Pharmacology Test 2

The nurse is caring for a client receiving lidocaine IV. Which factor is most relevant to administration of this medication?

Presnece of premature ventricular contractions (PVCs) on cardiac monitor

What drug may be used to terminate supraventricular tachycardia?

Adenosine (Adenocard)

What are the two main types of cholinergic receptors?

Nicotinic aand muscarinic receptors.

What receptors are more sensitive to norepinephrine?

Alpha receptors. Stimulation of alpha-receptor sites results in the constriction of blood vessels in the skin, cerebral, and splanchnic circulation.

Neurotransmitter that increases the force of ventricular contraction, heart rate, blood pressure, and cardiac output.

Norepinephrine

When caring for a client with a cardiac dysrhythmia, the most appropriate goal for the client is to maintain:

Cardiac Output

A nurse is preparing to discharge a female client newly prescribed warfarin (Coumadin). While assessing the client's knowledge of their drug, what would indicate that the client needs further instruction concerning her drug therapy?

"I take aspirin for my arthritis"

A 48-year-old client needs additional teaching regarding anticoagulants if the client states: "I'll use aspirin for arthritis pain." "I can use an electric razor." "I will carry a MedicAlert card." "I should report to the lab once a month."

"I'll use aspirin for arthritis pain."

A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why she is taking both medications. What is the nurse's most accurate response?

"Warfarin takes 3-5 days to develop anticoagulation effect and you still need heparin"

Action of a anticoagulants:

*Interfere/Altering* the clotting cascade and thrombin formation.

What are the causes of cardiac arrhythmias?

-Electrolyte disturbances that alter the action potential -Decreases in oxygen delivered to the cells -Structural damage changing the conduction pathway through the heart -Acidosis or accumulation of waste products altering the action potential -Drugs that alter the action potential or cardiac conduction

Types of cardiac arrhythmias:

-Tachycardia (faster-than-normal heart rate) -Bradycardia (slower-than-normal heart rate) -Premature atrial contractions (PACs) or premature ventricular contractions (PVCs) -Atrial flutter -Atrial fibrillation or ventricular fibrillation -Alterations in conduction through the muscle (heart blocks and bundle branch blocks)

What are the three things platelets must do to form a clot.

1. Activate 2. Go to where they are needed. 3.Stick together.

A client is to take diltiazem (Cardizem) 360 mg/d PO in four divided doses. How many mg will the client take per dose?

90mg

A male client has called the clinic because he is taking digoxin and is concerned about his pulse rate. The nurse should tell the client to hold the medication if he reports a pulse rate of:

>60. 52 beats/minute.

What neurotransmitter, is released when parasympathetic (cholinergic) nerve fibers are stimulated?

Acetylcholine.

What receptors are more sensitive to epinephrine?

Beta.

A female patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what does the nurse suspect is the cause of the pain?

Bleeding

An asthmatic client on a beta blocker should be observed for which adverse reaction?

Brochospasm

The nurse is caring for a client who takes an antidysrhythmic. What would be a priority nursing action before administering this drug?

Check the client's apical and radial pulses.

Embolus

Clot, fat, air that occludes a vessel(debris).

Thrombosis

Collection of platelets and fibrin that occludes a vessel.

A 51-year-old man is being discharged from the hospital following treatment with anticoagulants for a deep vein thrombosis. The nurse will instruct the client to:

Consider safety measures to prevent bleeding and be alert for signs of bleeding.

Intrinsic pathway

Converts prothrombin to thrombin.

An adult patient experiences premature atrial complex (PAC) on occasion (once every couple of hours) but remains hemodynamically stable. The patient expresses concern over the arrhythmia developing into a more fatal arrhythmia in the future. What is the most appropriate nursing diagnosis for this patient?

Deficient Knowledge

The nurse assists and educates clients about blood pressure regulation. Based on this information, the nurse asks the client what the number 80 in the blood pressure 120/80 represents. Which response by the client demonstrates correct understanding of the basic concepts of blood pressure?

Diastolic Pressure

Stimulation in dopaminergic receptors sites results in ________.

Dilation.

Class 1 of Antiarrhythmis that block the sodium channels in the cell membrane.

Disopyramide(Norpace), Procainamide(generic), and Quinidine (also generic).

This receptor sites are located in the coronary arteries, renal, mesenteric, and visceral blood vessels.

Dopaminergic

Antiplatelets

Drugs that bind to receptors on the surface of the platelet and inhibit platelet activity.

Thrombolytics

Drugs that dissolve existing clots

Anticoagulants

Drugs that inhibit clotting factors and prevent clot formation and extension. (Does not break down blood clots)

Where are nicotinic receptors found?

In the skeletal muscle.

What are the effects or Norepinephrine on Beta-1 Receptor sites?

Increased heart rate, Increased conductivity, and Increased contractility.

A client has a myocardial infarction and has been diagnosed as having damage to the layer of the heart responsible for the pumping action. The nurse is aware that the damage is in the:

Myocardium

Hageman Factor

Initiates activation of the coagulation cascade.

How does the majority of coagulation begin?

It begins with injury to the endothelial lining.

What is the Chronotropic Effect?

It refers to a change in heart rate. A positive effect refers to an increase in heart rate. A negative effect refers to a decrease in heart rate.

What is the Dromotropic Effect?

It refers to the change in the speed of conjuction through the AV junction. A positive dromotropic effect results in an increase in AV conduction velocity A negative dromotropic effect results in a decrease in AV conduction velocity

What are the effects of parasympathetic stimulation on the heart?

It slows the rate of discharge of the SA node, slows conduction through the AV node, decreases the strength of atrial contraction, and can cause a small decrease in the force of ventricular contraction. (There is little effect on the strength of ventricular contraction because of minimal parasympathetic innervation of these chambers.) The net effect of parasympathetic stimulation is slowing of the heart rate.

The black box warning associated with warfarin concerns its risk of causing what condition?

Major or fatal bleeding

A patient is scheduled to have a pacemaker implanted. After the patient signs the consent, the patient asks the nurse several questions about the procedure and the expected therapeutic results. What would the nurse suspect as a possible reason for the insertion of a pacemaker?

Malfunction of the sinoatrial (SA) node.

The effects of warfarin (Coumadin) are monitored by what laboratory test(s)?

PT and INR

When describing angina to a group of clients, what would be most accurate?

Pain due to lack of oxygen in the heart muscle

What nerve fibers supply the SA node, atrial muscle, and the AV junction of the heart by means of the vagus nerves?

Parasympathetic (inhibitory) nerves

What are the effects of norepinephrine on alpha receptor sites?

Peripheral vasoconstriction.

What are the elements of Hemostasis?

Platelets, Coagulation Factors, Endothelium.

A client is admitted to the hospital with deep vein thrombosis. Heparin 10,000 units is administered Sub-Q. Which drug should always be available in the pharmacy if the client begins to bleed?

Protamine Sulfate

Which factor would necessitate that the dosage of disopyramide (Norpace) be reduced?

Renal Impairment

Baroreceptors, or pressoreceptors.

Specialized nerve tissue, that is found in internal carotid arteries/aortic arch. They detect changes in blood pressure and cause a reflex response in either the sympathetic or parasympathetic divisions of the autonomic nervous system.

What are premature ventricular contractions?

Stimulation of the entricle from an ectopic focus in the ventricles

What nerve fibers supply the SA node, the AV node, the atrial muscle, and the ventricular myocardium?

Sympathetic (accelerator) nerve fibers.

The action of thrombolytic Drugs:

The break down the thrombus that has been formed by stimulating the plasmin system.

Plasmin

The enzyme that dissolves fibrin

Thrombin

The primary element of coagulation it powers the conversion of fibrinogen to fibrin.

Prothrombin

The protein found in plasma that when activated becomes thrombin.

Beta-2

The receptor site located in bronchial smooth muscle,and skeletal blood vessels. Stimulation of these receptor sites results in dilation of the smooth muscle of the bronchi and blood vessel dilation.

Dopaminergic

The receptor site located in the coronary arteries, renal, mesenteric and visceral blood vessels.

Beta-1

The receptor site located in the heart. Stimulation of beta-1-receptors results in an increased heart rate, contractility, and, ultimately, irritability of cardiac cells.

Alpha

The receptor site located in the vascular smooth muscle(arteries/ arterioles, veins)

Action of a anti-platelet:

They alter the formation of the platelet plug.

Where are muscarinic receptors found?

They are located in smooth muscle.

What is the Inotropic Effect?

This refers to the change in myocardial contractility. A positive effect results in an increased myocardial contractility. A negative inotropic effect results in a decrease in myocardial contractility.

Antiplatelet agents decrease the formation of the platelet plug by decreasing the responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. Which drug is an antiplatelet agent? (Mark all that apply.) Iprivask Arixtra Actuvase ReoPro Ticlopidine

Ticlopidine

What is the single most important factor determining the amount of blood pumped back to the heart?

Venous Return

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

aPTT

What is the primary parasympathetic neurotransmitter?

acetylcholine.

Fibrinolytic

an agent that breaks down fibrin

What mimics the response of the endothelium to thrombus?

fibrinolytics

A client is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid:

ginko

Stimulation of sympathetic nerve fibers results in the release of ______________, a neurotransmitter that increases the force of ventricular contraction, heart rate, blood pressure, and cardiac output.

norepinephrine

Extrinsic Pathway

system that clots blood that escapes the vascular system.

fibrin

the final product of coagulation that forms an insoluble mesh and stops blood flow(holds the platelets together)

Plasminogen

the inactivate precursor of plasmin (constantly floating throughout our circulation)

Fibrinogen

the soluble protein in plasma that when activated converts to fibrin.