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. 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. Enalapril C. Losartan D. Amlodipine

B. Enalapril

4. 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)

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

Alpha Receptor Blockers end with which suffex?

"osin"

The nurse in the community health clinic is educating a client recently prescribed propranolol for the treatment of atrial fibrillation (AF). Which instruction should the nurse include in the teaching? A. Avoid consuming grapefruit juice B. Do not consume more than one alcoholic beverage daily C. Decrease the amount of coffee consumed per day D. Avoid getting out of bed too quickly

D. A side effect of propranolol is orthostatic hypotension. Clients taking this medication should be instructed to get out of bed slowly to avoid falling.

The nurse in the gastroenterology office is gathering assessment data for a client who was recently prescribed pantoprazole for treatment of a peptic ulcer. Which client statement indicates that the nurse should provide additional teaching? Elimination tool A. "If I can't swallow my pills, I will just chew them." B. "I need to have my vitamin B-12 levels checked periodically." C. "If I notice increased episodes of vomiting, I should call my doctor." D. "This medication might increase my appetite."

A

The nurse is teaching a 41-year-old female client about the angiotensin II receptor blocker (ARB) Losartan to treat hypertension. Which instruction(s) should the nurse include? Select all that apply. Select all that apply Elimination tool A. Inform your healthcare provider right away if you become pregnant. B. Monitor your blood pressure at home with an automated machine. C. You may feel dizzy if you change positions abruptly. D. Routine blood work is not required while on this medication. E. Lip swelling is a harmless side effect that is self-limiting.

A, B, C. Clients prescribed angiotensin II receptor blockers (ARBs), like Losartan , should be instructed how and when to take blood pressure at home. The healthcare provider should also advise the client on the importance of routine blood work to check potassium levels and blood glucose levels (if diabetic). The client should also be instructed to avoid or limit potassium-rich foods to prevent hyperkalemia . The client should not discontinue taking ARBs abruptly. The healthcare provider should advise the client to report pregnancy and seek emergency care immediately if they develop side effects such as angioedema .

A newly graduated nurse is reviewing indications for the administration of heparin with the nurse preceptor. Which condition(s) can be treated using heparins? Select all that apply. Select all that apply Elimination tool A. Atrial fibrillation (Afib) B. Myocardial infarction (MI) C. Hemophilia A D. Venous thromboembolism (VTE) E. Disseminated intravascular coagulation (DIC)

A, B, D, E

The nurse is providing education to a client recently prescribed warfarin for the treatment of atrial fibrillation. Which instruction(s) should the nurse provide to the client? Select all that apply. Select all that apply Elimination tool A. "If you have a cut, hold pressure on the site for 15 minutes." B. "You should avoid being in the sunlight for prolonged periods of time." C. "You will have blood work drawn frequently while taking warfarin." D. "Avoid large amounts of green leafy vegetables in your diet." E. "If you miss a dose of warfarin, call your doctor immediately." F. "Use a soft bristle toothbrush and floss gently." Rate your confidence to submit: Low Medium

A, C, D, E

The nurse is teaching a client with hypertension about their prescribed extended-release Amlodipine. Which information should the nurse include? Select all that apply. A. Avoid grapefruit and grapefruit juice B. Take the medication with meals C. Limit caffeine consumption D. Avoid crushing, chewing, or dividing the tablet E. Avoid stopping the medication abruptly

A, C, D, E

The nurse manager is creating a list of information for the nurses to include in the educational care plans for clients prescribed digoxin to treat congestive heart failure (CHF). Which instructions should be included? Select all that apply. Select all that apply A. Teach the client how to count their heart rate B. Teach the client how to take their blood pressure C. Reinforce the importance of low sodium and a low-fat diet D. Instruct the client to take their digoxin at the same time every day E. Instruct the client to avoid abruptly stopping digoxin therapy

A, C, D, E, Clients should not take the digoxin if their heart rate is less than 60 beats per minute; instead, they should wait one hour and recheck their pulse If their heart rate is still less than 60 beats per minute, they should contact their healthcare provider right away. A side effect of digoxin is severe bradycardia. Clients with CHF should consume a diet low in sodium and fat. Diets high in sodium result in water retention, thus increasing the workload of the heart.

The nurse has administered digoxin to a client for treatment of atrial fibrillation. Which side effect(s) should the nurse monitor for? Select all that apply. Select all that apply A. Bradycardia B. Weight gain C. Hypertension D. Diplopia E. Seizures

A, D.

The nurse is monitoring a client receiving Semaglutidine for the treatment of type 2 diabetes mellitus (DM). Which laboratory test(s) should the nurse monitor throughout treatment? Select all that apply. Select all that apply A. Blood glucose B. Hemoglobin A1c C. Complete blood count (CBC) D. Prothrombin time (PT) E. Liver function tests

A,B,E E: The nurse should monitor the hepatic function for clients taking glucagon-like peptide-1 (GLP-1) agonists , such as Semaaglutidine. Abnormal liver functioncan lead to hyperglycemia.

A client was administered heparin during a surgical procedure. In the post-anesthesia care unit, the client develops a severe nosebleed and excessive blood leaking out from under their bandage. Which antidote should the nurse anticipate the healthcare provider to prescribe this client? A. Protamine sulfate B. Magnesium sulfate C. Vitamin K D. Kayexalate

A.

The nurse is discussing the risk of bleeding with a client prescribed enoxaparin for prevention of deep vein thrombosis (DVT). Which instruction should the nurse give to this client? A. "Alert your dentist before you have any procedures done." B. "Use a straight razor when shaving." C. "Dark, tarry stools are expected when taking heparin." D. "If you get cut, loosely cover the wound with a bandage." Skip

A.

The nurse in the intermediate care unit is reviewing the laboratory results for a client diagnosed with diabetic ketoacidosis (DKA) who is prescribed intravenous (IV) insulin. Which laboratory result should the nurse evaluate prior to administration? A. Potassium level B. White blood cell count (WBC) C. Thyroid panel D. Pancreatic enzymes

A. The nurse should review the potassium level of a client prescribed IV insulin. The normal potassium range is 3.5 to 5.1 mEq/L. IV insulin can decrease the potassium level, causing hypokalemia. This is because insulin causes potassium to shift into the cells.

The nurse gathers information from a client during a follow-up appointment at the primary care office. The client states to the nurse, "I used to be on lisinopril for my high blood pressure, but the doctor changed my medication to losartan instead three months ago. Do you know why my doctor switched my medication?" Which follow-up question should the nurse ask? Elimination tool A. "Did you experience a cough while taking lisinopril?" B. "Do you have a history of diabetes mellitus (DM)?" C. "Do you check your blood pressure at home?" D. "Did you find yourself rising too quickly from sitting positions?"

A. A dry cough is a common side effect of angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril . Like losartan, Angiotensin II receptor blockers (ARBs) do not cause an irritating, dry cough as ACE inhibitors do. Commonly, clients taking an ACE inhibitor who develop a cough may switch to an ARB, which does not cause this side effect.

The nurse is caring for a client prescribed Verapamil to treat atrial fibrillation. Which laboratory assessment should the nurse anticipate monitoring throughout the treatment? A. Liver function panel B. Creatinine Kinase (CK) C. Parathyroid hormone D. Hemoglobin A1C

A. A liver function panel will be monitored throughout the treatment for clients with atrial fibrillation prescribed Verapamil. Verepamil, a calcium channel blocker, can cause mild to transient serum liver enzyme elevations, as well as injury to the liver .

The nurse is performing discharge teaching with an older adult client who was prescribed furosemide 20 mg PO daily to treat congestive heart failure (CHF). Which instruction is the most important for the nurse to include? A. "Take your time changing positions such as from lying down to rising." B. "Consume about 4 liters of fluid per day to prevent dehydration." C. "Alert the doctor if you develop a rash on your face and torso." D. "Discontinue your potassium supplements while taking this medication."

A. Clients on diuretics, such as furosemide , should be advised to change positions very slowly to give their body time to adjust before standing. Orthostatic hypotension describes a condition involving a drop in blood pressure within a few minutes of a client rising to stand from a sitting or lying position. Furosemide is a loop diuretic that promotes excretion of sodium and water. As a result, clients taking this medication can lose blood volume through their urine, leaving them mildly hypovolemic. Without adequate blood volume, clients who stand up too quickly cannot compensate in time, leading to feeling dizzy or lightheaded and even syncopal episodes.

The nurse is conducting an assessment on a client who is scheduled to receive heparin after a minor surgery. Which statement should alert the nurse that this client has a contraindication for this medication? Elimination tool A. "I have a history of heparin-induced thrombocytopenia." B. "The doctor tells me that my heart beats irregularly." C. "Almost everyone in my family has had a heart attack." D. "I had problems with blood clots after my last surgery."

A. Heparin-induced thrombocytopenia (HIT) occurs when the body activates antibody complexes that cause a reduction in platelets following heparin administration. Clients with HIT should never be administered heparin .

The nurse is caring for a client with a new order for amlodipine. Which safety measure is most important for the nurse to take prior to administering this medication? A. Provide non-slip footwear and educate the client about slow position changes B. Provide a snack with juice and educate the client about signs of hypoglycemia C. Provide a urine collection device and educate the client about monitoring output D. Provide an incentive spirometer device and educate the client about proper usage

A. This answer is correct because amlodipine is a type of antihypertensive medication that is a dihydropyridine calcium channel blocker. Amlodipine may cause dizziness and orthostatic hypotension (or a drop in blood pressure with position changes), particularly when the initial dose of the medication is given. By providing non-slip footwear and educating the client about the importance of slow and careful position changes, the nurse helps to decrease the likelihood of falls due to dizziness.

A client with a history of depression, benign prostatic hyperplasia (BPH), and congestive heart failure (CHF) attends a follow-up cardiology appointment after being prescribed terazosin 2mg, escitalopram 20 mg, and furosemide 40 mg two months ago. The client tells the nurse that they have been struggling to get an adequate amount of sleep. Which question is most appropriate for the nurse to ask? A. "What are your dreams about?" B. "What time are you taking your medications?" C. "Do you take any additional herbal supplements?" D. "Have you tried alternative treatments such as meditation?"

B. Timing of medications, particularly diuretics like furosemide, can have a significant impact on a client's ability to sleep. Clients should be instructed to take diuretics in the morning because the effects will be strongest during the day. Clients taking diuretics at night may awake frequently to urinate. Therefore, the nurse should assess for insomnia related to nocturia.

A student nurse asks the nurse preceptor, "How does a proton pump inhibitor (PPI) like pantoprazole work?" Which is the best response by the nurse preceptor? A. "A PPI is an alkaline substance that quickly reduces the amount of acid in the stomach, and it also decreases heartburn." B. "PPIs inhibit the hydrogen/potassium adenosine triphosphatase (ATP) enzyme system, which reduces the amount of acid that is produced." C. "A PPI works to coat the stomach and mucosal lining, preventing acid secretion. The coating on the stomach prevents ulcers from forming." D. "PPIs hinder the dopamine receptor agonist, which decreases acid production, promoting gastric motility and emptying."

B

The nurse is caring for a client recovering from surgery for a mechanical heart valve replacement. Which medication involved in the prevention of unwanted clotting should the nurse administer? Elimination tool A. Celecoxib B. Warfarin C. Penicillin D. Gabapentin

B

A 65-year-old male client with a history of emphysema visits his cardiologist for a follow-up after being diagnosed with congestive heart failure (CHF) 6-months ago. He is currently asymptomatic except for reporting "heaviness" in his legs and his ankles appear swollen bilaterally. The client's vital signs are: Blood pressure: 185/91 mmHg Heart rate: 72/min Respirations: 16/min Oxygen saturation: 96% on room air Temperature: 36.9℃ (98.5℉) The healthcare provider prescribes furosemide 40 mg PO BID. Which client condition(s) is this medication useful in treating? Select all that apply. Select all that apply A. Emphysema B. Peripheral edema C. Congestive heart failure (CHF) D. Tachycardia E. Hypertension

B,C,E Peripheral edema is swelling and fluid retention in the extremities. This may occur due to immobility, peripheral injury, or fluid imbalance in the body, such as with CHF. Diuretics, such as furosemide, are medications that enhance the excretion of water and sodium, so they treat peripheral edema. CHF is a condition in which the heart cannot pump blood effectively due to myocardial dysfunction. As a result, blood can back up into the lungs and peripheral extremities. Diuretics , such as furosemide, do not act directly on the heart but they can help the kidneys excrete water and sodium. This decreases overall circulatory volume and helps reduce cardiac preload and fluid retention. High blood pressure can be both a cause and symptom of heart failure. High blood pressure increases demands on the heart , because it has to accommodate the increased preload and afterload. Over time, this increased work can make the heart become less efficient. Diuretics, such as furosemide, reduce circulatory volume because they enhance excretion of sodium and water, which lowers blood pressure .

When teaching a nursing student about the use of antidysrhythmic medications, which condition should the nurse include? A. Coronary artery disease (CAD) B. Supraventricular tachycardia (SVT) C. Angina D. Congestive heart failure (CHF)

B.

The nurse is caring for a client diagnosed with hypertension who was recently prescribed a thiazide diuretic. The nurse should question this prescription if which condition is present in this client's medical history? A. Penicillin allergy B. Gout C. Osteoporosis D. Hyperkalemia

B. Thiazidesare contraindicated in clients with gout .Gout is a form of arthritis that occurs when uric acid crystallizes and deposits in the joints, causing redness, swelling, and pain. Thiazide diuretics tend to cause retention of calcium and uric acid. This can result in hypercalcemia and hyperuricemia causing acute exacerbations of gout .

The nurse is assessing a client who has received enoxaparin for the past two days for deep vein thrombosis (DVT) prophylaxis. Which finding suggests the client is experiencing a common side effect of this medication? A. Blood pressure 122/82 mmHg B. Bruising in the left lower quadrant C. Heart rate 100/min D. Bilateral pedal pulses 3+

B. A common side effect of heparin is bruising. Bruising occurs when blood leaks from the capillaries under the skin and occurs most commonly at injection sites or in trauma.

A client is prescribed amiodarone for the treatment of atrial fibrillation (AF). Which classification of antidysrhythmic does this medication belong to? A. Class II B. Class III C. Class I D. Class IV

B. Amiodarone block potasium and sodium channels

The cardiovascular nurse is reviewing commonly prescribed cardiovascular medications. Which calcium channel blocker should the nurse identify as best to treat hypertension? A. Verapamil B. Amlodipine C. Atenolol D. Captopril

B. Amlodipine is a calcium channel blocker, specifically a dihydropyridine. Dihydropyridines have a more potent action on the blood vessels, specifically the arterioles, than the heart. As a result, they are preferred to treat hypertension over non-dihydropyridines .

The nurse administers a prescribed dose of intravenous (IV) morphine sulfate for a client following a surgical procedure. Which vital sign assessment is the priority when monitoring the client for complications associated with the administration of the prescribed opioid analgesic? Temperature Respiratory rate Pain rating Heart rate

B. Morphine is a central nervous system depressant which can cause decreased respirations and even respiratory failure if not dosed and monitored appropriately.

The nurse is preparing to administer furosemide 40 mg intravenous (IV) push to a client diagnosed with hypertension. Which laboratory value should prompt the nurse to contact the healthcare provider prior to administration? A. Sodium 147 mEq/L B. Potassium 3.1 mmol/L C. Calcium 9.6 mg/dL D. Magnesium 1.9 mg/dL

B. Normal serum potassium levels range from 3.6 to 5.2 mmol/L. This client's potassium level of 3.1 mmol/L indicates hypokalemia, which can lead to side effects such as muscle cramps or cardiac arrhythmias. Furosemide is known to cause electrolyte imbalances including hypocalcemia, hypomagnesemia, hypochloremia, hyponatremia, and hypokalemia. The nurse should report this laboratory value to the healthcare provider as furosemide could further decrease this client's potassium levels.

The nurse is providing education to a client recently diagnosed with hypothyroidism who is prescribed levothyroxine. Which client statement indicates that teaching has been successful? A. "I will make sure to take my levothyroxine when I take my pantoprazole." B. "I am going to take this medication as soon as I wake up in the morning." C. "I will take this tablet with a cup of milk to ensure I don't become nauseous." D. "When I start to feel better, I will begin to taper down my dose."

B. This statement indicates that teaching has been successful. Clients prescribed levothyroxine should be instructed to take this medication 30 to 60 minutes before breakfast.

The nurse is caring for a client prescribed to receive a dose of warfarin. Which finding would indicate that the nurse should hold the dose of warfarin and contact the provider? A. PT 12 seconds B. INR 4.2 C. aPTT 48 seconds D. PLT 180,000/microliter

B. This answer is correct because an INR of 4.2 is too high and would indicate that the client is at an increased risk of bleeding. The target INR for a client on warfarin is 2.0-3.0 (or 2.5-3.5 for clients with a mechanical valve replacement). For an INR of 4.2, the nurse should hold the scheduled dose of warfarin and contact the provider for further orders.

what is Tamsulosin most used for? A. HTN B. HF C. Edema D. BPH

BPH

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

The answer is 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.

A female client is prescribed warfarin for treatment of venous thromboembolism (VTE). The nurse conducts a health history prior to administration and recognizes which condition(s) as a contraindication to this medication? Select all that apply. Select all that apply Elimination tool A. The client has hemiplegia B. Atrial fibrillation C. A history of hemophilia D. Peptic ulcer disease (PUD) E. The client is pregnant

C, D, E

A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition?* A. Tapazole B. PTU (Propylthiouracil) C. Synthroid (Levothyroxine) D. Inderal

C.

The nurse receives the most recent lab work for a client on long-term warfarin therapy. Which lab results should be reported to the provider? Elimination tool A. A partial thromboplastin time (aPTT) of 40 seconds B. Erythrocyte sedimentation rate (ESR) of 14 mm/h C. Prothrombin time (PT) / international normalized ratio (INR) of 3.5 seconds D. A white blood cell count (WBC) of 11,000/mm³

C. A PT and INR should be reviewed for clients taking warfarin to determine the appropriateness of the treatment. The PT and INR are lab tests that measure how long it takes for the blood to clot. The values are reported together to provide an overall picture of the clotting action in the body. The therapeutic range of PT/INR for a client taking warfarin is 2.0-3.0 seconds. A PT/INR of 3.5 seconds should be reported to the provider because the medication dose may need to be adjusted

The nurse in the emergency department (ED) is triaging a client who states that they are taking an angiotensin II receptor blocker (ARB) but cannot recall the medication name. The nurse should know that this class of medication typically ends with which suffix? Elimination tool A. -olol B. -pril C. -sartan D. -afil

C. -sartan

The nurse is reviewing the medical history of a client newly prescribed amlodipine for hypertension. For which existing comorbidity should the nurse be concerned about? A. Emphysema B. Rheumatoid arthritis C. Second-degree heart block type I D. Gout

C. Amlodipine is contraindicated for clients with an atrioventricular block. The electrical cardiac signals for clients with a second-degree heart block type I have intermittent atrial conduction to the ventricle resulting in a blocked signal. Calcium channel blockers can cause further problems because they prevent the depolarization of cardiac pacemaker cells in the sinoatrial (SA) and atrioventricular(AV nodes), which will further decrease the heart rate .

The nurse has administered Verapamil to a client experiencing angina. For which side effect should the nurse monitor the client? A. Tinnitus B. Gingival hyperplasia C. Bradycardia D. Reflex tachycardia

C. Bradycardia is a side effect specifically associated with the category of calcium channel blockers referred to as non-dihydropyridines. Non-dihydropyridines such as Verapamil, have a more potent action on the heart than the blood vessels.

A new nurse asks the nurse preceptor how propranolol can correct atrial fibrillation (AF). Which is the best response by the nurse? A. "It blocks the sodium influx to affect conduction and repolarization." B. "Propranolol blocks potassium efflux which results in a decreased heart rate." C. "This medication blocks catecholamines, decreasing the heart's contraction." D. "Propranolol blocks the influx of calcium, which slows down the heart rate." Skip

C. Propranolol is a beta-blocker which blocks catecholamines and subsequently decreasing contractility of the heart .

The nurse provides care for a client who is postoperative for a cholecystectomy and prescribed hydromorphone 1 mg every 2 to 4 hours, as needed for pain. Which assessment data indicates a priority need for the nurse to hold the next dose of the prescribed opioid analgesic? A. The client has a temperature of 100.9 F. B. The client has a history of narcotic abuse. C. The client who has a respiratory rate of 10 breaths/minute. D. The client who has an apical heart rate of 60 beats/minute.

C. Respiratory depression is a known adverse reaction for hydromorphone thus this finding requires the nurse to hold the next dose of hte medication and prepare to administer naloxone, if needed.

The nurse is teaching a newly graduated nurse about the administration considerations for omeprazole. Which statement made by the newly graduated nurse indicates teaching has been effective? Elimination tool A. "I need to obtain a blood pressure and pulse rate before I administer this medication." B. "The extended-release capsule should be opened and sprinkled into applesauce." C. "I will insert the medication into the peripheral venous access device and push it rapidly." D. "This medication should be administered one hour prior to the client's morning meal."

D Omeprazole is a proton pump inhibitor (PPI) that should be administered one hour prior to the morning meal. Taking the medication before the first meal will allow the medication enough time to reduce the acid produced in the stomach prior to eating.

The nurse is discussing heparin administration with a client newly diagnosed with atrial fibrillation. The client asks the nurse, "Why am I getting this medication?" Which is the best response by the nurse? Elimination tool A. "Heparin controls the heart rate and decreases blood pressure." B. "The medication inhibits vitamin K in the body." C. "This medicine will promote white blood cell production." D. "Heparins work in the body to prevent clot formation."

D. This is the best response by the nurse. Heparins disrupt the clotting cascade in the body. This medication inhibits thrombin formation, interfering with the ability of fibrin to form a clot.

The nurse is reviewing the medical and surgical history of a client with type 2 diabetes mellitus (DM) who was recently prescribed Semaglutide. The nurse should notify the healthcare provider of which condition in the client's medical history prior to administering this medication? A. Asthma B. Epilepsy C. Systemic lupus erythematosus (SLE) D. Hypothyroidism

D. Glucagon-like peptide-1 (GLP-1) agonists , such as Semaglutide, should be used with caution in clients with thyroid disease. GLP-1 agonists have a boxed warning for increasing the risk of thyroid cancer development .

The nurse is providing education to a nursing student about conditions for which calcium channel blockers can be used in the treatment. Which example should the nurse include in the teaching? A. Parkinson's disease B. Hypotension C. Focal seizures D. Angina

D. Calcium channel blockers are used to treat angina. Calcium channel blockers dilate coronary vessels and increase oxygen supply to the heart .

The student nurse is preparing to administer levothyroxine to a client on the medical surgical unit. The nursing instructor asks the student nurse, "Why is the client prescribed this medication?" Which is the bestresponse by the student nurse? A. "Levothyroxine is prescribed to help lower blood pressure and heart rate." B. "My client needs this medication to decrease iodine use by the body." C. "I am administering this medicine to treat my client's diabetes insipidus (DI)." D. "My client needs this medication because they have a decrease in their thyroid hormones."

D. Hypothyroidism occurs when there are decreased levels of circulating thyroid hormones, such as triiodothyronine (T3) and thyroxine (T4). This condition is treated with thyroid hormone replacement therapy, which involves medications to replace the reduced thyroid hormones, such as levothyroxine, which is a synthetic form of T4.

The nurse is caring for an adult client with a history of hypertension after an abdominal surgery one day ago. Now that the surgery is over, the client has restarted on their home medication, losartan 80 mg. Before the nurse administers the medication, the assistive personnel (AP) obtains vital signs. The client's current heart rate is 86/min, and blood pressure is 89/53 mmHg. Which is the most appropriate initialnursing intervention? Elimination tool A. Wait for one hour to give the medication to increase blood pressure. B. Ask the healthcare provider to change the prescription to metoprolol 5 mg instead. C. Administer the medication and ask the AP to check the blood pressure later D. Hold the medication and contact the attending surgeon.

D. Normal blood pressure in an adult is approximately 120/80 mmHg, with a mean arterial pressure above 60 mmHg. This client is currently hypotensive, and, given their recent abdominal surgery, this is a reason to notify the surgeon due to the risk of postoperative bleeding . These medications work to relax vascular smooth muscle and increase excretion of water and sodium to lower blood pressure . Administration of this medication to a hypotensiveclient may cause a further reduction in blood pressure .

The cardiovascular intensive care unit (CVICU) nurse is completing an admission assessment for a client diagnosed with paroxysmal atrial tachycardia (PAT). The healthcare provider prescribes the client intravenous verapamil once STAT. The nurse should hold the medication and notify the healthcare provider due to which medical condition? Elimination tool A. Chronic obstructive pulmonary disease (COPD) B. Type 2 diabetes mellitus (DM) C. Hypothyroidism D. Congestive heart failure (CHF)

D. Verapamil is a calcium channel blocker which is contraindicated in clients diagnosed with CHF. CCB slows the conduction velocity of the heart, thus decreasing heart contractility . This decrease in contractility can further decrease the function of the heart muscle in clients with CHF .

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.

The answer is 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.

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)."

The answer is 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.

A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You've provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication? A. "This medication will help relieve the inflammation and pain during an acute attack." B. "It is important I have regular eye exams while taking this medication." C. "I will not take large doses of vitamin C supplements while taking this medication." D. "Allopurinol decreases the production of uric acid."

The answer is A. Allopurinol is used to PREVENT gout attacks....not treat an acute attack. NSAIDs and Colchicine are best for treating the inflammation and pain during a gout attack. Allopurinol can cause vision changes, therefore the patient should receive annual eye exams along with avoiding large doses of vitamin C due to the risk of renal calculi formation.

3. 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

The answer is 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.

4. 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."

The answer is 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 Bisoprolol. 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."

The answer is 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.

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation....(ex: up to 4.5)

You are performing discharge teaching with a patient who is going home on Synthroid (Levothyroxine). Which statement by the patient causes you to re-educate the patient about this medication? A. "I will take this medication at bedtime with a snack." B. "I will never stop taking the medication abruptly." C. "If I have palpitations, chest pain, intolerance to heat, or feel restless, I will notify the doctor." D. "I will not take this medication at the same time I take my Carafate."

The answer is A: Synthroid is best taken in the MORNING on an empty stomach. All the other statements are correct about taking Synthroid.

Your patient's blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Aspart (Novorapid) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time? A. 1145 B. 1230 C. 1430 D. 1630

The answer is B. If you gave the Aspart at 1130, the patient is at most risk for hypoglycemia 1 hour after administration, which is 1230. Onset: 5-15 minutes Peak: 1-3 hour Duration: 3-5 hours

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.

The answer is 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.

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."

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

Identify which patient below is at MOST risk for developing gout: A. A 56 year old male who reports consuming foods low in purines. B. A 45 year old male with a BMI of 40 who reports taking Metolazone (Thiazide) and aspirin. C. A 39 year old female hospitalized with bulimia that has a BMI of 24. D. A 27 year old female with ulcerative colitis.

The answer is B. Gout is due to high levels of uric acid in the blood. This can either be due to the kidney's inability to excrete uric acid out of the body or the body is producing too much uric acid. Some causes that can lead to increased uric acid levels include: being overweight (BMI >25 is considered overweight), usage of aspirin or diuretics (thiazides (hydrochlorothiazide) or loop), HIGH consumption of purines, dehydration, renal problems. Option B is the only patient MOST at risk for developing gout.

A patient is taking Warfarin (Coumadin). What order received from the physician requires that you ask for an order clarification? A. Check PT/INR daily B. Administer Prednisone IM daily C. Ambulate three times per day D. Draw CBC in the morning

The answer is B. IM (intramuscular) injections should be AVOIDED in patients taking Warfarin (Coumadin) due to the bleeding risk. Other routes should be ordered.

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

The answer is B. Remember ARBs end with "SARTAN". Losartan is an ARB.

6. 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."

The answer is 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

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

7. 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

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

A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Synthroid (Levothyroxine) for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing? A. Thryoid Storm B. Myxedema Coma C. Iodism D. Toxic Nodular Goiter

The answer is B: Myxedema Coma...The red flags in this question are the patient's signs/symptoms and the report from the family the patient hasn't been taking the prescribed Synthroid. The patient is showing signs and symptoms of extreme hypothyroidism known as Myxedema coma (which is life-threatening if not treated).

5. 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

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

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."

The answer is 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.

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

The answer is 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.

1. 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

The answer is 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.

7. 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 Propranolol? 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."

The answer is 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.

6. At 1000 your patient is scheduled to take a dose of Bisoprolol. 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.

The answer is 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.

15. Which of the following insulins has no peak but a duration of 24 hours?* A. NPH B. Novolog C. Lantus D. Humulin

The answer is C. Lantus is the only option here that is a LONG-ACTING insulin which has NO peak and a 24 hour duration.

You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicate the patient did NOT understand your education about how to take this medication? A. "I will make sure I take this medication with food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."

The answer is C. Patients should not take Colchicine with grapefruit juice because it increases the amount of Colchicine the body absorbs (causing an increased chance of Colchicine toxicity). This medication can be taken WITH or WITHOUT food.

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.

The answer is 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."

The answer is 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

The answer is 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.

4. 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

The answer is 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.

What is the antidote for Warfarin (Coumadin)? A. Flumazenil B. Narcan C. Protamine Sulfate D. Vitamin K

The answer is D. Vitamin K is the antidote for Warfarin (Coumadin).

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

The answer is D: cardiac glycosides

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.

The answers are A and B. ACE inhibitors inhibits the renin-angiotensin-aldosterone system (RAAS), which will prevent the conversion of Angiotensin I to Angiotensin II. Options C and D are false statements about these medications.

. 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

The answers are 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.

8. 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

The answers are 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.

Your patient was started on Warfarin (Coumadin) a week ago for the treatment of a DVT. Which findings below would indicate an adverse reaction to this medication? Select all that apply: A. Patient reports a severe and sudden headache B. Melena C. Chvostek's Sign D. Hematuria E. Coffee ground emesis F. Bleeding gums

The answers are A, B, D, E, and F. An adverse reaction would be associated with bleeding. Patients who take Warfarin should be monitored for signs and symptoms that bleeding is occurring internally. Example would be: sudden/severe headache (represents intracranial bleed), melena (dark, tarry stools...represent blood), hematuria (urine reddish or pink), coffee ground emesis (bleeding in the stomach), or bleeding gums....along with tachycardia, hypotension, nosebleeds, or bruising for no reason. Chvostek's Sign is associated with a low calcium level (hypocalcemia).

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

The answers are 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).

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

The answers are 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

The answers are 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).

You're providing discharge teaching to a patient who will be going home on Warfarin (Coumadin). Which statements by the patient demonstrate they understood the educational material provided? Select all that apply: A. "I will switch and use a hard bristle toothbrush." B. "When I shave I will be sure to use an electric razor." C. "I will be sure that I eat a diet rich in spinach, kale, and broccoli." D. "I will avoid drinking any alcoholic beverages."

The answers are B and D. A patient should use a SOFT bristle toothbrush rather than a hard bristle to prevent damaging the gums (this can lead to bleeding). Also, the patient should maintain a normal diet, but avoid consuming excessive amounts of green leafy vegetables (like spinach, kale, broccoli, lettuce etc.) because this can alter how the medication works. The patient should AVOID alcoholic beverages and use electric razors.

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."

The answers are 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.

4. A patient is prescribed Verapamil 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

The answers are B and D. Verapamil 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.

1. 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

The answers are 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.

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

The answers are 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.

. 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

The answers are 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).

. 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."

The answers are 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

The answers are 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.

2. 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

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

Which patients below are NOT candidates for Warfarin (Coumadin)? Select all that apply: A. A 45-year-old male patient with alcoholism and an active GI ulcer. B. A 55-year-old female with a heart valve replacement. C. A 36-year-old female with a deep vein thrombosis. D. A 52-year-old male who needs a liver transplant.

The answers are: A and D...Option A is NOT a candidate because active ulcer disease places the patient at risk for bleeding while taking Warfarin (Coumadin). In addition, patients should NOT drink alcohol while taking Warfarin (Coumadin) because it majorly affects how the drug works. Option D is NOT a candidate because of the liver disease. Warfarin affects the liver's clotting factors. Option B and D would benefit because both are at risk for a blood clots (especially option B). While Option C already has a blood clot, Warfarin (Coumadin) would help prevent it from becoming larger and new clots from forming.

Warfarin (Coumadin) affects the formation of certain clotting factors. Select below ALL the clotting factors this medication affects: A. I B. V C. II D. VII E. XI F. X G. IX

The answers are: C, D, F, and G. Warfarin (Coumadin) affects FOUR clotting factors that require vitamin K to form. These clotting factors are: 2, 7, 9, and 10 (II, VII, IX, X)