UWORLD CARDIO PHARMACOLOGY

The nurse is reinforcing discharge instructions for the parents of a 4 year old with heart failure. Which statement by one of the parents indicates the need for further teaching related to digoxin administration? 1. We will hold the dose if our child's heart rate is above 90/min 2. We will not give a second dose if our child vomits after the first dose 3. We will not mix the medication with other foods or liquids 4. We will report symptoms of nausea and vomiting to our health care provider

1, Digoxin is a cardiac glycoside given to infants and children with heart failure. It is given to increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion. Digoxin is a potentially dangerous drug due to its narrow margin of safety in dosage. Parents should receive thorough education and be able to demonstrate appropriate administration procedures for this medication.

In which scenarios should the nurse hold the prescribed medication and question its administration? SATA 1. Client on IV heparin and the platelet count is 50,000/mm 2. Client on newly prescribed lisinopril and is at 8 weeks gestation 3. Client on nitroglycerin patch for heart failure and blood pressure is 84.56 mm Hg 4. Client on phenytoin for epilepsy and the nurse notes gingival hyperplasia 5. Client on warfarin and prothrombin time/international Normalized Ratio is 1.5 tines control value

1, 2, 3 Heparin should be held when there is significant thrombocytopenia. Angiotensin-converting enzyme inhibitors are not administered to pregnant women and nitrates are not administered when a client is hypotensive. Prothrombin time/International. Normalized ratio is expected to be 1.5-2.5 times the control value when therapeutic effects are reached. Gingival hyperplasia is a side effect of phenytoin (Dilantin) administration and is not a reason to stop the drug.

The nurse is reinforcing discharge teaching to several clients with new prescriptions. Which instructions by the nurse about medication administration are correct. SATA 1. Avoid salt substitutes when taking valsartan for hypertension. 2. Take levofloxacin with an aluminum antacid to avoid gastric irritation 3. Take sucralfate (for a gastric ulcer) after meals to minimize gastric irritation 4. When taking ethambutol, notify the health care provider (HCP) for changes in vision 5. When taking rifampin, notify the HCP if the urine turns red orange in color.

1, 4 Both angiotensin-converting enzyme (ACE) inhibitors (prils-captopril, enalapril, lisinopril, ramipril) and angiotensin receptor blocker (sartans-valsartan, losartan, telmisartan) can cause hyperkalemia. Salt substitutes contain high potassium and must not be taken without consulting the health care provider Ethambutol (Myambutol) is used to treat tuberculosis but can result in an ocular toxicity that causes loss of vision and red green color discrimination. Vision acuity and color discrimination must be monitored regularly.

A client with a history of heart failure calls the clinic and reports a 3-lb (1.4 kg) weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medications? 1. Bumetanide 2. Candesartan 3. Carvedilol 4. Isosorbide

1. Most clients with HF are prescribed a loop diuretic (eg, furosemide, torsemide, bumetanide) to reduce fluid retention. If the client has signs and symptoms of excessive fluid accumulation, the nurse will need to assess the situation by asking the client about dietary and fluid intake, adherence to prescribed medications, and the presence of any other associated symptoms (eg, shortness of breath). If the client is stable, the nurse may anticipate the need to increase the dosage of the prescribed loop diuretic (eg, bumetanide)

The nurse prepares to administer morning medications to assigned clients. Which prescription should the nurse clarify with the HCP? 1. Clopidogrel for client with history of stroke and platelet count of 154,000/mm 2. Losartan for client with hypertension who is 8 weeks pregnant 3. Prednisone for client with herpes simplex lesions and Bell palsy 4. Tiotropium for client with pneumonia and chronic obstructive pulmonary disease

2 Losartan is an angiotensin II receptor blocker (ARB) prescribed to treat hypertension. ACE inhibitors (eg, lisinopril, enalapril) and ARBs are teratogenic, causing renal and cardiac defects or death of the fetus. ARBs and ACE inhibitors have black box warnings that indicate contraindication in pregnancy.

The HCP has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension. Which finding by the nurse indicates that the spironolactone is having the desired effect? 1. Blood glucose of 95 mg/dL 2. Potassium level of 4.2 mEq./L 3. Reduction in dizziness 4. Sodium level of 138 mEq/:

2 Potassium sparing diuretics (eg, spironolactone, amiloride, triamterene eplerenone) are generally very weak diuretics and antihypertensives. However, they are useful when combined with thiazide diuretics to reduce potassium (K +) loss, Thiazide diuretics can cause hypokalemia when used as monotherapy.

sinus bradycardia A nurse receives an electrocardiogram of a client with type 2 diabetes, HF, and hypothyroidism. Base on the findings, which of the following mediations should the nurse suspect as the most likely cause? 1. Captopril 2. Carvedilol 3. Glimepiride 4. Levothyroxine

2 The client with sinus bradycardia, which can be caused by: Drugs (eg, beta blockers, calcium channel blockers, digoxin). Consider withholding beta blockers if systolic blood pressure <100 mm Hg or HR <60 and notify the provider. Vagal stimulation (eg, carotid sinus massage, Valsalva maneuver) Diseases (eg, hypothyroidism, myocardial infraction, increased intracranial pressure)

A client with long term hypertension and hypercholesterolemia comes to the clinic for an annual checkup. The client takes nifedipine, simvastatin, and spironolactone and reports some occasional dizziness. Which statement by the client would warrant intervention by the nurse? 1. I've been better about walking for 20 minutes 3 days a week on my treadmill 2. I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit. 3. I've heard that having a glass of red wine with dinner every night is good for my heart. 4. We no longer add salt wen preparing meals. It has really been hard to get used to that.

2 The nurse should intervene when the client talks about earing grapefruit. Grapefruit inhibits enzyme CYP1A4. The drugs that are metabolized by the same pathway would not be metabolized, resulting in higher drug levels and serious side effects. Calcium channel blockers (eg, nifedipine) use with grapefruit juice can cause severe hypotension, some statins (eg, simvastatin) may result in myopathy.

The nurse is preparing to administer medications to a client admitted with atrial fibrillation. The nurse notes the vital signs show in the exhibit. Which medications due at this time are safe to administer? (T: 98.4, BP: 124/78. HR: 46/min, RR: 22/min) SATA 1. Diltiazem extended release PO 2. Heparin subcutaneous injection 3. Lisinopril 4. Metoprolol 5. Timolol ophthalmic

2, 3 Lisinopril, an ACE inhibitor, does not lower HR and is not contraindicated in client with bradycardia. Heparin is an anticoagulant given to pt with DVT. Medications that decrease the heart rate should be held in clients with bradycardia. These include beta blockers such as metoprolol and timolol (including eye drops) and some types of calcium channel blockers (eg, diltiazem, verapamil).

The nurse is reinforcing discharge teaching with a client who has been prescribed warfarin for chronic atrial fibrillation. The client should avoid excess or inconsistent intake of which foods? SATA 1. Bananas 2. Broccoli 3. Grapefruit juice 4. Red meat 5. Spinach

2, 3, 5 Large amounts of vitamin K-rich foods can decrease the anticoagulant effects of warfarin therapy. Clients are not instructed to remove such foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach. Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter the drug's anticoagulant effects.

A client is being discharge with a prescription for apixaban after being treated for a pulmonary embolus. Which clinical data is most concerning to the nurse? 1. Client eats a vegetarian diet 2. Client has chronic atrial fibrillation 3. Client takes indomethacin for osteoarthritis 4. Client platelet count is 176x10/mm

3 A Pulmonary embolism (PE) occurs when the pulmonary arteries are blocked by a thrombus. Initial management of PE includes low-molecular-weigh heparin (eg, enoxaparin, dalteparin) or unfractionated IV heparin. once the PE is resolved, maintenance drug therapy often includes oral anticoagulants such as factor Xa inhibitors (eg, apixaban, rivaroxaban, dabigatran).

A client with uncontrolled hypertension is prescribed clonidine.. What instruction is most important for the clinic nurse to reinforce with this client? 1. Avoid consuming high sodium foods 2. Change positions slowly to prevent dizziness 3. Don't stop taking this medication abruptly 4. Use an oral moisturizer to relieve dry mouth

3 Clonidine is a very potent antihypertensive. Abrupt discontinuation can result in serious rebound hypertensive crisis. Other common side effects of clonidine include dizziness, drowsiness, and dry mouth. Beta Blockers, another class of blood pressure medications, can result in withdrawal symptoms if discontinued suddenly.

A client is in the cardiovascular clinic for a 3 month follow up visit. At the first visit, the client was prescribed hydrochlorothiazide and amlodipine for hypertension. Which statement by the client would be concerning and should be reported to the RN? 1. I like to have a banana every morning with breakfast 2. I occasionally experience slight dizziness when I get up in the morning 3. I started taking licorice root for occasional heartburn 4, I usually take my hydrochlorothiazide first thing in the morning

3 Licorice root is an herbal remedy sometimes used for gastrointestinal disorders such as stomach ulcers, heartburn, colitis, and chronic gastritis. Clients with heart disease or hypertension should be cautious about using licorice root. When used in combination with a diuretic such as hydrochlorothiazide, it can increase potassium loss, leading to hypokalemia (can cause cardiac dysrhythmias)

A client with hypertension and type 2 diabetes has recently started taking chlorthalidone. Which report by the client is most concerning to the nurse? 1. Dizziness on standing 2, Fasting blood glucose of 160 mg/dL 3. Presence of muscle cramps 4. Sunburn on both arms

3 Thiazide diuretics (eg, hydrochlorothiazide, chlorthalidone) are prescribed to treat hypertension and edema. The major side effects of thiazide diuretics include Hypokalemia-manifestation as muscle cramps Hyponatremia-manifestation as altered mental status and seizures Hyperuricemia-may precipitate or worsen gout attacks Hyperglycemia-may require adjustment of diabetic medications

The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation. Which statement Which statement by the client indicates a need for further teaching? 1. I will call my health care provider if I notice red urine or blood in my stool 2. I will not stop taking dabigatran even if I get a stomachache 3 I will place capsules in my pill box so I will not forget to take a dose 4. I will swallow the capsule whole with a full glass of water

3 Thrombin inhibitors such as dabigatran (Pradaxa) reduce the risk of clot formation and stroke in clients with chronic atrial fibrillation. The nurse should educate the client about implementing bleeding precautions (eg, using a soft-bristle toothbrush, shaving with an electric razor). Dabigatran capsules should be kept in their original container or blister pack until time of use to prevent moisture contamination.

The nurse reinforces teaching for a client taking atorvastatin to call the HCP if experiencing which symptom associated with a serious, adverse effect of the medication? 1. Diarrhea 2. Headache 3. Muscle aches 4. Numbness in the feet

3 Atorvastatin (Lipitor) is a statin drug, or HMG-CoA reductase inhibitor, prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. Myopathy with ongoing generalized muscle aches and weakness is a serious adverse effect of statins such as atorvastatin and rosuvastatin (Crestor)

A client with coronary artery disease and stable angina is being discharged home on sublingual nitroglycerin (NTG). The nurse has reinforced discharge teaching related to this medication. Which statement by the client indicates that the teaching has been effective? 1. I can keep a few pills in a plastic bag in my pocket in case I need them while I'm out 2. I can still take this with my vardenafil prescription 3. I can take up to 3 pills in a 15 minute period if I am experiencing chest pain. 4. I should stop taking the pills if I experience a headache.

3 The nurse should instruct the client who is taking sublingual NTG to keep the tablets in a tightly capped, dark bottle away from heat and light. The client should be taught to take 1 tablet every 5 minutes (up to 2 tablets). but notify EMS if the pain does not improve or worsens 5 minutes after the first pill has been taken. These instructions should be reinforced at each appointment.

The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate? 1. Administering PRN antiemetic prior to the infusion 2. Administering via an infusion pump over at least 30 minutes 3. Drawing a trough level just prior to administration of the vancomycin 4. Starting a new IV line before administration

3 Vancomycin is a very potent antibiotic that can cause nephrotoxicity and ototoxicity. Measuring for serum concentrations is a way to monitor for risk of nephrotoxicity as well as for therapeutic response. Though serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy. A trough should be obtained just prior (15-30 min) to administration of the next dose.

A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? SATA 1. Atorvastatin 2. Metformin 3. Metoprolol 4. Olanzapine 5. Omeprazole

3, 4 Drugs commonly associated with orthostatic hypotension include: 1. Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin). 2. Antipsychotic medications (eg, olanzapine, risperidone) and antidepressants (eg, selective serotonin reuptake inhibitors). 3. Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide) 4. Vasodilator medications (eg, nitroglycerine, hydralazine) 5. Narcotics (eg, morphine)

The nurse evaluating a 52 year old diabetic male client's therapeutic response to rosuvastatin would notice changes in which laboratory values? SATA 1. Alanine aminotransferase from 20 U/L to 80 U/L 2. High-density lipoprotein cholesterol from 48 mg/dL to 30 mg/dL 3. Low-density lipoprotein cholesterol from 176 mg/dL to 98 mg/dL 4. Total cholesterol from 250 mg/dL to 180 mg/d: 5. Triglycerides from 180 mg/dL to 149 mf/sL

3, 4, 5 Statins (rosuvastatin, atorvastatin, simvastatin) are the most preferred agents to reduce low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglyceride levels. The client's LDL level had decreased to a target range <100, total cholesterol <200, triglyceride <150Zx

The nurse is passing prescribed medications to assigned clients. The nurse should hold and seek clarification for which scheduled administrations? SATA 1. Client diagnosed with cirrhosis had 2 stools today, lactulose prescribed daily. 2. Client is receiving IV vancomycin, mild facial flushing noted after 30 minutes 3. Client is scheduled for abdominal surgery tomorrow, vitamin E PO prescribed daily 4. Client with diabetes has insulin glargine and aspart prescribed, AM glucose is 100 mg/dL 5. Lisinopril PO is prescribed daily, serum potassium level is 5.6 mEq/L

3, 5 ACE inhibitors (-prils) and angiotensin II receptor blockers (ARBs) (-sartans_ create a risk for hyperkalemia. ACE inhibitors decrease the excretion of aldosterone. Ordinarily, aldosterone would increase sodium and decrease potassium. However, when the ACE inhibitor suppresses aldosterone, potassium rises, placing clients at risk for hyperkalemia, especially in the presence of impaired renal function. The nurse should question the administration of an ACE inhibitor in a client who is hyperkalemic.

A client with atrial fibrillation has just been placed on warfarin therapy. The nurse preceptor overhears the student nurse reinforcing teaching to the client about potential food drug interaction. Which statement made by the student nurse requires the nurse preceptor to intervene? 1. Do you take any nutritional supplements? 2. You will need to monitor your intake of foods containing vitamin K 3. You will not be able to eat green leafy vegetables while taking warfarin 4. Your blood will be tested at regular intervals

3. A sudden increase or decrease in consumption of vitamin K rich foods (green leafy vegetables) alters the effectiveness of warfarin. Rather than avoid vitamin K intake to keep PT/INR stable and within the recommended therapeutic range. PT/INR is monitored at regular intervals.

An African American client comes to the clinic for a follow up visit 2 months after starting enalapril for hypertension. Which client statement should be reported to the HCP immediately? 1. Is there anything I can take for my dry, hacking cough? 2. My blood pressure this morning was 158/84 mm Hg 3. Sometimes I feel a little dizzy when I stand up 4. Will you look at my tongue? It feels thicker than normal

4 Angioedema is swelling that usually affect areas of the face (lips, tongue), larynx, extremities, gastrointestinal tract, and genitalia. It often starts in the face and can quickly become life-greatening as it progresses to the airways. Angioedema adverse effect of ACE inhibitors (eg, enalapril, lisinopril, captopril) and occurs more commonly in African Americans clients. (side effects can occur at any time after starting the medication).

A PN in the cardiac intermediate care unit is assisting the RN caring for a client with acute decompensated heart failure. The client also has a history of coronary artery disease and peripheral vascular disease. The PN is preparing to administer medications. Base on the assessment data, the nurse should question which medication? (VITALS: BP: 110/60, HR: 80/min, RR: 22/min, O2: 90%) 1. Aspirin 2. Atorvastatin 3. Furosemide 4. Metoprolol

4 Beta blockers, or "lols" (metoprolol, carvedilol, bisoprolol, atenolol), are the mainstay of therapy for clients with chronic heart failure as they improve survival rates for both systolic and diastolic HF. Beta blockers work by decreasing the effects of renin and inhibiting the sympathetic nervous system response (increase in HR) that stresses the failing heart.

The home health nurse is reinforcing teaching for a client with atrial fibrillation who is prescribed digoxin 0.25 mg orally on even-numbered days. Which client statement will required further teaching about digoxin? 1. I will call the HCP if I don't feel like eating 2. I will call the HCP if I feel dizzy and lightheaded 3. I will call the HCP if I have trouble reading 4. I will take my blood pressure before taking my medicine

4 Digoxin (Lanoxin) is a cardiac glycoside that increases contractility (positive inotropic effects) and decreases heart rate (negative chronotropic effects). It is used to treat atrial fibrillation because, at therapeutic levels (0.5-2.0 ng/mL), it decreases conduction through the sinoatrial node (SA) and ventricular heart rate. However, drug toxicity is common due to digoxin's narrow therapeutic range. Clients are instructed to recognize and report signs and symptoms of toxicity to the HCP.

A home health nurse visits a client 2 weeks after the client is discharged from treatment for an acute myocardial infarction and heart failure. After a review of the home medications, which symptoms report by the client is most concerning to the nurse? (Home meds: Aspiring, Clopidogrel, Metoprolol, Furosemide, & Fish oil) 1. Bruising easily, especially on the arms 2. Fatigue 3. Feeling depressed 4. Muscle cramps in the legs

4 Nurses caring for clients receiving potassium-wasting diuretic (eg, furosemide) should monitor for and report signs of hypokalemia )eg, muscle cramps), as unmanaged hypokalemia may result in lethal complications. Bruising, a side effect of antiplatelet medications, and fatigue, a side effect of beta blockers, should be monitored, but are not lethal.

A client diagnosed with stable angina is being discharged home on the cholesterol lowering drug rosuvastatin. The nurse should reinforce instructions for the client to report which side effect to the HCP immediately? 1. Abdominal discomfort 2. Insomnia 3. Morning headache 4. Muscle aches or weakness

4 Rosuvastatin (Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglycerides. It also increases HDL. A serious complication associated with statin medications is rhabdomyolysis (muscle toxicity). Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances can be harmful to the kidney and often causes kidney damage. The client should immediately report any signs of muscle aches or weakness to the HCP. These could be early signs of rhabdomyolysis, which can be fatal.

The HCP prescribes simvastatin for a client with hyperlipidemia. The nurse reinforces which teaching regarding correct timing of medication administration? 1. At noon with a meal 2. In the morning on an empty stomach 3. In the morning with breakfast 4. With the evening meal

4 Statin drugs (eg, simvastatin, atorvastatin, rosuvastatin) are prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. Most of the cholesterol in the body is synthesized by the liver during the fasting state, at nigh. Trials have found greater reductions of total and LDL cholesterol when statins are taken in the evening or at bedtime as opposed to during the day.

The nurse is reinforcing teaching about home administration of sublingual nitroglycerin tablets for a client with stable angina. Which statement by the client indicates the need for further teaching? 1. I will call 911 if my chest pain isn't relieved by NTG 2. If I have chest pain, I can take up to 3 pills5 minutes apart 3. I'll call my doctor if I start having chest pain at night 4. I'll keep one bottle in the house and none in the car

4 The NTG should be easily accessible at all times. Tablets are packaged in a light-resistant bottle with a metal cap. They should be stored away from light and heat sources, including body heat, to protect from degradation. Clients should be instructed to keep the tablets in the original container. Once opened, the tablets lose potency and should be replaced every 6 months. The car is not a good place to store NTG due to heat.

A client with coronary artery disease was discharged home with a prescription for sublingual nitroglycerin (NTG_ to treat angina. Which statement by the client indicates that further teaching is required? 1. I may experience flushing but will continue to take the medication as prescribed. 2. I should lie down before taking the medication. 3. I should not swallow the tablet. 4. I will wait to call 911 if I don't experience relief after the third tablet.

4 The nurse should instruct clients taking sublingual NTG that they should call EMS if their chest pain is unrelieved or worsening 5 minutes after the first tablet. The tablet should be allowed to dissolve under the tongue to allow for adequate absorption and should never be swallowed.

A 45 year old client with atrial fibrillation has been prescribed diltiazem. Which client outcome would best indicate that the medication has had its intended effect? 1. Atrial fibrillation is converted to sinus rhythm 2. Blood pressure is 126/78 mm Hg 3. No signs or symptoms of stroke 4. Ventricular rate decreased from 158/min to 88/min

4 Atrial fibrillation is characterized by disorganized electrical activity in the atria due to multiple ectopic foci. It leads to loss of effective atrial contraction and places the client at risk for embolic stroke as a result of the thrombi formed in the atria. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension) The treatment goals are to reduce ventricular rate to <100/min and prevent stroke.

An elderly client with depression, DM, and HF has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently? 1. Apical HR is 62/min 2. Blood sugar levels is 240 mg/Dl 3. Client is taking 20 mg fluoxetine daily 4. Serum creatine is 2.3 mg/dL

4 Digoxin (Lanoxin) is a cardiac glycoside that increases cardiac contractility but slows the HR and conduction. It is used in HF (to increase cardiac output) and atrial fibrillation (to reduce the HR). The drug is excreted almost exclusively by the kidney. BUN and creatinine levels are measurements of kidney function. The normal range for creatinine is 0.6-1.3 mg/dL

A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril. Which prescription does the nurse anticipate for this client? 1. Alprazolam 2. Dextromethorphan 3. Lisinopril 4. Valsartan

4 Major side effects of angiotensin converting enzyme (ACE) inhibitors include" Symptomatic hypotension intractable cough Hyperkalemia Angioedema (allergic reaction involving edema of the face and airways) Temporary increase in serum creatinine. Angiotensin II receptor blockers such as valsartan or losartan are recommended

A client with stable angina is being discharged home with a prescription for a transdermal nitroglycerin patch. The nurse is reinforcing discharge instructions on the medication with the client. Which statement by the client indicates that teaching has been effective? 1. I can continue to take my prescription of sildenafil 2. I should take patch off when I shower 3. I will remove the patch if I develop a headache 4. I will rotate the site where I apply the patch

4 Nursing education about transdermal nitroglycerin includes application of the patch to the upper arms or body, rotating the sites daily, removing the patch at night, taking no erectile dysfunction medications, and informing clients that headaches are common. Patches do not need to be removed for bathing.

The nurse is collecting date on a client with hypertension and essential tremor who received the first dose of propranolol 2 hours ago. Which assessment is most concerning to the nurse? 1. Client reports a headache 2. Current blood pressure is 160/88 mm HG 3. Heart rate has decreased from 70/min to 60/min 4. Slight wheezes auscultated during inspiration

4 Propranolol is a nonselective beta blocker that inhibits B1 (heart) and B2 (bronchial) adrenergic receptors. It is used for many indications (eg, essential tremor) in addition to blood pressure control. Blood pressure decreases secondary to a decline in heart rate. Bronchoconstriction may occur due to the effect on the B2 adrenergic receptors. The presence of wheezing in a client taking propranolol my indicate bronchoconstriction or bronchospasm.

A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the nurse would be concerning in relation to this new medication? SATA 1. BP of 140/84 mm Hg 2. HR of 98/min 3. Platelet count of 200,000/mm 4. Report of Ginkgo biloba use 5. Report of peptic ulcer disease

4, 5 If a client is prescribed clopidogrel, the nurse should be concerned about a history of peptic ulcer disease and Ginkgo biloba use. In this situation, the client would be at increased risk for bleeding. This data should be reported to the prescribing health care provider before the client is discharged.

Which prescription for these clients does the nurse question? SATA 1. Client with C. diff colitis, prescribed vancomycin 125 mg PO 2. Client with diabetes and elevated mealtime glucose, prescribed lispro insulin scale 6 units subcutaneously 3. Client with GI bleed and NG tube, prescribed pantoprazole 40 mg intravenous 4. Client with hypertension and BP 94/40 mm Hg, prescribed metoprolol succinate SR 50 mg PO 5. Client with otitis media and penicillin allergy, prescribed ampicillin 500 mg PO

4, 5 IV proton pump inhibitors are used for gastric ulcer bleeding. Oral vancomycin can be used for C. diff colitis, Ampicillin are contraindicated in clients with a penicillin allergy. Antihypertensives are held if the client has borderline low BP.

Parent teaching for digoxin administration includes the following: Know the pulse rate at which to hold the medication based on the health care provider's (HCP's) prescription (this instruction should be reinforced by the nurse). In general, dioxin is held if pulse is <90-110/min for infants and children or <70/min for an older child. Administer oral liquid in the side and back of the mouth. Do not mix the drug with food or liquids as the child's refusal to ingest these would result in inaccurate medication dose intake.

If a dose is missed, do not give an extra dose or increase the dosage. Maintain the same schedule If >2 doses are missed, notify the HCP If the child vomits, or slow pulse rate could indicate toxicity. Notify the HCP. Give water or brush the child's teeth after administration to remove the sweetened liquid

The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily. The client's blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago. The client reports a cold, a stuffy nose, and sneezing for 3 days. Which question is most appropriate for the nurse to ask? 1. Are you taking OTC medicines for your cold? 2. Are you taking extra vitamin C? 3. Did you babysit your granddaughter this past week? 4. Did your get a flu shot in the past week?

1 Clients with hypertension should be instructed not to take potentially high risk OTC medications, including high sodium antacids, appetite suppressants, and cold and sinus preparations, as they can increase blood pressure.

Rifampin (Rifadin)

Antitubercular. Use: prevention and treatment of TB. Latent TB INH: 6-9 months. Active TB: multiple therapy up to 24 months. Precautions: risk of neuropathies and hepatotoxicity, consume foods high in vitamin B6, avoid alcohol, discoloration of urine, saliva, sweat, and tears.

Drug classes & major side effects Beta blockers (carvedilol): Bradycardia, bronchospasm, hypotension, depression, impotence. Angiotensin-converting enzyme inhibitors (captopril): Dry cough, hypotension, reflex tachycardia, hyperkalemia, angioedema.

Sulfonylureas (glipizide): Hypoglycemia (diaphoresis, headache, hunger, tachycardia, confusion) a disulfiram-like reaction may occur if combined with alcohol. Thyroid replacement (levothyroxine): Symptoms of hyperthyroidism (diarrhea, weight loss, palpitations, tachycardia, sweating, heat intolerance)

A nurse is reinforcing teaching to a client who is being discharged on warfarin for atrial fibrillation. Which client statements indicate that teaching has been effective? SATA 1. Antibiotics can affect my INR value 2. I am going to eat more leafy greens 3. I will shoot for my INR value to be between 4 and 5 4. I will take warfarin at the same time daily 5. If I miss a dose, I can double it on the following day

1, 4 A therapeutic INR for most conditions is 2-3 but can be to 3.5 for heart valve disease. However, it is never between 4 and 5. Intestinal bacteria produce vitamin K antagonist, therefore, INR would overshoot in the setting of vitamin K deficiency, placing the client at risk for bleeding.

Elderly clients tend to develop age-related decrease in glomerular filtration rate (GFR). These clients and those with obvious kidney injury (possibly due to diabetes in this client) can accumulate digoxin.

The early symptoms of toxicity are nausea and vomiting. later signs of toxicity are arrhythmias, including heart blocks. Therefore, clients at risk for digoxin toxicity require frequent drug level monitoring and dose adjustment.

Nitroglycerin patches are transdermal patches used to prevent angina in clients with coronary artery disease. They are usually applied once a day (not as needed) and worn for 12-14 hours and then removed. Continues use of patches without removal can result in tolerance. No more than one patch at a time should be worn.

The patch should be applied to the upper body or upper arms. Clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused should be used. A different location should be chosen each day to prevent skin irritation.

A client with coronary artery disease and atrial fibrillation is being discharged home following coronary artery stent placement. Discharge medications are shown in the exhibit. The nurse identifies which educational topic as the highest priority to reinforce for this client? (discharge meds: Aspirin, clopidogrel, Rivaroxaban, Metoprolol, Rosuvastatin, Lisinopril.) 1. Bleeding risk 2. Bronchospasm 3. Muscle injury 4. Tinnitus

1 The client is on 3 different medications that increase bleeding risk (aspirin, clopidogrel, and rivaroxaban). The highest priority for the nurse is to reinforce client teaching on the sings/symptoms and risk reduction of bleeding. The client should be instructed to monitor for black tarry stools, bleeding gums, and excessive bruising. The client should also use a soft bristle toothbrush, shave with an electric razor, and refrain from playing contact sports.

A male client with hypertension was prescribed amlodipine. Which of these adverse effects is most important to teach the client to watch for? 1. Erectile dysfunction 2. Dizziness 3. Dry cough 4. Leg edema

2 Calcium channel blockers (nifedipine, amlodipine, felodipine, nicardipine) are vasodilators used to treat hypertension and chronic stable angina. They promote relaxation of vascular smooth muscles leading to decreased systemic vascular resistance and arterial blood pressure. The most important adverse effects of calcium channel blockers include dizziness.

A client recently diagnosed with heart failure is being discharged on the angiotensin-converting enzyme inhibitor lisinopril. Which information related to this new medication is important for the nurse to reinforce at discharge? 1. Instruct client to report for monthly blood work to monitor drug levels 2. Review foods high in potassium 3. Teach client to check own pulse for 1 minute, hold medication if heart rate is <60/min 4. Teach client to rise slowly and sit on side of bed for several minutes before rising

4. Client education after initiation of an ACE inhibitor (eg, captopril, lisinopril) includes a discussion on development of a dry cough, taking several minutes to get out of bed, possible allergic reactions (rash, angioedema), and the teratogenic effects of the drug.

Sucralfate (Carafate)

Adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hour, has no systemic effects. Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and do not administer within 30 minutes of antacids.

Levofloxacin (Levaquin) is a quinolone antibiotic.

For this class of antibiotics, 2 hours should pass between the drug ingestion and taking aluminum/magnesium antacids, iron supplements, multivitamins with zinc, or sucralfate. In addition, these substances can bind up to 98% of the drug, making it ineffective.

Trough level of a drug

Point in time when a drug is at its lowest level in the body. The trough level is the lowest concentration in the patient's bloodstream, therefore, the specimen should be collected just prior to administration of the drug. The peak level is the highest concentration of a drug in the patient's bloodstream.

Nitroglycerin (NTG) is a vasodilator

use to treat stable angina. It is a sublingual tablet or spray is place under the client's tongue. It usually relieves pain in about 3 minutes and lasts 30-40 minutes/ The recommended dose is 1 tablet or 1 spray taken sublingual for angina every 5 minutes for a maximum of 3 doses. If symptoms are unchanged or worse 5 minutes after the first dose, emergency medical symptoms are unchanged or worse 5 minutes after the first dose, emergency medical service should be contacted.

Valsalva maneuver

forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart

carotid sinus massage

the physician massages over one carotid artery for a few seconds, observing for a change in cardiac rhythm.