Saunders NCLEX Ch. 57: Cardiovascular Medications

The nurse is planning to administer hydrochlorothiazide to a client. The nurse should monitor for which adverse effects related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hyperglycemia, sulfa allergy Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Aldo, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristics of digoxin toxicity? *Select all that apply.* 1. Tremmors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2, 4, 5 Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred visions, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 05. to 0.8 ng/mL

The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential adverse complication associated with this medication? 1. The development of complaints of insomnia. 2. The development of auditory expiratory wheezes. 3. a baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mmHg after two doses of the medication. 4. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication.

2. The development of auditory expiratory wheezes. Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and hear rate are expected. Insomnia is a frequent mild side effect and should be monitored.

The nurse provides discharge instructions to a client who is taking warfarin sodium,. Which statement, by the client, reflects the *need for further teaching*? 1. "I will avoid alcohol consumption" 2. "I will take my pills every day at the same time" 3. "I have already called my family to pick up a MedicAlert bracelet." 4. I will take coated aspirin for my headaches because it will coat my stomach."

4. I will take coated aspirin for my headaches because it will coat my stomach." Aspirin-containing products need to avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provided health care personnel with emergency information.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving the therapeutic effect based on which of the following results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

2. Activated partial thromboplastin time of 60 seconds Common laboratory ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds. Because the aPTT should be 1.5 to 2.5 times the normal value, the client's aPTT would be considered therapeutic if it was 60 seconds. Prothrombin time assesses the response to warfarin therapy.

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the clients laboratory results? 1. Collaborate with the HCP to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP tp obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate withe the HCP to continue the heparin infusion at the same rate and to discuss the use of dabigatran etexilate in place of warfarin sodium

2. Collaborate with the HCP tp obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate withe the HCO to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid

2. Protamine sulfate The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin k is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum 2. Urine output increases from 10 mL/hour to greater than 50 mL hourly 3. The serum potassium level changes from 3.8 to 3.1 mEq/L 4. B-type natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL

2. Urine output increases from 10 mL/hour to greater than 50 mL hourly Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 3, and 4 are incorrect.

The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4 orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths/minute

3. Blood pressure of 198/110 mm Hg Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore, the nurse would report the results of the blood pressure to the HCP before initiating therapy.

A client is diagnosed ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a *priority* nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

3. Monitor for signs of bleeding. Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1. Administer oxygen and protamine sulfate. 2. Cut the infusion rate in half and sit the client up in bed. 3. Stop the infusion and call for the Rapid Response Team (RRT). 4. Administer dyphenhydramine and epinephrone and continue the infusion.

3. Stop the infusion and call for the Rapid Response Team (RRT). The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the RRT. The healthcare provider should be contacted once the client has been stabilized. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed, but the infusion should not be continued.

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran) and the nurse teaches the client about the medication. Which statement, by the client, indicates the *need for further teaching*? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

4. "I'll continue my nicotinic acid from the health food store." Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the 2 most common adverse effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol." 2. " The medication should be taken with meals to decrease flushing." 3. Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing."

4. "Ibuprofen IB taken 30 minutes before the nicotinic acid should decrease the flushing." Flushing is an adverse effect of this medications. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minute prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the health care provider immediately.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and is complaining of anorexia. The HCP prescribes a serum digoxin level to be done. The nurse checks the results and should expect to note which level that is outside of the therapeutic range? 1. 0.3 ng/ml 2. 0.5 ng/ml 3. 0.8 ng/ml 4. 1.0 ng/ml

4. 1.0 ng/dl The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/ml. If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and an elevated level.

A client is being treated with procainamide for a cardiac dysrhythmia. Following IV administration of the medication, the client complains of dizziness. What interventions should the nurse take *first*? 1. Measure the heart rate on the rhythm strip. 2. Administer prescribed nitroglycerine tablets. 3. Obtain a 12-lead electrocardiogram immediately. 4. Auscultate the client's apical pulse and obtain a blood pressure.

4. Auscultate the client's apical pulse and obtain a blood pressure. Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead electrocardiogram ay be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure.

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.0 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

4. Serum magnesium level An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium, is 1.3 to 2.1 mEq/L and the results in the correct option are reflective of hypomagnesemia.