Verapamil (class IV)

The nurse is teaching an elderly patient with hypertension about his new prescription for verapamil (Calan). Which statement(s) made by the patient indicate(s) the teaching was effective? Select all that apply.

"I will increase my intake of fluid and foods high in fiber." "I will call my physician if I notice swelling in my ankles." Feedback: Verapamil often causes constipation and can also cause peripheral edema. Patients should take measures to prevent constipation and should call about new symptoms of peripheral edema. Patients should not experience photosensitivity, hyperkalemia, or increased bruising and bleeding.

Which of the following assessment findings, if discovered in a client receiving verapamil (Calan) for angina, would be the cause for the nurse to withhold the medication? Select all that apply: 1. Bradycardia: heart rate of 40 beats per minute. 2. Tachycardia heart rate of 126 beats per minute. 3. Hypotension: blood pressure of 76/46 mm Hg. 4. Tinnitus with hearing loss. 5. Hypertension: blood pressure 156/92 mm Hg.

1. Bradycardia: heart rate of 40 beats per minute. 3. Hypotension: blood pressure of 76/46 mm Hg.

A nurse is teaching a client who is starting verapamil (Calan) to control HT. Which of the following should the nurse include in the teaching? 1. Increase the amount of dietary fiber in the diet 2. Drink grapefruit juice daily to increase vit. C 3. Decrease the amount of calcium in the diet 4. Withhold food for 1 hour after the medication is taken.

1. Increase the amount of dietary fiber in the diet --Avoid drinking grapefruit juice because concurrent use can lead to toxicity. Also not necessary to increase vit. c. --No restriction on dietary calcium. --Can take with or with out food.

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. concurrent use of which of the following medications places the client at risk for dig toxicity? 1. Phenytoin (Dilantin) 2. Verapamil (Calan) 3. Warfarin (Coumadin) 4. Aluminum hydroxide (Amphojel)

2. Verapamil (Calan) -- CCB, can increase digoxin levels. if used together dig dosage may need to be lowered.

Because of its effect on the heart, verapamil should be used with extra caution or is contraindicated in patients with: 1.Hypertension 2.Tachycardia 3.Heart failure 4.Angina

3. Heart failure Rationale: Calcium channel blockers such as verapamil (Calan) are used cautiously or are contraindicated in patients with heart failure because of the negative inotropic effects on cardiac muscle which may precipitate or worsen heart failure. Verapamil and calcium channel blockers are often prescribed to treat these conditions.

A client with primary hypertension has started therapy with verapamil (Calan). The nurse performs what important intervention during the initial course of this treatment? 1. Uses an electric razor to shave the client. 2. Monitors the client for increased thrombocyte levels. 3. Administers the medication only during waking hours. 4. Measures intake and output ratio and daily weight.

4. Measures intake and output ratio and daily weight. (verapamil can cause fluid retention and can manifest into chest pain, dyspnea, crackles, weight gain, or edema.)

The nurse is administering oral verapamil (Isoptin) to a client. Before administering the verapamil the nurse should check the client's 1. electrolytes. 2. urine output. 3. weight. 4. heart rate.

4. heart rate. Strategy: Think about the action of the drug. (1) unnecessary action (2) unnecessary action (3) unnecessary action (4) correct-Verapamil is indicated for the treatment of supraventricular tachycardias, so the client's heart rate should be checked prior to administration

A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching? A) "I may become constipated, so Ishould increase fluids and fiber." B) "I may experience a rapid heart rate as a result of taking this drug." C) "I may have swelling of my hands and feet, but this will subside." D) "I may need to increase my digoxin dose while taking this drug."

A) "I may become constipated, so I should increase fluids and fiber."

A nurse is caring for a patient who is receiving verapamil (Calan) for hypertension and digoxin (Lanoxin) for heart failure. The nurse will observe this patient for: A) AV blockade. B) gingival hyperplasia. C) migraine headaches. D) reflex tachycardia.

A) AV blockade.

A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate: A) administering intravenous norepinephrine (NE) and isoproterenol. B) assisting with direct-current (DC) cardioversion. C) placing the patient in an upright position. D) preparing to administer a beta blocker.

A) administering intravenous norepinephrine (NE) and isoproterenol.

The nurse is teaching an older adult patient with hypertension who has a new prescription for verapamil (Calan). Which statement or statements by the patient indicate that the teaching was effective? (Select all that apply.) A. "I will increase my intake of fluid and foods high in fiber." B. "I will avoid exposing my skin to the sun." C. "I will call my physician if I notice swelling in my ankles." D. "I will avoid salt substitutes and potassium supplements." E. "I may notice easy bruising and bleeding with this drug."

A. "I will increase my intake of fluid and foods high in fiber." (Verapamil can cause constipation) C. "I will call my physician if I notice swelling in my ankles." (Verapamil can cause peripheral edema)

2. A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min and the blood pressure is 74/44 mg Hg. The nurse should expect a prescription for which of the following IV medications? A. Calcium gluconate B. Sodium bicarbonate C. Potassium chloride D. Magnesium sulfate

A. CORRECT: Reverse severe hypotension caused by verapamil with calcium gluconate, given slowly IV. The calcium counteracts vasodilation caused by verapamil. Other measures to increase blood pressure can include IV fluid therapy and placing the client in a modified Trendelenburg position. B. IV sodium bicarbonate is used to treat metabolic acidosis. It is not used to increase blood pressure in clients who have received verapamil. C. IV potassium chloride is used to treat hypokalemia. It is not used to increase blood pressure in clients who have received verapamil. D. IV magnesium sulfate is used to treat ventricular dysrhythmias, such as torsades de pointes. It is not used to increase blood pressure in clients who have received verapamil.

A nurse is preparing to assist a nursing student in administering intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching? A) "I will check to see when the last dose of the beta blocker was given." B) "I will monitor vital signs closely to assess for hypotension." C) "I will monitor the heart rate frequently to assess for reflex tachycardia." D) "I will prepare to administer intravenous norepinephrine if necessary."

C) "I will monitor the heart rate frequently to assess for reflex tachycardia." (Verapamil can cause bradycardia not tachycardia)

Verapamil class IV action

Calcium channel blocker prolongs cardiac conduction, depresses depolarization and decreases oxygen demand of the heart.

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: A) digoxin (Lanoxin) to slow the heart rate. B) immediate discontinuation of the nitroglycerin. C) periods of rest when the heart rate increases. D) verapamil as an adjunct to nitroglycerin therapy.

D) verapamil as an adjunct to nitroglycerin therapy.

A patient is prescribed verapamil 120 mg daily. Which statement by the patient indicates understanding of the medication? A. "I will take the medication with grapefruit juice each morning." B. "I should expect occasional loose stools from this medication." C. "I'll need to reduce the amount of fiber in my diet." D. "I will swallow the pill whole."

D. "I will swallow the pill whole."

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 experience which of the following conditions? A. Tachycardia B. Dehydration C. Diarrhea D. Hypotension

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

The nurse is caring for a patient with hypertension receiving verapamil (Calan). The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? Select all that apply.

Peripheral vasodilation Coronary vasodilation Feedback: Verapamil causes peripheral and cardiac vasodilation, which leads to decreased blood pressure and improved coronary perfusion. It does not cause vasoconstriction and usually has little effect on heart rate or contractility in healthy hearts.

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by:

inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

Intravenous verapamil has been ordered immediately in the treatment of a client experiencing supraventricular tachycardia. In order to ensure client safety, the nurse should be aware that concurrent use of which medication is absolutely contraindicated?

propranolol (this medication can cause additive effects leading to bronchospasm and AV blocks.)