, but they can be sometimes be used when the patient is in compensated/stable heart failure). The reason is because beta blockers slow down the heart rate and decrease the strength of contractions (negative inotropic effect), which can lead to heart failure in SOME patients, and this is why the nurse must monitor for this.

Your patient is taking an ACE Inhibitor to manage blood pressure. Which finding below requires immediate nursing action?* A. Urinary output is 190 mL within the past 4 hours. B. Patient has a persistent, dry cough. C. EKG shows tall, peaked t-waves. D. Patient has a negative Chvostek's sign.

C. This EKG finding demonstrates hyperkalemia. Remember ACE Inhibitors can cause a high potassium level because the kidneys will keep potassium, but excrete water and sodium (so it has a diuretic effect too).

You're providing discharge teaching to a patient that will be taking an Angiotensin II Receptor Blocker (ARB) at home. What statement by the patient requires you to re-educate them about this medication?* A. "This medication does not cure hypertension. Therefore, I will need to also make lifestyle changes." B. "I will always stand and change positions slowly." C. "A persistent, dry cough is not common with this medication." D. "This medication can decrease potassium levels. So, I will consume a diet rich in potassium to help keep my level normal."

D. ARBs can cause a HIGH potassium level. Therefore, the patient should avoid consuming a diet rich in potassium and using salt-substitutes with potassium.

An infant is ordered a scheduled dose of Digoxin. The patient's apical pulse rate is 78 bpm. The nurse would:* A. Administer the dose as ordered B. Hold the dose and reassess the apical pulse rate in 1 hour C. Skip this dose but administer the next scheduled dose D. Hold the dose and notify the physician

D. The nurse should hold a dose of Digoxin and notify the physician if the INFANT'S heart rate is less than 90-110 bpm.

Your patient, who is 55-years-old, is prescribed to take Digoxin. What patient finding requires that the nurse hold the dose of Digoxin and notify the physician?* A. Digoxin level of 1.2 ng/mL B. Blood glucose 82 C. Heart rate 61 bpm D. Potassium 2.8 mEq/L

D. The patient's potassium level is low (<3.5 mEq/L). Remember hypokalemia increases the chances of Digoxin toxicity developing. The nurse should notify the MD and hold the ordered dose until further instructions are given by the doctor.

Digoxin is part of what family of drugs?* A. Angiotensin-converting enzyme inhibitors B. Beta-blockers C. Angiotensin II receptor blockers D. Cardiac glycosides

D: cardiac glycosides

Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia? Baclofen [Lioresal] Dantrolene [Dantrium] Diazepam [Valium] Tizanidine [Zanaflex]

Dantrolene, a direct-acting skeletal muscle relaxant, is the preferred treatment for malignant hyperthermia. Malignant hyperthermia is a life-threatening syndrome that usually occurs when a general anesthetic is used with a neuromuscular blocking agent. It presents with muscle rigidity and profound temperature elevation.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? Phenytoin [Dilantin] 200 mg IV over 4 minutes Phenobarbital 30 mg IM Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.