Unit4 pharm

The client receives warfarin (Coumadin) and becomes pregnant. The physician changes her anticoagulant to enoxaparin (Lovenox). She asks the nurse "Why did the doctor do that?" What is the best rationale by the nurse?

"Because enoxaparin (Lovenox) cannot get into your baby."

The nurse is managing care for a client with cirrhosis of the liver. The nurse teaches the client about how to avoid injury that may result in bleeding. The client asks the nurse why he is at risk to start bleeding. What is the best response by the nurse?

"Because your liver is injured and cannot make clotting factors."

The client receives an appropriate dose of warfarin (Coumadin), but the international normalized ratio (INR) is in the high range. The client denies taking any aspirin products. What is the best assessment question to ask the client at this time?

"Have you been eating much garlic?"

The client is being discharged on warfarin (Coumadin) following a valve replacement. The nurse has completed medication education and determines that learning has occurred when the client makes which statement?

"I must wear a medic alert bracelet that says I'm on warfarin (Coumadin)."

The client receives enoxaparin (Lovenox) postoperatively. The nurse teaches the client about this medication and evaluates that learning has occurred when he makes which statement?

"It increases the time it takes for me to form a clot."

The physician orders pentoxifylline (Trental) for the client with peripheral vascular disease. The nurse has completed medication education and determines that learning has occurred when the client makes which statement(s)? Select all that apply.

"It makes my red blood cells (RBCs) squishy so they can go into the little blood vessels." "It decreases my platelets so my blood is less likely to clot." "It decreases the "stickiness" of my blood."

The new mother receives heparin. She asks the nurse if she can breast-feed her baby. What is the most therapeutic response by the nurse?

"No, because this could cause your nipples to bleed."

A woman brings her husband to the emergency department and tells the nurse that her husband just had a stroke. The physician verifies a thrombotic cerebral vascular accident (CVA) occurred and plans to use alteplase (Activase). What priority assessment question will the nurse ask the wife?

"What time did your husband have the stroke?"

Match the items.The task is to match the lettered items with the correct numbered items. Appearing below is a list of lettered items. Following that is a list of numbered items. Each numbered item is followed by a drop-down. Select the letter in the drop down that best matches the numbered item with the lettered alternatives. a. systolic 140-159 and diastolic 90-99 b. systolic = or >160 and diastolic = or >100 c. = or < 119/79 d. systolic 120-139 and diastolic 80-89 1. Normal BP 2. Prehypertension 3. Stage 1 Hypertension 4. Stage 2 Hypertension

1. C 2. D 3. A 4. B

Match the items.The task is to match the lettered items with the correct numbered items. Appearing below is a list of lettered items. Following that is a list of numbered items. Each numbered item is followed by a drop-down. Select the letter in the drop down that best matches the numbered item with the lettered alternatives. a. caused by bacteria/toxins in the blood b. trauma to the brain or spinal cord c. cardiac pump failure d. related to blood loss 1. hypovolemic shock 2. neurogenic shock 3. cardiogenic shock 4. septic shock

1. D 2. B 3. C 4. A

Match the items.The task is to match the lettered items with the correct numbered items. Appearing below is a list of lettered items. Following that is a list of numbered items. Each numbered item is followed by a drop-down. Select the letter in the drop down that best matches the numbered item with the lettered alternatives. a. disease that occurs in the absence of pain b. decreased myocardial blood flow caused by spasms of the coronary artery c. Predictable duration, frequency, intensity of pain d. Pain occurs more frequently, bcomes more intense, or occurs at periods of rest 1. Stable Angina 2. Unstable agina 3. Vasospastic (Prinzmetal's) angina 4. Silent angina

1. c 2. d 3.b 4. a

Match the items a. filters the blood b. block aldosterone c. passes filtrate d. filtrates e. functional unit which receives blood f. increase urine output 1. loop of Henle 2. Bowman's capsule 3. nephrone 4. distal tubule 5. loop diuretic 6. potassium-spring diuretics

1.d 2.a 3.e 4.c 5.f 6.b

Neupogen should be given at least ________ hours before chemotherapy.

24

Patients must be instructed to take one nitroglycerine (Nitrostat) tablet (under the tongue) every 5 minutes until pain is relieved, or up to ____ doses.

3

An apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is less than _____ bpm, the medication should be held and the ordering practitioner informed.

60

Order of importance for patients with renal failure: A. reducing the medication dosage B. recognizing which medications that are nephrotoxic C. measure the patient's fluid intake and output D. knowing which drugs will increase fluid retention

A.1, B.2, C.3, D.4

apoprotein for lipid transport

A1

In life-theatening situations, there are no ___________ contraindications for using epineprhine.

ABSOLUTE

The physician orders enoxaparin (Lovenox) for the postoperative client. What is the best administration technique by the nurse?

Administer the medication in the abdomen, subcutaneously.

The client receives warfarin (Coumadin). The nurse notes that the client's morning international normalized ratio (INR) is 7. What are the priority nursing interventions at this time?

Administer vitamin K and hold the next dose of warfarin (Coumadin).

The client has a deep vein thrombosis (DVT) and is admitted for initial heparin therapy. Which order(s) would the nurse want to validate with the physician? Select all that apply.

Advil as needed (PRN) for headaches Low vitamin K diet Heparin 1,000 units intravenous (IV) every 6 hours

Risk factors for developing hypertension [mark all correct answers] a. age b. race c. female d. smoking e. obesity f. youth

Age, Smoking, obesity

Alteplase (Activase) must be given within ___ hours of a thrombotic cerebro vascular accident (CVA) for maximum effectiveness

Alteplase (Activase) must be given within 3 hours of a thrombotic cerebro vascular accident (CVA) for maximum effectiveness.

To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important?

Avoid drinking grapefruit juice

LDL

Bad lipoprotein

For which potential adverse effects would the nurse monitor patients prescribed amiodarone?

Bluish skin discoloration, hypothyroidism, photosensitivity

Match the items.The task is to match the lettered items with the correct numbered items. Appearing below is a list of lettered items. Following that is a list of numbered items. Each numbered item is followed by a drop-down. Select the letter in the drop down that best matches the numbered item with the lettered alternatives. a. improve force of cardiac muscle contraction b. change the heart rate by affecting the nerves controlling the heart, or by changing the rhythm produced by the sinoatrial node c. alters the force or strength of the heart's muscular contractions (heartbeats). d. increase the heart rate 1. ionotropic drugs 2. chronotropic drugs 3. positive chronotropic effect 4. positive ionotropic drugs

C B D A

Which class of drugs is used to treat both hypertension and dysrhythmias?

Calcium channel blockers

Enalapril is pregnancy category ___ drug that has a higher fetal risk than do the other drugs listed.

D

General symptoms of shock include behavioral changes such as restlessness, anxiety, confusion, depression, and apathy. The skin may feel warm and dry.

FALSE

The most important food for a patient taking anticoagulants to avoid is:

Garlic.

The nurse is aware that the mechanism of action of anticoagulant drugs is to:

Inhibit clotting factors to prevent clot formation.

The ____ are the primary organs for regulating fluid and electrolyte balance. These organs are also the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure.

Kidneys

Laboratory studies related to heparin therapy include:

Laboratory studies related to heparin therapy include aPtt The correct response(s): aPtt

furosemid (Lasix) is called a _____diuretic because it acts by preventing the reabsorption of sodium in the _______ of Henle.

Loop

Thrombolytic drugs are used to:

Lyse a thrombus.

-Read about the drug class -Read about the Mechanism of Action, and know how it works on the cellular level -Read about Indications, the first is the FDA approved one and the second type is nonFDA or off label indications -Contraindications, meaning don't take it, or relative if the benefit out weights the risk -Adverse effects/side effects -Don't have to remember dosage -read nursing process and read teaching tips

Macrolides MOA: Indications: Contraindications: Adverse effects: Interactions: Proto type drug :Erythromycin Over Macrolides implementation: Evaluation: Patient teaching:

Anticoagulants are used to:

Prevent the formation of blood clots.

The process of fibrinolysis is to:

Remove a blood clot.

Side effects of antidysrhythmic medications include: (mark all that apply) [mark all correct answers] a. palpitations b. fever c. constipation d. weakness e. nausea f. fatigue g. dry mouth

Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. The correct response(s): a,d,f

Albumin is a natural blood product and allergic reactions are possible.

TRUE

The client receives heparin. During the morning assessment of the client, the nurse notes that the client's blood pressure and red blood cell (RBC) count are low. There is no evidence of bleeding on the bed linen or the client's gown. What will the best assessment of this client reveal?

The client may be bleeding internally.

The nurse is managing care for a client with a DVT (deep vein thrombosis) of the right calf. The client receives heparin intravenously (IV). What is the priority outcome for this client?

The client will not experience bleeding

The blood vessel spasms, causing constriction during the initial event in the hemostasis process. The nursing instructor is teaching student nurses about the process of hemostasis after an injury. What does the nursing instructor include as the initial event in this process?

The vessel spasms

The client receives warfarin (Coumadin). The nurse plans to teach the client to avoid which foods that are served for lunch?

Tomato salad with basil

A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order?

Ventricular arrhythmias

The patient receiving sodium bicarbonate is prone to _____; monitor for cyanosis, slow respirations, and irregular pulse.

acidosis

Angina pectoris is _______ chest pain caused by insufficient oxygen reaching a portion of the myocardium. Accompanying the discomfort is severe emotional distress, a feeling of panic with fear of impending death.

acute

Epoetin alfa (Procrit) is prescribed to treat _____________ associated with chemotherapy;

anemia

Vitamin K is the __________ for warfarin (Coumadin) overdose

antidote

Before administering a dose of an antidysrhythmic drug to an assigned patient which assessments would be of highest priority?

apical pulse and blood pressure

Potassium chloride (KCL) must never be administered intravenous (IV) _______.

arrest

The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary _______ walls

artery

The myocardium receives blood from the right and left coronary arteries that arise from aortic sinuses at the _______ of the aorta. These divulge into smaller branches that encircle the heart.

base

A patient is taking warfarin sodium. The nurse will reinforce teaching by telling the patient that he should watch for

bleeding

An absence of ___________is a priority outcome for any patient receiving anticoagulant therapy.

bleeding

The liver is responsible for the production of essential clotting factors necessary to prevent ________

bleeding

The nurse will teach the patient taking warfarin that he should watch for

bleeding

Use of heparin during breastfeeding can trigger _______ from the nipples and should be avoided.

bleeding

With increased doses, beta-adrenergic blockers can slow the heart rate and cause _______

bronchoconstriction

Verapamil ( Calan) acts by inhibiting the flow of _______ ions both into myocardial cells and in vascular smooth muscles.

calcium

Grapefruit juice in combination with a sustained release _______ _________ __________ could result in rapid toxic overdose, which is a medical emergency.

calcium channel blocker

Heart walls thicken and enlarge with heart failure. These changes occur over time, and are referred to as _____________ remodeling. Blood can back up into the lungs, but this would be a result of left ventricular hypertrophy, not right. Blood pressure can go up, but would result in a higher, not lower, afterload.

cardiac

when developing a nursing care plan for a patient receiving epoetin alfa(Epogen) the nurse will include monitoring for which adverse effects?

change in level of consciousness

Thrombolytics break up the _____.

clot

Atrial fibrillation is the most ________ type of dysrhythmia.

common

Triglycerides

common classification lipids

the nurse knows a common expected adverse effects of iron supplementation is which effect?

constipation

The patient's ECG is usually monitored ______________during the infusion of milrinone (Primacor).

continuously

Beta-blockers are __________ for patients with chronic bronchitis. Beta-blockers may be used for patients with migraines. Beta-blockers may be used for patients with compensated heart failure. Beta-blockers may be used for patients with apical pulse rates of 100.

contraindicated

Ascorbic acid affects the stability of ______________ (Nascobal), and should not be used concomitantly with cyanocobalamin

cyanocobalamin

Patients receiving thiazide diuretics should check weight ___ and report a weight gain of 2 or more pounds in 24 hours.

daily

blood volume is one of the three factors influencing blood pressure. Diuretics ___blood pressure by decreasing total blood volume

decrease

direct vasodilators produce reflex tachycardia, a compensatory response to the sudden ___ in blood pressure caused by the drug.

decrease

When beta blockers are abruptly ___________, adrenergic receptors are stimulated causing excitation. This could result in tachycardia or myocardial infarction (MI).

discontinued

A hypotonic solution will cause a fluid shift out of the plasma into the tissues and cells in the intracellular compartment. This will increase _______.

edema

Wheezes are commonly auscultated with pulmonary ____, which can occur with chronic renal failure and fluid retention. This is a priority nursing assessment because pulmonary edema affects the patient's oxygenation.

edema

Small, inorganic molecules possessing a positive or negative charge are called ________. These ions are able to conduct electricity.

electrolytes

Some children have several life-threatening allergies to insect stings, foods (peanuts), and medications. For this reason, the patient, family, and caregivers need to know how use an ___-___ correctly.

epi-pen

Hydrochlorothiazide (HydroDIURIL) is a potassium-_______ diuretic and potassium supplementation is often necessary.

excreting

Sodium bicarbonate makes the urine more basic, which aids in the renal _________ of acidic drugs such as aspirin

excretion

Beta blockers increase myocardial oxygen demand, which is critical for patients who have experienced a recent myocardial infarction (MI).

false

Weight gain could indicate improvement in the symptoms of heart failure.

false

taking a diuretic early in the day will help prevent excessive urination.

false

Constipation is a common side effect of ferrous sulfate; therefore, an increase in dietary ________ may be indicated.Ferrous sulfate (Feosol) will turn stools a harmless, dark green or black color; this is an expected side effect of the medication.

fiber

Insufficient __________ acid can manifest itself as anemia. This is often observed in chronic alcoholism, since alcoholics consume alcohol instead of eating nutritious foods. Alcohol interferes with folate metabolism in the liver.

folic

A primary goal in the treatment of angina is to reduce the intensity and ________________ of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode

frequency

HDL

good lipoprotien

Discontinuation of vasopressor therapy (norepinephrine) is always _________, due to the possibility of rebound hypotension and undesirable cardiac effects.

gradual

adverse effect statins

headache

Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to __________

hyperkalemia

Diuretics are indicated for the treatment of renal failure, _____and for the removal of edema fluid.

hypertension

The most serious adverse effect of epoetin alfa (Epogen) is _________________, which can raise blood pressure to dangerous levels, and which occurs in as many as 30% of clients receiving the drug.

hypertension

what is an electrolyte depletion adverse effect of diuretic therapy?

hypokalemia

A patient with erectile dysfunction is likely to use sildenafil (Viagra). Concurrent use of sildenafil (Viagra) and nitroglycerine (Nitrostat) may cause life-threatening ___________ and cardiovascular collapse.

hypotension

Enalapril (Vasotec) may produce a first dose phenomenon resulting in profound ______, which may result in syncope. Enalapril (Vasotec) is more likely to cause hyperkalemia.

hypotension

primary hypertension is known as _____, and has no known cause

idiopathic

Cardiac glycosides _____________ cardiac output by increasing the force of contraction.

increase

Antidysrhythmic drugs may cause hypotension. Orthostatic hypotension may increase the risk of falls and _____

injury

Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the patient might require less _________

insulin

Serum potassium levels may be temporarily lowered by administering glucose and ____, which cause potassium to leave the extracellular fluid and enter cells.

insulin

A laboratory test used to best measure the effectiveness of warfarin sodium therapy is known as ______________.

international normalized ratio

the nurse will plan to inject iron dextran by which technique

intramuscular injection using the z track injection

The four target organs most commonly affected by hypertension are the heart, _____, brain, and retina.

kidney

The nurse must closely monitor the patient's renal status during the administration of ammonium chloride, because the excretion of this drug depends on normal _____ function.

kidney

An adverse effect of propranolol (Inderal) which might cause noncompliance with the medication includes diminished______ and impotence.

libido

Procainamide is effective for the treatment of all but the following: a. local anesthesia b. atrial fibrillation c. ventricular tachycardia d. premature atrial contractions

local anesthesia

A _____blood pressure and red blood cell (RBC) count in the patient could indicate internal bleeding.

low

Patients on anticoagulant therapy should wear a ___________bracelet.

medicalert

Cerebral hemorrhage is a concern with reteplase (Retavase) therapy; the nurse must assess for changes in ________ and neurological status.

mental

Elderly patients should take diuretics early in the __ to avoid nocturia.

morning

All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the _____________.

myocardium

Anorexia and _________ are common adverse effects of digoxin (Lanoxin). Hypotension, bradycardia, blurred vision, and constipation can occur.

nausea

Extravasion of dopamine can cause severe, localized vasoconstriction resulting in tissue________.

necrosis

NSAIDS, such as ibuprofen, are ______drugs.

nephrotoxic

The use of ACE inhibitors can lead to___________, and the patient should be monitored for this side effect by having his absolute neutrophil count (ANC) measured.

neutropenia

Loop diuretics are ________. Instruct the patient to report ringing in the ears or becoming "hard of hearing" and notify the physician.

ototoxic

The primary means by which antianginal drugs terminate an acute angina episode, or decrease the frequency of angina episodes, is by reducing the myocardial demand for ________.

oxygen

Dopamine is contraindicated for ________________

pheochromocytoma

Garlic has been shown to decrease the aggregation of ___________, thus producing an anticoagulant effect.`

platelets

Orange juice and bananas are high in _______ and are contraindicated with a potassium sparing diuretic.

potassium

Orange juice is a source of __________, which will minimize the risk for digoxin (Lanoxin) toxicity.

potassium

Most antidysrhythmic drugs act by interfering with myocardial action __________, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats.

potentials

A cough is an adverse effect of captopril (Capoten) and should be reported to the _____

prescriber

Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in blood ______ and chemoreceptors that detect oxygen, carbon dioxide, and pH levels.

pressure

During fluid replacement therapy, the nurse must assess for fluid volume deficit and fluid volume excess. This is commonly done by assessment of blood ____ and urinary output.

pressure

Anticoagulants inhibit the specific clotting factors and interfere with clotting cascade, and thereby __________ clots.

prevent

Because human serum albumin pulls fluid into the vascular space, circulatory overload is a serious complication. The nurse must monitor breath sounds; crackles will be heard with _________ congestion.

pulmonary

Fluid overload may result when an IV infuction rate is too _______ . Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, and cough.

rapid

Conduction through the heart originates in the ________(SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers.

sinoatrial

The most common cause of vitamin B12 deficiency (pernicious anemia) is absence of intrinsic factor, a protein secreted by _________cells. This protein is required for vitamin B12 to be absorbed from the intestine. Symptoms of pernicious anemia involve the nervous system, and include memory loss, confusion, tingling or numbness in the limbs, and mood disturbances.

stomach

In early shock, the body compensates for the fall in blood pressure by activating the ____________nervous system.

sympathetic

0.45% NaCl is a hypotonic solution. This will cause fluid to shift from plasma to the ______ and cells in the intravasular compartment. Hypotonic solutions are indicated for patients who are dehydrated with normal blood pressure.

tissues

Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin(Lanoxin) _______.

toxicity

An ACEI-induced cough will not be relieved by cough mediation.

true

Antidysrhythmic drugs have the potential to correct dysrhythmias and also to worsen dysrhythmias or to create new dysrhythmias.

true

Implementing lifestyle modifications may eliminate the need for pharmacotherapy in people with hypertension.

true

The blood vessel spasms, causing constriction occurs during the initial event in the hemostasis process.

true

When treating myocardial infarction (MI), thrombolytic therapy is administered to dissolve clots obstructing the coronary arteries, thus restoring circulation to the myocardium.

true

prehypertension should be initially treated by modication in lifestyle.

true

Any amount of protein in the _____ is considered abnormal.

urine

Side effects of diltiazem (Cardizem) are generally not serious and are related to _______________: headache, dizziness, and edema of the ankles and feet.

vasodilation

Pentoxifylline (Trental) acts on red blood cells (RBCs) to reduce their __________ and increase their flexibility.

viscosity

The central problem with hypovolemic shock is the inability of the cardiovascular system to send sufficient blood to the ______organs, with the heart and brain being affected early in the progression of the disease.

vital

Plain ____ is the best fluid for the patient to consume while receiving diuretic therapy.

water

therapeutic lifestyle change

weight control

Calcium channel blockers may worsen heart failure. Assess for signs of fluid retention by obtaining daily _________. A sudden increase in weight of 2 pounds or more may indicate fluid retention.

weights

Some calcium channel blockers can reduce myocardial contractility and can _____heart failure.

worsen