batch #7

A patient with hemophilia is frightened about contracting human immunodeficiency virus (HIV) from therapy. How should the nurse respond to the patient?

"All blood is screened for viruses."

The nurse is teaching a patient whose dysrhythmia is being treated with medication therapy. Which fact should the nurse include in the teaching plan?

"Almost all drugs used to treat dysrhythmias can cause dysrhythmias."

Which instructions should the nurse include in the plan of care for a patient receiving ferrous sulfate therapy?

"Antacids should not be taken with iron." Antacids can decrease the absorption of iron. Iron is typically taken in the morning. It is absorbed readily and is taken orally.

Which should the nurse include in a teaching plan for a patient receiving digoxin therapy?

"Digoxin toxicity can cause dysrhythmias."

A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response?

"Heparin suppresses coagulation by helping antithrombin perform its natural functions." Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

The nurse is teaching a group of nursing students about statin drugs and asks about the mechanism of action of lovastatin [Mevacor]. Which response from the students indicates understanding?

"It inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase to reduce the biosynthesis of cholesterol in the liver."

A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response?

"Stop taking the drug and visit the clinic immediately."

For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]?

aspirin

Before the nurse administers isosorbide mononitrate [Imdur], what is a priority nursing assessment?

assess blood pressure

A patient with coronary artery disease complains of chest pain. On assessment, the nurse notes the patient was sitting when the pain occurred. What other factors may have contributed to the chest pain? Select all that apply.

A large meal Very cold weather Emotional excitement

Which patient with angina would be at increased risk for adverse effects after the administration of beta blockers?

A patient with diabetes mellitus

The nurse is caring for a patient who is taking the drug amiodarone. The patient has also been on a treatment regimen that includes digoxin. Based on this information, the nurse should monitor the patient closely for evidence of what?

AV block

In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?

AV node

Which patient assessment would assist the nurse in evaluating therapeutic effects of verapamil [Calan, Covera-HS, Verelan]? Select all that apply.

Absence of chest pain Absence of irregularities in heart rate

A patient who has been receiving intravenous heparin as treatment for a deep vein thrombosis requires immediate surgery for a suspected bowel perforation. Which intervention is essential at this time?

Administer protamine sulfate. Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect. Allowing the patient to undergo surgery while receiving heparin would be life threatening because of the risk for excessive bleeding. Assessing the international normalized ratio (INR) or administering vitamin K is not appropriate in this situation. The patient is about to go into surgery, and the heparin will be discontinued; therefore, it is not the appropriate time to teach the patient about heparin.

A bleeding patient receiving warfarin [Coumadin] has an international normalized ratio (INR) of 6. What is the nurse's best course of action?

Administer vitamin K1 (phytonadione). The nurse should administer vitamin K1 (phytonadione) to the bleeding patient who is on warfarin and has an extremely elevated INR. This medication will block the vitamin K-dependent clotting factors. Increasing vitamin K can hasten the return to normal coagulation. Warfarin is given PO not IV. Protamine sulfate is an antidote to heparin therapy, not warfarin.

Which nursing intervention will decrease the flushing reaction of niacin?

Administering aspirin 30 minutes before niacin

The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching?

Applies the prescribed ribbon of ointment to the applicator paper and always places it over the heart

A patient has not had relief from angina using beta blockers, calcium channel blockers (CCBs), and nitrates. What is the patient's next choice?

Assess the need for coronary artery bypass grafting.

What is the primary cause of ischemic heart disease in a patient?

Atherosclerosis

Which instruction should be included in the discharge teaching for a patient with atrial fibrillation? Select all that apply.

Atrial fibrillation may cause rapid ventricular rates. Atrial fibrillation is the most common dysrhythmia. There is a high risk of stroke with atrial dysrhythmia.

The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. The nurse realizes bile acid sequestrants may cause what interaction? Select all that apply.

Binding with digoxin Binding with warfarin

Which is the most appropriate outcome for a patient who has been prescribed an antidysrhythmic medication?

Cardiac output increased

The nurse in the emergency department receives a report on a patient diagnosed with ST-elevation myocardial infarction (STEMI). What are the common biochemical markers and symptoms for a STEMI? Select all that apply.

Chest pain and electrocardiographic (ECG) changes Elevated troponin T level Elevated creatinine kinase level Weakness and diaphoresis

Which assessment finding could indicate a myocardial infarction (MI) in a patient who is taking nitroglycerin [Nitrostat] for angina?

Chest pain is not relieved by administering nitroglycerin.

What is a priority assessent for a patient with severe anemia?

cardiac assessment

A patient who is receiving antidysrhythmic drugs exhibits improved cardiac output, increased activity tolerance, blood pressure 120/76, pulse 86, and has voided 400 mL of urine during the past 8-hour shift. What is the nurse's best action?

Document the findings in the client's medical record.

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia?

Epoetin alfa [Procrit]

Which are common causes of dysrhythmias? Select all that apply

Hypoxia cardiac surgery Myocardial infarction electrolyte imbalance

Which adverse effect is the greatest concern with thrombolytic therapy?

Intracranial hemorrhage

What is the mechanism of action of ezetimibe [Zetia]?

It inhibits absorption of dietary and biliary cholesterol in the small intestine.

A patient has been receiving intravenous heparin. The nurse notes that today's activated partial thromboplastin time (aPTT) result is elevated. What is the nurse's best action?

Monitor the patient and check the therapeutic range.

Before the nurse administers simvastatin [Zocor], which baseline data are collected to help prevent adverse effects of therapy? Select all that apply.

Muscle pain Liver enzymes Renal function Gastric distress

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug?

Muscle pain and tenderness

The nurse is caring for a newly admitted patient who will begin heparin therapy. While documenting the patient's history, the nurse notes that the patient is currently undergoing treatment with enoxaparin. What is the nurse's highest priority?

Notify the provider that the patient should not be started on heparin. A potential medication error is to give heparin in combination with enoxaparin.

Which effect will beta blockers have on the conduction system in the heart? Select all that apply

Reduced contractility in the atria and ventricles Slowed conduction in the atrioventricular (AV) node Reduction of automaticity in the sinoatrial (SA) node

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? Select all that apply.

Reduction of LDLs Elevation of HDLs Stabilization of the plaque in coronary arteries Reduction of risk of cardiovascular events

Which is the most beneficial treatment for patients experiencing an ST-segment elevation myocardial infarction (STEMI)?

Reperfusion therapy Reperfusion therapy restores blood flow through the blocked coronary arteries responsible for the myocardial infarction (MI). It is the most effective way to preserve myocardial function and limit infarct size. Reperfusion therapy can be accomplished through percutaneous coronary intervention or fibrinolytic therapy.

Which structure in the heart is referred to as the pacemaker?

SA node

The nurse is caring for a patient receiving nitrates for relief of angina. Which pharmacodynamic action is responsible for the relief of anginal pain with nitrates?

Vasodilation leads to decreased preload, which decreases oxygen demand.

The nurse is preparing to administer an anticoagulant to a patient. Which action, if observed, is in error?

The nurse administers enoxaparin [Lovenox] intramuscularly to a patient.

Which patient does the nurse anticipate will receive alteplase [Activase] therapy?

The patient with severe chest pain for the past 2 hours

The nurse is monitoring a patient during intravenous (IV) nitroglycerin infusion. Which assessment finding will cause the nurse to take action?

chest pain

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?

discolored urine The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including cloudy or discolored urine, reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, pelvic pain, headache, and lumbar pain.

Which adverse effects will the nurse report after administering nitrates [Nitrostat]? Select all that apply.

headache postural hypotension tachycardia

Which medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain?

morphine

Which classes of drugs are used in the treatment of angina pectoris? Select all that apply.

nitrates beta blockers calcium channel blockers

Which form of nitroglycerin is likely to have a large first-pass effect?

oral

Which is the most important assessment to complete before the nurse administers an antidysrhythmic medication?

pulse

Which is a risk for a patient who has developed atrial flutter?

stroke