Chapter 24-27

adenosine to a patient with supraventricular tachycardia. considerations before administration:

Constant ECG monitoring is necessary. Rapid IV bolus administration is recommended. Saline flush following bolus is necessary.

A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?

Continue with the prescribed rate.

A patient with elevated LDL cholesterol level has been prescribed HMG CoA reductase inhibitor. primary use of this med is to:

Lower cholesterol levels.

fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction will

Lyses the blood clot

The pharmacologic agents used to treat DVT may act in which way(s)?

Prevent platelet aggregation. Prevent the extension of existing clots. Inhibit steps in the fibrin clot formation cascade. Prolong bleeding time.

peripheral vascular disease foot care:

change socks daily.

The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C section. To prevent clot formation, the nurse will:

implement deep breathing and coughing exercises.

blood pressure in the left arm of 142/84, blood pressure in the right arm of 138/80, temperature of 98.8° F, and radial pulse of 80 and that is weak and irregular. The nurse should notify the physician regarding:

pulse only.

action of amiodarone [Cordarone], a class III agent used to treat cardiac dysrhythmias:

slows the rate of electrical conduction. prolongs time between contractions.

administer translingual nitroglycerin spray

under the tongue.

The nurse is assessing a patient on papaverine therapy and notes tachycardia, which is a compensatory effect of which condition?

Hypotension

Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?

Leave the needle in place for 10 seconds after injection.

Which patient statement indicates to the nurse that the patient has a good understanding of PVD?

"Controlling contributing factors may affect the progression of the disease."

warfarin (Coumadin) discharge education:

"Do not make any major changes to your diet" "Keep appointments." "Report signs of bleeding." "Avoid aspirin products."

The nurse has completed teaching to a patient recently prescribed cilostazol [Pletal. Which statement by the patient indicates a need for further teaching?

"Grapefruit juice will increase the effects of this medication."

cilostazol [Pletal] is effective when:

"I have less leg cramping when I walk."

The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?

"I will rinse my mouth with mouthwash instead of brushing my teeth."

patient complains of a headache when using sublingual nitroglycerin:

"This is a common adverse effect that can be managed with acetaminophen."

How many milligrams of lidocaine will the nurse administer I.V. bolus to a 30 year old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?

75

med combination beneficial in treating angina pectoris:

ACE inhibitors and statins

avoid tolerance to nitroglycerin by

Allowing for a daily 8 to 12 hour nitrate free period.

clients taking pentoxifylline [Trental], may have adverse effects if also taking:

Antihypertensive

Raynaud's disease. improve circulation and prevent complications of this disease:

Begin a daily exercise program. Keep hands and feet warm. Smoking cessation will improve outcomes.

baseline assessment of PVD:

History of heart disease Smoking and dietary habits Current medications Weight Limb pain

Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event?

Cardiac valve replacement

A patient taking amiodarone [Cordarone] complain of dizziness. instruct to:

Change positions slowly.

Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)?

Check for intolerance to caffeine. Obtain baseline data on pain that may be present. Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia. Ask specifically if the patient has any cardiac symptoms or dizziness.

Which type of angina is precipitated by physical exertion and is relieved by rest?

Chronic stable

therapies used in the treatment of angina pectoris:

Coronary artery bypass Coronary angioplasty Avoidance of caffeine and emotional stress Use of nitrates

a patient taking papaverine must consult pharmacist before taking:

Cough and cold remedies

Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?

Cover the patch with a clear plastic wrap.

The nurse is preparing to mix a lidocaine infusion for a patient. Which consideration(s) should the nurse take into account before administration?

Dextrose 5% is the solution to mix with lidocaine. Therapeutic blood levels should be 1 to 5 mg/L. The rate of administration is 1 to 4 mg/min. Monitor for changes in neurologic status.

quinidine, common adverse effect:

Diarrhea

when administering heparin subcutaneously

Document ecchymotic areas Monitor vital signs

patient with dysrhythmias and shortness of breath - baseline nursing assessment priorities:

ECG monitoring, medication and medical histories, oxygen saturation, presence of chest pain, fatigue and dyspnea, and mental status

before giving ranolazine (Ranexa) to a patient with chronic stable angina, assess:

Electrocardiography BUN Creatinine Electrolyte levels CBC

Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest?

Encourage passive leg exercises.

How frequently are nitroglycerin tablets discarded and prescriptions refilled?

Every 6 months

sustained release nitroglycerin tablets are administered

Every 8 to 12 hours

What will the nurse include in the teaching plan for a patient with angina who is prescribed a beta adrenergic blocking agent?

Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance. Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina. Cardioselective agents minimize pulmonary and peripheral vascular adverse effects. Stress exercise is an effective way to determine the most appropriate dosage.

A patient taking phenytoin [Dilantin] and amiodarone [Cordarone] may experience an

Increase in serum phenytoin levels

Which assessment verifies increased blood perfusion to the lower extremities?

Increased amplitude of pedal pulses

action of pentoxifylline (Trental):

Increases erythrocyte flexibility

Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?

Injectable lidocaine without preservative

Which statement about ranolazine [Ranexa], a fatty oxidase enzyme inhibitor, is true?

It causes QT interval prolongation.

Which statement is true regarding the pain associated with angina?

It is highly variable in intensity and location.

assessing for peripheral vascular disease [PVD] and unable to palpate the pedal pulse in either foot.

Obtain a Doppler ultrasound device for auscultation.

Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?

Petechiae

drugs used to treat thromboembolic disease:

Prevent platelet aggregation.inhibiting clot formation

A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?

Protamine sulfate

What will the nurse include in discharge teaching for patients on nitrate therapy?

Relaxation techniques Proper storage of medications Pain assessment

neuromuscular blocking agents and lidocaine complication:

Respiratory depression

Amiodarone is contraindicated for patients with which condition?

Severe sinus node dysfunction causing bradycardia

The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?

Spinach

A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?

Stop the heparin drip.

PVD treatment

Stress reduction techniques An exercise program Bed positioning techniques

patient prescribed sublingual nitrate PRN for angina instructions:

Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes.

What is the rationale behind administering calcium channel blockers to patients with angina?

They dilate blood vessels.

Anticoagulant therapy may be used

To prevent stroke in patients at high risk. Following a myocardial infarction. Following total hip or knee joint replacement surgery. With DVT. To prevent thrombosis in immobilized patients.

minimize ______ by using smallest dose of nitroglycerin for results

Tolerance

patient taking flecainide should report:

Weight gain

lifestyle modifications for patient with angina pectoris:

Weight reduction therapy Smoking cessation Stress management

When obtaining information for angina therapy, the nurse will document:

anxiety level.

assessing peripheral perfusion, the nurse will note:

any loss of hair on lower legs. Check pedal pulses.

Before giving dofetilide [Tikosyn]

assess potassium level.

for patients taking this med. carry nitroglycerin with you:

at all times

before administering procainamide hydrochloride to a patient with atrial fibrillation. assess:

cardiac rhythm. blood pressure. oxygen saturation.

The nurse observes a patient taking papaverine hydrochloride to be flushed and diaphoretic following the initial dose. The nurse's best response is to:

provide comfort measures.

Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling

elsewhere in your body.

Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue:

for 12 days postsurgically.

The nurse has admitted a resident with the diagnosis of PVD to a long term care facility. When providing care to this patient, the nurse will:

implement pain management as ordered. assess skin temperature. palpate pedal pulses.

beta adrenergic blocking agents reduce myocardial oxygen demand by

inhibiting the stimulation of norepinephrine and epinephrine

dalteparin [Fragmin] will be:

injected slowly. alternate injection sites every 24 hours.

adenosine:

is a naturally occurring chemical in the body.