PHARM - Cardiac Practice Questions

During discharge teaching, which statement by the nurse would be MOST appropriate for a patient prescribed a transdermal clonidine (Catapres)?

"The patch should be applied to a non-hairy site, and abrupt withdrawal should be avoided." Transdermal clonidine patches should be applied to non-hairy areas of the skin, and abrupt withdrawal should be avoided.

A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? (select all that apply)

- Apply the patch to a hairless skin area and rotate sites - Apply a new patch when you start the day - Remove patches 10 to 12 hours each day

A nurse is caring for a client who has a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? (select all that apply)

- Hyperkalemia - Throat swelling - Cough

A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions?

Acute myocardial infarction Milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who have an acute myocardial infarction and aortic or pulmonary valve disorders.

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications?

Diuretics & calcium channel blockers Research has demonstrated that African Americans do not typically respond therapeutically to beta-blockers or ACE inhibitors. They respond better to diuretics & calcium channel blockers.

What is the classification of carvedilol (Coreg)?

Dual-action alpha1 & beta receptor blocker Carvedilol blocks both the alpha1 & beta receptors of the adrenergic nervous system.

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug?

Grapefruit juice Grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers, such as amiodarone.

A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of the drug?

Headache Adverse effects of nitrates, such as nitroglycerin, include headaches, which can be severe at the beginning of nitrate therapy but decrease in severity with continued exposure to nitrates.

A nurse is administering hydrochlorothiazide to a client who has arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effect of this drug?

Hyperuricemia Increased uric acid levels, along with gouty arthritis, can occur in clients who have a history of these conditions and are taking hydrochlorothiazide.

A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions?

Hypoglycemia There are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic drugs. Also, carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.

A nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects?

Hypokalemia Manifestations of hypokalemia include a thready, irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, polyuria, nausea, and vomiting.

When administering nitroprusside (Nipride) by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity?

Hypotension The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination places the client at an increased risk for which of the following adverse effects?

Myopathy When taking a statin drug, it is important to know that concurrent use of fibric acid derivatives, such as gemfibrozil, or other drugs to lower cholesterol, can increase the risk for myopathy.

The nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythmia. The nurse should instruct the client to avoid which of the following types of over the counter drugs while taking propranolol?

NSAIDs NSAIDs can interact with propranolol and decrease the anti-hypertensive action because vasoconstriction can occur in some COX-2 inhibitors.

To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker?

Nimodipine (Nimotop) Nimodipine crosses the blood-brain barrier & has a greater effect on the cerebral arteries than on other arteries in the body; thus, it is indicated for the treatment of cerebral artery spasm after subarachnoid hemorrhage.

Which medication should the nurse question if prescribed together with ACE inhibitors?

Potassium chloride (K-Dur) ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion; thus, a decrease in aldosterone production can result in an increase in serum potassium.

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?

Raisins Diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium-rich foods in their diet, such as raisins and other dried fruits.

A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client?

Reserpine Severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers, such as reserpine. These adverse effects develop because of the depletion of serotonin and norepinephrine and can persist after clients discontinue taking the drug.

A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions?

Second-degree AV block Verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second- or third-degree AV block. Verapamil is indicated for hypertension, angina pectoris, and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches.

Before administering eplerenone (Inspra) to a patient, what is the priority nursing action?

Serum electrolytes Eplerenone (Inspra) is contraindicated in patients with an elevated serum potassium level (greater than 5.5 mEq/L) or severe renal impairment. Therefore, it is imperative that the nurse assess the patient's most recent serum electrolytes before administering this medication.

A nurse is caring for a client who has glomerular filtration rate (GFR) of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothizaide for this client because of which of the following characteristics of the drug?

The drug does not promote diuresis for patients who have renal insufficiency. Adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic, to promote urine production and effective excretion.

A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following types of drugs? (select all that apply)

- MAOI - general anesthetic - tricyclic antidepressant - beta-blocker

A nurse is caring for a client who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication?

Antigen-binding fragments Antigen-binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition?

Benign prostatic hyperplasia (BPH) Alpha1 blockers have beneficial in the treatment of BPH. The blocking of alpha1-adrenergic receptors decreases the urine outflow obstruction related to BPH by preventing smooth muscle contractions in the bladder neck and urethra.

A nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported?

Facial edema Losartan, an angiotensin II receptor blocker, can cause angioedema, which often manifests as swelling around the eyes and lips.

The nurse would question an order for a calcium channel blocker in a patient with which condition?

Hypotension Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions?

Hypotension Large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the drug in the body can intensify otherwise therapeutic effects like hypotension, causing serious risk for syncope and dizziness.

A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include?

Monitor your pulse rate and report changes Sodium channel blockers, like quinidine, can worsen dysrhythmias, or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.

A health care professional is caring for a patient who is about to begin taking simvastatin (Zocor). The health care professional should tell the patient to report which of the following indications of a serious adverse reaction that could warrant stopping drug therapy?

Muscle pain Simvastatin, an HMG-CoA reductase inhibitor (statin), can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious adverse effect, muscle protein breaks down and is excreted, resulting in kidney damage.

ACE inhibitors and ARBs both work to decrease blood pressure by which action?

Prevent aldosterone secretion Whereas ACE inhibitors block the formation of angiotensin II, ARBs allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone secretion is inhibited, preventing the reabsorption of sodium and water

A nurse should identify that which of the following drugs is used only for the short term treatment of a cardiac dysrhythmia because of the serious adverse effects associated with long term use?

Procainamide Procainamide is a sodium channel blocker and a broad-spectrum antidysrhythmic. It should not be used for long-term treatment of dysrhythmias because of its risk for serious adverse effects, including cardiotoxicity and arterial embolism.

A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia?

Simvastatin Simvastatin is an HMG-CoA reductase inhibitor. It blocks the synthesis of cholesterol by the body to help lower cholesterol levels.

When teaching a patient about a new prescription for carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which action? (Select all that apply)

- Peripheral vasodilation - Decreases heart rate Carvedilol (Coreg) has the dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade).

A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue drug therapy?

- Rash - Distorted taste - Swelling of the tongue - Dry cough

A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include? (select all that apply)

- report any new intolerance to fried foods - report muscle tenderness - expect periodic liver function testing Can cause gallstones, clients should monitor and report any new intolerance to fried foods, as well as any bloating or upper abdominal discomfort. Can cause myopathy, clients should monitor and report any unexplained muscle or joint pain. Increases the risk for liver toxicity, clients will require liver function testing while taking this drug.

The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect?

Dry, nonproductive cough ACE inhibitors block the breakdown of bradykinins and may cause a dry, nonproductive cough. ARBs do not block this breakdown, thus minimizing this adverse effect. ACE inhibitors and ARBs are equally effective for the treatment of hypertension, but ARBs do not cause cough.

A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory value requires immediate intervention?

Potassium of 5.2 mEq/L Spironolactone is a diuretic and an aldosterone antagonist that can cause hyperkalemia and places the client at risk for cardiac dysrhythmias.

The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse?

"When my blood pressure is over 140/90, I will take my medication." Patients must adhere to prescribed antihypertensive regimen to prevent end-organ damage. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, but the medication may produce unwanted adverse effects. Patient teaching is essential.