Cardiovascular PHARM EAQ study

A client is scheduled to have a coronary artery bypass graft (CABG). The client's spouse asks what the benefit of the surgery is. How should the nurse respond?

"This surgery significantly decreases symptoms in most clients."

Which class of antihypertensive would the nurse identify as the probable cause of a persistent hacking cough when reviewing a list of a client's medications? 1 Angiotensin-converting enzyme (ACE) inhibitors 2 Thiazide diuretics 3 Calcium channel blockers 4 Angiotensin receptor blockers

1 Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors are commonly associated with a dry, persistent cough. This is associated with an accumulation of bradykinin and substance P. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or angiotensin receptor blockers.

Which adverse reaction will the nurse monitor for in a client receiving sulfa-type loop diuretics who is also on an aminoglycoside antibiotic? Select all that apply. One, some, or all responses may be correct. 1 Ototoxicity 2 Dehydration 3 Hypokalemia 4 Excessive diuresis 5 Orthostatic hypertension

1 Ototoxicity The combination of sulfa-type loop diuretics and aminoglycosides increases the potential for the development of ototoxicity. Administering sulfa-type loop diuretics with metolazone may result in excessive diuresis, posing a risk for development of dehydration. Hypokalemia may occur in combination with diuretics and corticosteroids. Orthostatic hypotension (not hypertension) is a possible outcome of diuretics; dizziness is a possible side effect of aminoglycosides.

Which action would the nurse perform prior to administering cilostazol? Select all that apply. One, some, or all responses may be correct. 1 Ask specifically about any cardiac symptoms. 2 Assess for presence of dizziness or headache. 3 Question the client about history of heart failure. 4 Determine if there is a history of peptic ulcer disease. 5 Obtain a baseline assessment of degree of pain present.

1,2,3,4,5 Ask specifically about any cardiac symptoms. Assess for presence of dizziness or headache. Question the client about history of heart failure. Determine if there is a history of peptic ulcer disease. Obtain a baseline assessment of degree of pain present. Cilostazol is a platelet aggregation inhibitor used to manage intermittent claudication. Prior to administering the medication, the nurse should assess the client for the presence of dizziness or headache. The nurse should obtain and record baseline of vital signs and degree of pain the client is experiencing. It is imperative for the nurse to ask the client about the presence of any cardiac symptoms, history of peptic ulcer disease, and heart failure as these problems may be exacerbated by cilostazol.

A nurse is auscultating a client's heart sounds. Which valves close when the first heart sounds are produced? 1. Mitral and tricuspid 2. Aortic and tricuspid 3. Mitral and pulmonic 4. Aortic and pulmonic

1. Mitral and tricuspid

A client with heart failure is digitalized and placed on a maintenance dose of digoxin (Lanoxin) 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved?1 Diuresis and decreased pulse rate2 Increased blood pressure and weight loss3 Regular pulse rhythm and stable fluid balance4 Corrected heart murmur and decreased pulse pressure

1.Digoxin slows the heart rate, which is reflected in a slowing of the pulse; it also increases kidney perfusion, which promotes urine formation, resulting in diuresis and decreased edema. Digoxin will decrease, not increase, the blood pressure; digoxin does promote weight loss through diuresis. Although digoxin produces diuresis as a result of improved cardiac output, which increases fluid output, it does not regulate an irregular pulse. Digoxin will not correct a heart murmur or decrease the pulse pressure.

Which information would the nurse include in a teaching plan to help reduce the side effects associated with diltiazem? 1 Lie down after meals. 2 Change positions slowly. 3 Avoid dairy products in the diet. 4 Take the drug with an antacid.

2 Change positions slowly. Changing positions slowly would help prevent the side effect of orthostatic hypotension. Lying down after meals can relax the esophagus and lead to acid reflux. Avoiding dairy products and taking the drug with an antacid are not necessary.

Which finding in a client prescribed pentoxifylline would the nurse report to the health care provider immediately? 1 Dry, flaky, itchy skin 2 Complaints of indigestion 3 Pain in the legs while walking 4 Peripheral pulses 2+ bilaterally

2 Complaints of indigestion Pentoxifylline is a hemorheologic agent used to treat intermittent claudication. The nurse would specifically ask about cardiac symptoms such as indigestion, chest pain, shortness of breath, or diaphoresis and report findings to the health care provider immediately. Dry, flaky, itchy skin is not an emergent finding in this situation. Pain in the legs while walking and relieved with rest are indications of intermittent claudication and are the reason the medication is prescribed. Peripheral pulses 2+ bilaterally is a normal finding.

Which action would the nurse take for a client with hypertension who states, "My tongue feels thick" after the initial dose of an angiotensin converting enzyme (ACE) inhibitor? 1 Hold the next dose of the client's medication 2 Contact the health care provider immediately 3 Provide ice chips to the client to reduce the swelling 4 Inform the client that swelling after the first dose is expected

2 Contact the health care provider immediately Hypersensitivity to angiotensin converting enzyme inhibitors can result in angioedema, which causes swelling of the face, eyes, lips, and tongue. The health care provider is contacted immediately as angioedema can result in respiratory arrest. Providing ice chips during angioedema may result in aspiration as swelling progresses and it will not reduce swelling. Angioedema after the first dose is not expected. The medication should be discontinued (not held).

Which response would the nurse monitor for to determine the effectiveness of amiodarone? 1 Results of fasting lipid profile 2 Presence of cardiac dysrhythmias 3 Degree of blood pressure control 4 Incidence of ischemic chest pain

2 Presence of cardiac dysrhythmias Amiodarone is a class III antidysrhythmic used to treat ventricular and supraventricular tachycardia and conversion of atrial fibrillation. Results of fasting lipid profile are expected with antilipidemics. Blood pressure control is expected with antihypertensives. Monitoring for ischemic chest pain is with antianginal agents, such as nitrates.

A client has edema in the lower extremities during the day, which disappears at night. With which medical problem does the nurse conclude this clinical finding is consistent? 1. Pulmonary edema 2. Myocardial infarction 3. Right ventricular heart failure 4. Chronic obstructive lung disease

3. Right ventricular heart failure

A client has an open reduction and internal fixation of a fractured hip. To prevent the most common complication after this type of surgery, the nurse expects the client's postoperative plan of care to include: 1. Routinely turning the client from side to side 2. Sequential compression stockings 3. Isometric exercises to the extremities 4. Passive range of motion (ROM) to the affected extremity

2. Sequential compression stockings

The health care provider prescribes isosorbide dinitrate 10 mg as needed three times a day and a nitroglycerin transdermal disk once a day for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. Which response would be given by the nurse? 1 "It prevents the blood from clotting." 2 "The isosorbide suppresses irritability in the ventricles." 3 "It allows more oxygen to get to heart tissue." 4 "The isosorbide increases the force of contraction of the heart."

3 "It allows more oxygen to get to heart tissue." Isosorbide dinitrate dilates the coronary vasculature and improves the supply of oxygen to the hypoxic myocardium. Preventing blood from clotting is the action of anticoagulants. Suppressing irritability in the ventricles is the action of antidysrhythmics. Increasing the force of contraction of the heart is the action of cardiac glycosides.

A client with heart failure is on a drug regimen of digoxin (Lanoxin) and furosemide (Lasix). The client dislikes oranges and bananas. Which fruit should the nurse encourage the client to eat? 1. Apples 2. Grapes 3. Apricots 4. Cranberries

3. Apricots

A nurse is advising a client about the risks associated with failing to seek treatment for acute pharyngitis caused by beta-hemolytic streptococcus. For what health problem is the client at risk? 1. Asthma 2. Anemia 3. Endocarditis 4. Reye syndrome

3. Endocarditis

A client is admitted to the hospital with atrial fibrillation. A diagnosis of mitral valve stenosis is suspected. The nurse concludes that it is most significant if the client presents with a history of:1 Cystitis as an adult2 Pleurisy as an adult3 Childhood strep throat4 Childhood German measles

3. Streptococcal infections occurring in childhood may result in damage to heart valves, particularly the mitral valve. Group A streptococcal antigens bind to receptors on heart cells, where an autoimmune response is triggered, damaging the heart. Cystitis usually is caused by Escherichia coli, which does not affect heart valves. Pleurisy usually follows pulmonary problems unrelated to streptococcal infection; it does not result in damage to heart valves. The rubella virus does affect the valves of the heart.

Which explanation about the mechanism of action would the nurse give to a client who is prescribed enoxaparin 40 mg subcutaneously daily after abdominal surgery? 1 "It controls expected postoperative fever." 2 "It provides a constant source of mild analgesia." 3 "It limits the inflammatory response associated with surgery." 4 "It provides prophylaxis against postoperative thrombus formation."

4 "It provides prophylaxis against postoperative thrombus formation." Enoxaparin is a low-molecular-weight heparin that prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic, an analgesic, or an antiinflammatory drug.

A client with emphysema experiences shortness of breath and uses pursed-lip breathing and accessory muscles of respiration. The nurse determines that the cause of the dyspnea is:1 Spasm of the bronchi that traps the air2 Increase in the vital capacity of the lungs3 Too rapid expulsion of the air from the alveoli4 Difficulty in expelling the air trapped in the alveoli

4 Emphysema involves destructive changes in the alveolar walls, leading to dilation of the air sacs; there is subsequent air trapping and difficulty with expiration. Bronchospasm is characteristic of asthma, not emphysema. The vital capacity is decreased because of restriction of the diaphragm and thoracic movement. Expiration is slowed by pursed-lip breathing to keep the airways open so less air is trapped.

Amlodipine (Norvasc) is prescribed for a client with hypertension. Which response to the medication should the nurse instruct the client to report to the health care provider?1 Blurred vision2 Dizziness on rising3 Excessive urination4 Difficulty breathing

4. Dyspnea may indicate development of pulmonary edema, which is a life-threatening condition. Blurred vision may occur in some people, but it is not life-threatening. Dizziness on rising and excessive urination are common side effects of this medication, which are not life-threatening.

A client with a history of hypertension comes to the emergency department with double vision and a blood pressure of 260/120 mm Hg. The health care provider prescribes a sodium nitroprusside (Nitropress) infusion. The nurse recalls that sodium nitroprusside decreases blood pressure by:1 Decreasing the heart rate2 Increasing cardiac output3 Increasing peripheral resistance4 Relaxing arterial smooth muscles

4. This drug decreases blood pressure by relaxing venous and arteriolar smooth muscles and is used for immediate reduction of blood pressure. This drug may increase the heart rate as a response to vasodilation. It decreases cardiac workload by decreasing preload and afterload. It decreases peripheral resistance by dilating peripheral blood vessels.

A nurse is completing the admission assessment of a client with peripheral arterial disease. What assessments are consistent with this diagnosis? (Select all that apply.)

Absence of hair on the toesReports of pain associated with exercising

Which action would the nurse perform to ensure safe administration to a client with angina pectoris prescribed a transdermal nitroglycerin patch? Select all that apply. One, some, or all responses may be correct. 1 Shave the chest area and apply the patch. 2 Don sterile nitrile gloves before applying patch. 3 Apply patch for 12 hours and remove until next dose. 4 Review vital signs upon admission. 5 Never administer sublingual nitroglycerin when patch is present

Apply patch for 12 hours and remove until next dose. Current recommendations for application of the transdermal nitroglycerin patch are to apply patch for 10 to 12 hours then to remove it, creating a nitrate-free interval. Do not apply the patch to shaved areas as irritation to the skin may alter drug absorption. Donning sterile gloves is not necessary. The nurse should don clean gloves to apply the patch. Historic vital signs should always be reviewed, but the vital signs should be taken and recorded right before the patch is applied for safety. Sublingual nitroglycerin may be necessary as the patch dosage is adjusted.

A client with a history of severe intermittent claudication has a femoral-popliteal bypass graft. What is an appropriate postoperative nursing intervention on the day after surgery?

Assist the client with walking

A client who has had an uncomplicated myocardial infarction asks the nurse about the resumption of sexual activity. Which parameters should the nurse consider to determine the safe resumption of sexual activity? (Select all that apply.)

At least between 4 and 6 weeks after the myocardial infarction The point at which two flights of stairs can be climbed without dyspnea

A nurse is caring for clients with a variety of problems. Which health problem does the nurse determine poses the greatest risk factor for the development of a pulmonary embolus?

Atrial fibrillation

A client who has been taking digoxin (Lanoxin) for 20 years is hospitalized. The client exhibits signs of dehydration and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity?

Blurred Vision

When assessing a client with the diagnosis of left ventricular failure, the nurse expects to identify:

dyspnea on exertion

What clinical indicators are the nurse most likely to identify when taking the admission history of a client with right ventricular failure? (Select all that apply.)

edema dyspnea

A nurse is collecting data from a client with varicose veins who is to have sclerotherapy. What should the nurse expect the client to report?

Feeling of heaviness in both legs

A nurse is providing discharge medication teaching to a client who will be taking furosemide (Lasix), digoxin (Lanoxin), and potassium chloride (K-Dur) after discharge from the hospital. What information is most important for the nurse to include in the teaching plan?

Signs and symptoms of digoxin toxicity

A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of two weeks. What reason should the nurse provide for this gradual reduction in dosage?

Slow reduction of the drug will prevent a physiological crisis because the adrenal glands are suppressed