Quiz 2

The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.) Prevent platelet aggregation. Prevent the extension of existing clots. Inhibit steps in the fibrin clot formation cascade. Prolong bleeding time. Lower serum triglycerides.

Prevent platelet aggregation. Prevent the extension of existing clots. Inhibit steps in the fibrin clot formation cascade. Prolong bleeding time.

pharm

ch 25-27

The nurse takes into consideration that age-related changes can affect the peripheral circulation because of: sclerosed blood vessels. hypotension. inactivity. poor nutrition.

sclerosed blood vessels.

Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)? "I eat a banana every morning with breakfast." "I try to eat more green leafy vegetables, especially broccoli, spinach, and kale." "I try to eat a well-balanced, low-fat diet." "I don't drink alcohol or caffeine."

"I try to eat more green leafy vegetables, especially broccoli, spinach, and kale."

Which instruction by the nurse will be included when teaching an adult patient about digoxin( Lanoxin) for management of heart failure? "Report nausea and vomiting to your health care provider." "Decrease the amount of high potassium foods you eat." "Omit your dose of digoxin if your pulse is 60 beats/min." "Visual disturbances are common adverse effects."

"Report nausea and vomiting to your health care provider."

Which drug is used to obtain vasodilation in the treatment of chronic heart failure? ACTH ACE inhibitors ARBs ANB agents

ACE inhibitors

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)? Bradycardia Petechiae Increased urinary output Dry skin

Petechiae

The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take? Administer the medication. Contact the pediatric cardiologist for further orders. Hold the digoxin. Request that another unit nurse assess the child.

Administer the medication.

Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.) Administer diuretics at bedtime. Assess electrolyte levels. Report daily weight fluctuations. Encourage sodium intake. Maintain skin hygiene.

Assess electrolyte levels. Report daily weight fluctuations. Maintain skin hygiene.

Which is the initial manifestation of digoxin toxicity in children? Hallucinations Weakness Atrial dysrhythmia Diuresis

Atrial dysrhythmia

Which patient teaching would help to prevent venous stasis? (Select all that apply.) Dangle legs when sitting. Avoid crossing the legs at the knee. Elevate legs when lying in bed or sitting. Massage extremities to help maintain blood flow. Wear elastic stockings when ambulating.

Avoid crossing the legs at the knee. Elevate legs when lying in bed or sitting. Wear elastic stockings when ambulating.

Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.) Ringing in the ears Bradycardia Headache Visual disturbance Hematuria Gastrointestinal complaints

Bradycardia Headache Visual disturbance Hematuria Gastrointestinal complaints

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event? Myocardial infarction Transient ischemic attack Cardiac valve replacement

Cardiac valve replacement

A patient with heart failure has been prescribed nesiritide (Natrecor). Which statement(s) is/are true regarding this medication? ( Select all that apply. ) It increases preload. Cardiac ventricles secrete this hormone in response to fluid overload. It suppresses aldosterone. It promotes norepinephrine secretion. It causes vasodilation.

Cardiac ventricles secrete this hormone in response to fluid overload. It suppresses aldosterone. It causes vasodilation.

Which nursing assessment is most important to determine fluid status for a patient with heart failure? Auscultation of lungs Daily weights Intake and output Measurement of abdominal girth

Daily weights

What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.) Detect thrombi before a cardioversion. Check for cardiac arrhythmias. Visualize vegetation on the heart valves. Measure effectiveness of diuretic therapy. Visualize abscesses on the heart valves.

Detect thrombi before a cardioversion. Visualize vegetation on the heart valves. Visualize abscesses on the heart valves.

Which drug will be administered to a patient being admitted with severe digoxin intoxication? Amiodarone (Cordarone) Spironolactone (Aldactone) Digoxin immune Fab (Digibind) Digitalis glycoside

Digoxin immune Fab (Digibind)

The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? ( Select all that apply. ) Reports of recent weight loss Complaints of peripheral edema Diminished exercise tolerance Shortness of breath with activity Blood pressure elevation

Diminished exercise tolerance Shortness of breath with activity

3. Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.) Assessment of recent aPTT levels Massaging the site after injection of medication Aspirating after needle insertion Documenting ecchymotic areas Monitoring of vital signs

Documenting ecchymotic areas Monitoring of vital signs

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer? Cool dry lower limb Edematous, red scaly skin on medial surface of the leg Lack of hair and shiny appearance of the lower leg Lack of a pedal pulse

Edematous, red scaly skin on medial surface of the leg Suggestion of a stasis ulcer in the making is an edematous, dry scaly area on the medial surface of the lower leg that has a darker pigmentation (rubor). Cool hairless limbs with absent or weak pedal pulses are indicative of arterial insufficiency.

The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed? Potassium supplements Furosemide (Lasix) Acetylsalicylic acid (aspirin) Antibiotics

Furosemide (Lasix)

The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times? Late in the afternoon At bedtime With any meal In the morning

In the morning

Which action of ACE inhibitors results in effective treatment of heart failure? Increased afterload Increased aldosterone Increased preload Increased cardiac output

Increased cardiac output

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low- molecular-weight heparin product? Expel the air bubble from the prefilled syringe. Leave the needle in place for 10 seconds after injection. Administer the medication into the deltoid muscle. Massage the site after injection to increase absorption.

Leave the needle in place for 10 seconds after injection

The nurse is performing a head to toe assessment on a resident in a long term care facility with a history of angina pectoris. When assessing peripheral perfusion, the nurse will perform which intervention(s)? (Select all that apply.) Count heart rate and describe rhythm. Note any loss of hair on lower legs. Auscultate blood pressure. Check pedal pulses. Assess pupil reaction.

Note any loss of hair on lower legs. Check pedal pulses.

hat is the mechanism of action of drugs used to treat thromboembolic disease? Dissolving clots and preventing formation of new clots Making platelets more flexible and preventing formation of new clots Causing vasodilation and increased blood flow Preventing platelet aggregation and inhibiting clot formation

Preventing platelet aggregation and inhibiting clot formation

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? Warfarin sodium (Coumadin) Enoxaparin (Lovenox) Protamine sulfate Vitamin K

Protamine sulfate

Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? ( Select all that apply. ) Review of the digoxin blood level Administration of the medication with pulse less than 60 beats/min Review of serum electrolytes, liver, and kidney function studies Administration of the medication with a pulse of 110 beats/min Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

Review of the digoxin blood level Review of serum electrolytes, liver, and kidney function studies Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

What is the difference between primary and secondary hypertension?

Secondary hypertension is caused by another disorder like renal disease.

How should the nurse advise a patient with an international normalized ratio (INR) of 5.8? Make arrangements to go to the emergency room immediately. Increase fluid intake to 2000 mL/day. Stop taking the anticoagulant and notify health care provider. Add more leafy green vegetables to patient diet.

Stop taking the anticoagulant and notify health care provider.

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate? Document in the nursing notes that these results are within therapeutic range. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. Stop the heparin drip. Assess the patient for signs and symptoms of decreased sensorium.

Stop the heparin drip.

What is the rationale behind administering calcium channel blockers to patients with angina? They decrease heart rate. They dilate blood vessels. They increase cardiac contractility. They promote fluid excretion.

They dilate blood vessels.

Which statements about vasodilators is/are true? ( Select all that apply. ) They reduce systemic vascular resistance. They increase afterload. They reduce preload. They decrease pulmonary congestion. They increase tissue perfusion to muscles and organs. They increase the volume of blood returning to the heart.

They reduce systemic vascular resistance. They increase afterload. They reduce preload. They decrease pulmonary congestion. They increase tissue perfusion to muscles and organs.

Anticoagulant therapy may be used for which situation(s)? (Select all that apply.) To prevent stroke in patients at high risk Following a myocardial infarction Following total hip or knee joint replacement surgery With DVT To prevent thrombosis in immobilized patients Peptic ulcer disease

To prevent stroke in patients at high risk Following a myocardial infarction Following total hip or knee joint replacement surgery With DVT To prevent thrombosis in immobilized patients

The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply.) Warming hands and feet with a heating pad Using mittens in cold weather Practicing stress-reducing techniques Complete smoking cessation Using caution when cleaning the refrigerator or freezer

Using mittens in cold weather Practicing stress-reducing techniques Complete smoking cessation Using caution when cleaning the refrigerator or freezer

Which medication combinations may be beneficial in treating angina pectoris? Antidysrhythmics and platelet active agents ACE inhibitors and statins Vasoconstrictors and diuretics Analgesics and thrombolytics

Vasoconstrictors and diuretics

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C-section. To prevent clot formation, the nurse will position the patient with knees flexed. initiate use of fitted thromboembolic disease deterrent (TED) stockings. maintain complete bed rest. implement deep breathing and coughing exercises.

implement deep breathing and coughing exercises.

The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive heart failure. The nurse will schedule this medication: in the morning. after lunch. with dinner. at bedtime.

in the morning.

The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can: cause severe episodes of diarrhea. cause a severe skin eruption if taken with Coumadin. increase the action of the Coumadin. cause the Coumadin to be less effective

increase the action of the Coumadin.

The pain that a person with arterial insufficiency feels on exertion, which is relieved by rest, is ______________ _____________.

intermittent claudication

The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between: 1 and 2. 2 and 3. 3 and 4. 4 and 5.

2 and 3.

The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.) "Do not make any major changes to your diet without discussing it with your health care provider." "Keep outpatient laboratory appointments for monitoring of therapy." "Take the medication after meals." "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." "Avoid aspirin products."

"Do not make any major changes to your diet without discussing it with your health care provider." "Keep outpatient laboratory appointments for monitoring of therapy." "Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium." "Avoid aspirin products."

A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate? "It takes at least 3 days for the symptoms to resolve once the clot dissolves." "Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body." "I will report this to your health care provider because there may be a need to look at alternative treatments." "You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge."

"Heparin does not dissolve blood clots but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body."

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching? "I will always wear a medical alert bracelet." "I will check with my health care provider before I take any OTC medications." "I will be careful when I use a knife or other sharp objects." "I will rinse my mouth with mouthwash instead of brushing my teeth."

"I will rinse my mouth with mouthwash instead of brushing my teeth."

The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate? "This medication dilates your coronary arteries." "This medication will help your kidneys get rid of fluid." "This medication reduces volume returning to your heart so it doesn't overstretch." "This medication reduces the resistance your heart has to pump against."

"This medication reduces the resistance your heart has to pump against."

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate? Bolus the patient with an additional 5000 units of heparin. Stop the heparin immediately and notify the health care provider that the patient's blood level is toxic. Administer protamine sulfate stat. Continue with the prescribed rate.

Continue with the prescribed rate.

What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction? Enhances myocardial oxygenation Lyses the blood clot Promotes platelet aggregation Inhibits clotting mechanisms

Lyses the blood clot

The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot? Pain, which would be a positive Homans' sign Muscular spasm, which would be a sign of hypocalcemia Rigidity, which would be a sign of ankylosis Crepitus, which would be a sign of a joint disorder

Pain, which would be a positive Homans' sign

Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.) Increase the dose of aspirin for better therapy. Take medication at the same time each day. Report to physician cuts that do not stop bleeding with direct pressure. No restrictions for food or drink. Report for prescribed blood tests (PTT, INR, CBC, blood sugar).

Take medication at the same time each day. Report to physician cuts that do not stop bleeding with direct pressure. Aspirin should not be used with anticoagulant therapy because it will increase bleeding. Gums, nosebleeds, excessive bruising, and cuts that do not stop bleeding with direct pressure should be reported to the physician. Alcohol and dark green and yellow vegetables should be avoided because they contain vitamin K. Normal blood tests for anticoagulant therapy are PTT, INR, and PT.

The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for: reduction of alcohol intake. avoiding cold remedies. cessation of smoking. weight reduction.

cessation of smoking.

Following an angiogram with the insertion site of the left groin, the nurse will include in the plan of care provisions for: (Select all that apply.) checking pedal pulses. ambulating with assistance 2 hours after recovery. checking color and warmth of left leg frequently. sandbagging over insertion site. placing patient in semi-Fowler's position.

checking pedal pulses. checking color and warmth of left leg frequently. sandbagging over insertion site.