Cardiovascular Medications

A client with hyperlipidemia is in for a follow-up appointment. The client has lost some weight, but lab work reveals that the client still has hyperlipidemia. Which of the following changes would help to lower this client's lipid levels? Select all that apply. A. Begin a plant-based diet B. Stop smoking C. Decrease soluble fiber intake D. Use vegetable oil instead of olive or coconut oil for cooking E. Start taking atorvastatin

A, B, E - Studies show that a plant-based diet improves cholesterol levels, because the client is avoiding foods such as red meat and full fat dairy products. One of the benefits of smoking cessation is lower cholesterol levels. A statin will reduce hyperlipidemia. Rather than decreasing soluble fiber, the client with hyperlipidemia should increase soluble fiber intake to lower cholesterol. Vegetable oil is full of trans fats, which raise overall cholesterol levels.

A 60-year-old client is seeking care for chest pain and the nurse has an order to place a nitroglycerin patch. Which implications must the nurse consider when administering this medication? Select all that apply. A. If the client forgets to replace the patch, he should put a new one on as soon as he remembers B. A new patch should always be applied to the same area of skin C. The client should not put more patches on than prescribed D. The patch should be used for treatment during a heart attack E. The client should have a period of at least 10 hours a day when he does not wear the patch

A, C, E - A new patch should be applied to a different area each time, and if the client forgets to replace the patch, they should put one on as soon as they remember, as long as they are removing it for 10 hours per day. It is likely that a client might want extra patches if their chest pain is unrelieved. However, continued chest pain despite a nitroglycerin patch indicates a need for further evaluation, as the client might be experiencing a myocardial infarction. The nurse must educate the client to seek immediate help if the chest pain is unrelieved by the prescribed amount of nitroglycerin. Nitroglycerin is a medication used for angina pectoris, or chest pain. It is a nitrate that causes vasodilation, decreasing preload and relieving angina. It is available as a transdermal patch, so the medication is absorbed through the skin. To avoid drug tolerance, the client should remove the patch for at least 10 hours of the day.

Which of the following best describes the action of beta-blockers as cardiac medications? A. Block vasoconstriction and decreased afterload on the heart B. Increasing sodium and water absorption C. Regulating the cardiac conduction system to stabilize heart rhythms D. Decreasing preload to reduce the work of the heart

A. Beta-blockers are cardiac medications that are used for the treatment of hypertension. By binding to receptor sites within the heart they prevent sympathetic stimulation which decreases vasoconstriction and cardiac output, decreasing afterload on the heart. Beta-blockers also improve left ventricular function and exercise tolerance.

A client who takes digoxin has developed signs of toxicity, including nausea, vomiting, diarrhea, confusion, and cardiac arrhythmias. Once the nurse determines that toxicity is present, what is the first action the nurse should perform? A. Hold the digitalis dose and notify the provider B. Administer the medication intravenously instead of orally C. Check the client's pulse before giving the next dose D. Administer antiarrhythmics and drugs to prevent nausea along with the next dose

A. If a client develops toxicity from digoxin, the nurse must hold the next dose and contact the healthcare provider. The client should not continue to receive the medication when signs of toxicity are present. Labs will be drawn to determine the level of digoxin in the blood. It is possible the client will continue to receive digoxin after the provider has determined the cause of the toxicity, because the dosage can be adjusted if the client needs the therapy provided by the drug. However, as long as the levels of digoxin are toxic, the drug will be held, the client will be on cardiac monitoring and transferred to the ICU.

The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates that the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum. 2. Urine output increases from 10 mL/hr to greater than 50 mL hourly. 3. The serum potassium level changes from 3.8 to 3.1 mEq/L (3.8 to 3.1 mmol/L). 4. B-type natriuretic peptide (BNP) factor increases from 200 to 262 ng/mL (200 to 262 mcg/L).

Answer: 2 Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Potassium loss is a side effect rather than an expected effect of the diuretic. Frothy pink sputum indicates progression to pulmonary edema. A BNP greater than 100 pg/mL (100 ng/L) is indicative of heart failure; thus, a rise from a previous level indicates worsening of the condition.

Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid

Answer: 2 Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results? 1. Collaborate with the primary health care provider (PHCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the PHCP to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed. 3. Collaborate with the PHCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the PHCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.

Answer: 2 Rationale: When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

Answer: 2, 4, 5 Rationale: Digoxin is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L).

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 28 seconds 3. Activated partial thromboplastin time of 60 seconds 4. Activated partial thromboplastin time longer than 120 seconds

Answer: 3 Rationale: Common laboratory ranges for activated partial thromboplastin time (aPTT) are 30 to 40 seconds. Because the aPTT should be 1.5 to 2.5 times the normal value, the client's aPTT would be considered therapeutic if it was 60 seconds. Prothrombin time assesses response to warfarin therapy.

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? 1. Obtain a 12-lead electrocardiogram. 2. Check the client's fingerstick blood glucose level. 3. Auscultate the client's apical pulse and blood pressure. 4. Measure the QRS interval duration on the rhythm strip.

Answer: 3 Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the QRS duration on the rhythm strip and obtaining a 12-lead electrocardiogram may be interventions, these would be done after the vital signs are taken. Dizziness directly following the procainamide indicates that the medication was the likely cause and should be addressed before assessing for other possible causes such as hypoglycemia.

The nurse should report which assessment finding to the primary health care provider (PHCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4° F (37.4° C) orally 3. Blood pressure of 198/110 mm Hg 4. Respiratory rate of 28 breaths per minute

Answer: 3 Rationale: Thrombolytic therapy is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore, the nurse would report the results of the blood pressure to the PHCP before initiating therapy.

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

Answer: 4 Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.8-2.6 mEq/L (0.74-1.07 mmol/L), and the results in the correct option are reflective of hypomagnesemia.

The nurse provides discharge instructions to a client with atrial fibrillation who is taking warfarin sodium. Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption." 2. "I will take my pills every day at the same time." 3. "I have already called my family to pick up a MedicAlert bracelet." 4. "I will take coated aspirin for my headaches because it will coat my stomach."

Answer: 4 Rationale: Aspirin-containing products need to be avoided when a client is taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking the prescribed medication at the same time each day increases client compliance. The MedicAlert bracelet provides health care personnel with emergency information.

The nurse provides instructions to the client about nicotinic acid prescribed for hyperlipidemia. Which statement by the client indicates understanding of the instructions? 1. "The medication should be taken with meals to decrease flushing." 2. "It is not necessary to avoid the use of alcohol when taking nicotinic acid." 3. "Clay-colored stools are a common side effect and should not be of concern." 4. "Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing."

Answer: 4 Rationale: Flushing is an adverse effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug, as prescribed, can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be reported to the primary health care provider (PHCP) immediately.

The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (10 mmol/L). The client is taking cholestyramine, and the nurse teaches the client about the medication. Which statement by the client indicates the need for further teaching? 1. "Constipation and bloating might be a problem." 2. "I'll continue to watch my diet and reduce my fats." 3. "Walking a mile each day will help the whole process." 4. "I'll continue my nicotinic acid from the health food store."

Answer: 4 Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the 2 most common adverse effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

A client has a new prescription for propranolol. The client tells the nurse that he is training for a 10K and wants to know if he can still exercise. Which information is true regarding beta-blockers and exercise? Select all that apply. A. The client who exercises should try to maintain a heart rate at an elevated level to gain the most effect B. The client can exercise hard but still should be able to talk while working out C. Beta-blockers can slow heart rate D. Beta-blockers can treat angina that develops during exercise E. The client may need to determine a target heart rate while taking beta-blockers

B, C, E - Persons who exercise a lot may experience changes in their cardiovascular systems, evidenced by a decrease in heart rate and blood pressure. If the client cannot talk while working out, they have pushed themselves too much. Slow heart rate is an effect of beta-blockers. A client who exercises and uses beta-blockers may need to determine a specific target heart rate during exercise and may need to monitor the heart rate during activity. A client on beta-blockers should not try to work against the effect of the beta-blocker by attempting to elevate his heart rate, but could instead try to maintain exercise for a certain amount of time. Nitroglycerin is a common drug to treat angina, not beta-blockers.

A nurse is administering Epinephrine during a cardiac arrest. The nurse knows that Epinephrine produces its effects by stimulating which receptors? Select all that apply. A. Muscarinic B. Alpha 1 C. Nicotinic D. Beta 1 E. Beta 2

B, D, E - Epinephrine is a Non-selective adrenergic agonist and can bind with all alpha and beta receptors. Stimulating Alpha 1 receptors would cause peripheral vasoconstriction, increasing peripheral vascular resistance and therefore increasing blood pressure. The ultimate goal is to increase coronary blood flow. Stimulating Beta 1 receptors would cause the heart to beat faster (increasing heart rate) by increasing conductivity within the heart muscle - the goal being that the heart would return to an efficient pumping pattern. Stimulating Beta 2 receptors would dilate the bronchioles of the lungs to allow improved oxygenation, which can improve oxygenation during a cardiac arrest. Muscarinic and nicotinic receptors are cholinergic receptors that are involved in the parasympathetic nervous system. Stimulating these would likely provide the opposite effect than what is desired in a cardiac arrest situation.

A nurse is caring for a client admitted for NSTEMI who suddenly goes unresponsive. The nurse notes no pulse, calls a code blue, and begins compressions. The provider arrives and orders a dose of epinephrine. What is the appropriate concentration and dose for this situation? A. 1 mg of 1:1,000 B. 10 mg of 1:10,000 C. 0.5 mg of 1:1,000 D. 1 mg of 1:10,000

B. According to ACLS guidelines, the appropriate dose of Epinephrine is 1 mg (10 mL) of Epinephrine in a 1:10,000 concentration. This is given IV or IO every 3-5 minutes during a cardiac arrest situation. In this case, if 1:10,000 concentration is not available, it is possible to administer 1 mg of 1:1,000, diluted in normal saline. However, this is not standard, therefore not the most appropriate option. This may also be facility-specific as to whether this alternate option is allowed.

While reviewing a client's medication list at admission, the nurse notes that the client is taking digoxin. Which of the following medications should the nurse tell the client to avoid? A. Duloxetine B. Amiodarone C. Tiotropium D. Guaifenesin

B. Amiodarone has the potential to increase intestinal transit time and reduce renal clearance. When combined with digoxin, this leads to high levels of digoxin in the blood, and eventually digoxin toxicity.

The nurse administers a client's daily dose of 40 mg lisinopril. 3 hours later, the nurse notes a systolic blood pressure of 195 mm/Hg. Which of the following medications does the nurse anticipate giving? A. IV hydromorphone B. IV hydralazine C. An additional dose of p.o. lisinopril D. Nitroglycerin SL

B. Hydralazine is a direct acting vasodilator given to quickly lower blood pressure. It is usually written as a prn order. The order will state to give this for a systolic and/or diastolic blood pressure above a certain level.

The nurse is preparing to administer aspirin to a client. Which of the following conditions in the client's health history would concern the nurse? A. An allergy to iodine B. Thrombocytopenia C. Deep vein thrombosis D. Polycythemia

B. Thrombocytopenia increases the risk of bleeding in a client. Administering aspirin to a client with this condition will further increase the risk of bleeding. The nurse should hold the dose and contact the provider for clarification on this order.

A nurse is preparing to administer a dose of warfarin to a client. Based on the nurse's knowledge of this drug, the nurse knows to monitor for which of the following side effects? A. Constipation B. Black stools C. Back pain D. Shortness of breath

B. Warfarin is an anticoagulant medication that prevents blood clots. Because of its anticoagulant effects, the risk of bleeding is also increased. The nurse should teach the client to watch for signs of bleeding, which in the gastrointestinal system can manifest as black stools.

A nurse is administering metoprolol to a client. For which of the following signs and symptoms should the nurse monitor the client? Select all that apply. A. Tachycardia B. Hypotension C. Bradycardia D. Hyperglycemia E. Hypertension

C, E - The nurse should monitor the client on beta blockers because they can cause bradycardia, hypotension, bronchoconstriction, and mask hypoglycemia.

An 87-year-old client has a prescription for nitroglycerin that must be applied topically. Which factor must the nurse consider when administering this type of medicine to an older adult? A. Use sterile technique when administering the drug B. Massage the ointment into the skin after application C. Teach the client about signs of toxicity D. Apply the medication over the same site of the last dose

C. An older adult may use medication that is applied topically to the skin. Because older adults often have thinner skin, they may absorb the medication more quickly. The nurse should teach the client about signs of toxicity of the nitroglycerin in case the client rapidly absorbs the drug. Toxicity signs include hypotension leading to shock, flushing of the face, headache, dizziness, restlessness, and syncope. Symptoms can appear within a few minutes to an hour after exposure.

A nurse is caring for a client who has an atrial flutter and has received an order for a diltiazem (Cardizem) infusion. The provider has ordered the following: "Diltiazem bolus 0.25 mg/kg then 10 mg/hr to keep HR between 80 and 110." Which of the following actions would the nurse perform first? A. Set up the continuous infusion B. Infuse the bolus over two minutes C. Assess the client's blood pressure D. Contact the provider to clarify the order

C. Diltiazem is a medication used to manage supraventricular tachycardias like atrial fibrillation or atrial flutter and to regulate normal heart rate and treat hypertension. Diltiazem is a calcium channel blocker that causes vasodilation of coronary and peripheral arteries. Before administering this medication the nurse will check the client's blood pressure because diltiazem can cause hypotension. The provider may order the drug as a bolus followed by a continuous infusion. The nurse should administer the bolus over two minutes and then assess the client's heart rate to determine the rate of the continuous infusion.

A client with cardiac dysrhythmia takes digoxin for management of symptoms. When the breakfast trays arrive on the unit, which food should the nurse remove from the client's tray? A. Wheat toast B. Orange juice C. Bran muffins D. Scrambled eggs

C. Foods that are high in fiber can reduce the amount of Digoxin (Lanoxin) in the body, and bran muffins contain extra fiber. Digoxin is a medication that regulates the heart rate; it can be taken with or without food.

The nurse is caring for a client with bilateral leg swelling who reports taking 40 mg furosemide daily. The nurse notes +4 pitting indents over the client's tibia. The provider orders IV furosemide. What is the priority nursing intervention? A. Place the client on continuous pulse oximetry B. Wrap the client's legs in ace wrap and elevate them C. Check the client's BMP D. Obtain vital signs

C. Furosemide is a potassium-wasting diuretic. If the client has been on this at home and the nurse will be administering the IV form, the client is at risk for hypokalemia and corresponding EKG changes. The nurse should note the client's potassium level first.

A patient is receiving digoxin for treatment of atrial fibrillation. When you enter the room to give the medication, you find the patient irritable and complaining of nausea and blurred vision. She's also disoriented to place and time. The most appropriate action at this time is to: A. attempt to reorient the patient while helping her take the digoxin. B. return to the room later and see whether the patient will take the medication. C. withhold the digoxin and notify the provider about your assessment findings. D. check the medication profile for possible drug interactions after giving the digoxin to the patient.

C. Irritability, nausea, blurred vision, and confusion are signs and symptoms of digoxin toxicity. The digoxin dose should be withheld, the prescriber notified, and the digoxin level checked. You should try to reorient the patient and prepare for possible emergency treatment pending the laboratory results.

A nurse is caring for a client receiving metoprolol for migraines as an off-label treatment. Which of the following would be the most important for the nurse to monitor? A. Pain level B. Temperature C. Blood pressure D. Respirations

C. Metoprolol is a beta blocker, which is an antihypertensive medication. Because the client is NOT receiving this medication for high blood pressure, it is possible that it could make their blood pressure fall too low. The nurse should be alert to possible hypotension.

A home health nurse makes a visit to an independent 95-year-old client who lives alone. The client reports not feeling well. The nurse suspects the client may have taken multiple doses of metoprolol by mistake. Which of the following actions is the first step the nurse should take? A. Check glucose B. Call the client's primary health care provider C. Check vital signs D. Assess mental status

C. Metoprolol is a beta blocker. Overdose can cause bradycardia, hypotension, hypoglycemia masking, and bronchi restriction. The nurse should first get a set of vital signs to determine whether overdose symptoms are present.

A client has been prescribed sublingual nitroglycerin to use PRN for chest pain. The nurse is teaching the client how to administer the medication. Which of the following statements by the nurse is correct? A. "Place this tablet in your cheek and let it dissolve" B. "Swallow this medication with a full glass of water" C. "Place the tablet under your tongue until it has dissolved completely" D. "Put the tablet on your tongue for one minute, then chew and swallow"

C. Nitroglycerin is a medication that dilates blood vessels to allow more blood to flow through them, which can effectively treat episodes of chest pain by dilating the coronary arteries. Sublingual medication is administered under the tongue to dissolve completely to get the full effect of the medication. The nurse should teach the client in this situation to place the nitroglycerin tablet under his tongue and let it dissolve, rather than chewing it or swallowing the tablet before it has dissolved.

Which adverse reaction associated with ACE inhibitors is common and can lead to disruption of therapy? A. Constipation B. Cough C. Sexual dysfunction D. Tachycardia

B. A common adverse reaction, cough causes the discontinuation of ACE inhibitor therapy because it disrupts the patient's sleep patterns.

Which of the following foods should the nurse encourage for a child who is prescribed furosemide? Select all that apply. A. Legumes B. Bananas C. Grapes D. Onions E. Berries

A, B - Furosemide is a potassium wasting diuretic. Eating foods that are high in potassium, like bananas and legumes, will help prevent hypokalemia. Grapes, onions, and berries are not high in potassium.

The nurse is preparing to give a client digoxin as ordered. The nurse is aware that which of the following is a priority nursing action before administering this drug? A. Assess the apical pulse for one minute B. Assess the serum potassium C. Palpate the radial pulse for 60 seconds D. Monitor renal function tests

A. An apical pulse of less than 60 could indicate digoxin toxicity. Therefore, the nurse should check the apical pulse for one minute to get an accurate reading before administering a dose of digoxin. Renal function tests and serum potassium are important in giving digoxin but are not the priority action when giving the client the medication.

The nurse is reviewing a client's medications and notes that the client is taking metoprolol. Which of the following medications would the nurse recognize as causing an interaction with metoprolol? A. Ibuprofen B. Levothyroxine C. Acetaminophen D. Ondansetron

A. Ibuprofen causes a decreased effect of metoprolol and should be avoided by a client taking metoprolol.

A client with high blood pressure during labor has been given magnesium sulfate IV. In addition to the regulation of blood pressure and prevention of seizures, which of the following side effects would the nurse expect to see after administration of this medication? A. Cool, pale skin B. Muscle weakness C. Constipation D. Neck pain

B. Administration of magnesium sulfate is a form of treatment used for some women who have preeclampsia during pregnancy and labor. Magnesium sulfate is given to prevent preterm delivery but it can also cause some negative effects in the mother, including muscle weakness, blurred vision, headache, nausea, and vomiting.

A nurse arrives on the unit to receive bedside report on a client. When the nurse enters the room the client is assessed to be in pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). The nurse knows to give which two medications to help the client? A. Atropine B. Shock the client C. Amiodarone D. Epinephrine E. Adenosine

C, D - Amiodarone is an antiarrhythmic drug. It is used during pulseless VT/VF events. Epinephrine is an adrenergic agonist is used during pulseless VT/VF events. Shocking the client might occur in this state but it is not a medication. Atropine is used during unstable bradycardic events. Adenosine is used during tachycardiac events (with a pulse).

Thrombolytic therapy is used for which of the following conditions? Select all that apply. A. Hemorrhagic stroke B. Hypertension C. Pulmonary embolism D. Acute coronary thrombosis E. Ischemic stroke

C, D, E - Thrombolytic medications break up clots quickly. Acute coronary thrombosis, pulmonary embolism, and ischemic stroke are examples where this drug would be used. Hypertension is not relieved by a thrombolytic. A hemorrhagic stroke occurs when the vessel is hemorrhaging, in which case a thrombolytic would be contraindicated.

Calcium gluconate is given to reverse respiratory depression caused by the administration of which drug? A. Potassium B. Calcium C. Magnesium sulfate D. Sodium bicarbonate

C. Calcium gluconate is given to reverse the respiratory depression in patients receiving magnesium sulfate.

The nurse has administered atenolol to a client. Which of the following is an intended effect of the medication? A. Hypoglycemia B. Rebound tachycardia C. Smooth muscle constriction D. Decreased angina

D. A beta-blocker can be prescribed for angina, so the client taking this medication would be expected to report a decrease in angina.

A patient comes to the emergency department complaining of chest pains, which started 1 hour ago while he was mowing the lawn. Nitroglycerin was given sublingually as prescribed. Which of the following adverse reactions would be most likely to occur? A. Hypotension B. Dizziness C. GI distress D. Headache

D. The most common adverse reaction to nitrates is headache. Nitrates dilate the blood vessels in the meningeal layers between the brain and cranium. Hypotension, dizziness, and GI distress may occur, but the likelihood varies with each patient.

Upon admission, the nurse takes a client's blood pressure and the result is 197/105 mmHg. The nurse reviews the client's home medications and notes that the client takes medication for hypertension. Which of the following medications is for hypertension? A. Metocloprimide B. Metoprolol C. Medazolam D. Methylphenidate

B. Metoprolol is a beta blocker used to treat hypertension.

The nurse knows that a thrombolytic medication depends on the conversion of plasminogen to plasmin. Plasmin performs which of the following functions? A. Plasmin activates prothrombin B. Plasmin causes fibrolysis C. Plasmin increases bioavailability of blood plasma proteins D. Plasmin allows for increased clotting factors

B. Plasmin is the substance that causes fibrolysis, or breakdown, of a clot.

The nurse is caring for a client who is exhibiting signs and symptoms of digoxin toxicity. Which of the following signs is suggestive of digoxin toxicity? A. Shortness of Breath B. Halo vision C. Diarrhea D. Diaphoresis

B. Signs and symptoms of digoxin toxicity include nausea, vomiting, vision changes, cardiac arrhythmias, and confusion.

The nurse is preparing the client's scheduled medications, one of which is digoxin. For which of the following vital signs would the nurse hold the client's digoxin dose? A. A heart rate of 55 bpm B. A blood pressure of 198/101 mmHg C. An oral temperature of 99.8F D. A respiratory rate of 27 breaths per minute

A. The nurse should hold digoxin if the client's heart rate is under 60 bmp.

The nurse is reviewing the medication list of a client who is taking atorvastatin. Which of the following medications should concern the nurse? A. Warfarin B. Heparin C. Lovenox D. Xarelto

A. When a client is taking a statin, it is common that the provider adjusts their dose of warfarin, because of the potential for increased bleeding in multiple case studies when the two are taken concurrently.

A nurse is caring for a client with asthma and knows which drug could cause bronchospasms for the client? A. Atropine B. Adenosine C. Epinephrine D. Amiodarone

B. Hypersensitivity to adenosine can cause bronchospasms in clients with asthma.

A nurse must administer nitroglycerin 0.4 mg sublingually to a client experiencing chest pain. Which best describes how nitroglycerin works to relieve chest pain? A. Nitroglycerin slows blood clotting, which improves blood flow to the heart B. Nitroglycerin reduces cell damage, which restores blood flow to the heart C. Nitroglycerin relaxes the smooth muscles of the coronary arteries to improve blood flow D. Nitroglycerin acts on pain receptors in the brain so the client does not feel the pain

C. Nitroglycerin is a vasodilator medication that increases the size of the blood vessels. When a client is experiencing chest pain because of the lack of blood flow, the administration of nitroglycerin increases the size of the vessels and improves blood flow, which can reduce chest pain.

The nurse is preparing to administer streptokinase to a client. Which of the following conditions would cause the nurse to hold the dose? Select all that apply. A. Pulse 45 B. Chest pain with breathing C. Pneumothorax D. Blood pressure 170/88 E. A history of central line occlusion

D. Streptokinase is a thrombolytic. This client is hypertensive, and giving a thrombolytic medication to a hypertensive client puts the client at risk for hemorrhage. This client's blood pressure must be managed prior to administration of a thrombolytic. This client is bradycardic, but this is not a contraindication for a thrombolytic medication. Central line occlusions are often treated with thrombolytics. Chest pain with breathing is not a contraindication for thrombolytics. A hemothorax would cause concern for the nurse, but not a pneumothorax. Test taking tip: The NCLEX SATA questions may have anywhere from 1 to 5 correct responses.

The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide? Select all that apply. 1. Sulfa allergy 2. Osteoporosis 3. Hypokalemia 4. Hypouricemia 5. Hyperglycemia 6. Hypercalcemia

Answer: 1, 3, 5, 6 Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions should the nurse anticipate? Select all that apply. 1. Stop the infusion. 2. Raise the head of the bed. 3. Administer protamine sulfate. 4. Administer diphenhydramine. 5. Call for the Rapid Response Team (RRT).

Answer: 1, 4, 5 Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the RRT. The client may be treated with antihistamines. Raising the head of the bed would not be helpful, as that may exacerbate the hypotension. Protamine sulfate is the antidote for heparin, so it is not useful for a client receiving alteplase.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range? 1. 0.5 ng/mL (0.63 nmol/L) 2. 0.8 ng/mL (1.02 nmol/L) 3. 0.9 ng/mL (1.14 nmol/L) 4. 2.2 ng/mL (2.8 nmol/L)

Answer: 4 Rationale: The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L). If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and elevated.

The nurse is administering an anti-platelet drug to a client. The nurse knows it is most important to monitor for which of the following adverse effects? A. Prolonged QT interval B. Flushing C. Hemorrhage D. Nausea and vomiting

C. Since an anti-platelet medication reduces the clotting ability of the blood, the nurse should monitor any client taking this type of medication for signs of bleeding. HODS is a mnemonic to help remember some drug combinations that cause adverse effects when taken with anti-platelet aggregates: Heparin = increased bleeding potential, Oral antidiabetic drugs + aspirin = uncontrolled BG results, Dipyridamole = increase bleeding potential, and lastly Steroids + aspirin = increased risk for GI ulceration.

The nurse has an order to administer a thrombolytic to a client. The nurse knows that a thrombolytic medication is indicated for all of the following conditions except which? A. Pulmonary embolism B. Shunt occlusion C. Intracranial tumor D. Acute myocardial infarction

C. Thrombolytics have been associated with intracranial hemorrhage when a person has a brain tumor. They are contraindicated for this condition.

The nurse preceptor on a telemetry floor is reviewing sympatholytics with a student nurse. The student asks the nurse which substance is blocked by a B-adrenergic blocker. Which response by the nurse is correct? A. Catecholamines B. Histamines C. Amphetamines D. Cholestyramine

A. The catecholamines epinephrine and norepinephrine are blocked by B-adrenergic blockers, which means that the 'flight or fight' response, or stress response, is inhibited with this medication.

A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? 1. Monitor for kidney failure. 2. Monitor psychosocial status. 3. Monitor for signs of bleeding. 4. Have heparin sodium available.

Answer: 3 Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? 1. Report of infrequent insomnia 2. Development of expiratory wheezes 3. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after 2 doses of the medication 4. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after 2 doses of the medication

Answer: 2 Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

The healthcare provider ordered Furosemide 40 mg PO BID for a client. The nurse knows that this medication is used to treat which of the following diagnoses? A. Gastritis B. Pneumonia C. Encephalopathy D. Acute renal failure

D. Acute renal failure is when the kidneys aren't able to function and filter the blood and remove fluid from the body. This results in fluid volume overload. Furosemide is a diuretic that will help to push fluid out of the body by urination.

The nurse is preparing to administer clopidogrel to a client. The nurse knows that the purpose of this medication is which of the following? A. To slow down the formation of thrombi B. To dissolve a thrombus C. To prevent fibrinolysis D. To prevent a thrombus from forming

D. The purpose of anti-platelet aggregates is thrombus prevention. They work by preventing platelet grouping and clumping.

A client is being admitted to the intensive care unit following an acute ischemic stroke. The nurse has an order to administer clopidogrel. The nurse knows that in addition to preventing recurrent strokes, which of the following conditions indicate this type of medication? A. Varicose veins B. Myocardial infarction C. Anemia D. 3rd degree heart block

B. Anti-platelet aggregates are given acutely during an MI or for MI prevention.

Types of anti-platelet aggregates include which of the following? Select all that apply. A. Aggregation inhibitors B. Angiogenesis inhibitors C. Glycoprotein inhibitors D. ARB inhibitors E. MAO inhibitors

A, C - A glycoprotein inhibitor is an anti-platelet aggregate (example: abciximab). An aggregation inhibitor is an anti-platelet aggregate (example: aspirin or clopidogrel). An ARB inhibitor, or angiotensin receptor blocker inhibitor is an antihypertensive and a vasodilator. An angiogenesis inhibitor is a cancer growth-blocking medication. An MAOI, or monoamine oxidase inhibitor is an antidepressant.

A client with heart failure has a new prescription for digoxin. What should be included as part of teaching this client about digoxin? Select all that apply. A. Digoxin may be affected by concurrent intake of St. John's wort B. The drug could cause serious side effects, such as cardiac arrhythmias C. The client should not take the drug with a pulse less than 60 D. The drug may not be well absorbed if the client has a high-fiber meal E. Common signs of drug toxicity include petechiae on the chest and hair loss

A, B, C, D - St. John's Wort is a type of herbal medicine may also affect the absorption of Digoxin. Other items may affect absorption of digoxin, including a high-fiber meal or intake of some types of supplements. Digoxin is a cardiac medication that must be carefully monitored with client use because of its effects. The client should know his heart rate before taking digoxin, as the drug can cause changes in the rate. If the client has a pulse less than 60, they should hold the digoxin and recheck the pulse later to see if it is above 60. If it is above 60 at that time, the client may take the medication.

Upon admission, a client tells the nurse that she takes verapamil. Which of the following additional medications in the client's medication list would cause concern for the nurse? Select all that apply. A. Metoprolol B. Acetaminophen C. Metformin D. Digoxin E. Lisinopril

A, D, E - When taken with a beta blocker such as metoprolol, verapamil can lead to severe bradycardia. When taken concurrently with digoxin, it leads to severe bradycardia and digoxin toxicity. When taken with an ACE-inhibitor such as lisinopril, verapamil can cause severe hypotension. Acetaminophen and Metformin do not interact with verapamil to cause an adverse effect.

A patient is taking an HMG-CoA reductase inhibitor. Which of the following tests should be performed at the start of therapy and periodically thereafter? A. Liver function B. Electrolyte levels C. Complete blood count D. ECG

A. Because increased liver enzyme levels may occur in patients receiving long-term HMC-CoA therapy, liver function test results should be monitored.

The nurse is caring for a client with congestive heart failure. This client regularly takes a vasodilator. The nurse understands that this type of drug helps congestive heart failure in what ways? Select all that apply. A. Increase blood pressure B. Reduce cardiac afterload C. Dilate the kidney's arterioles D. Increase cardiac preload E. Enhance skeletal muscle circulation

B, C, E - In general, a vasodilator benefits the client in heart failure by dilating blood vessels so that cardiac afterload is reduced. When peripheral blood vessels are dilated, circulation is enhanced which means that both skeletal and coronary circulation is increased. The kidney's arterioles are also dilated which promotes blood filtration. Vasodilation decreases the forward flow of blood, which decreases cardiac preload and afterload and decreases blood pressure.

A nurse calls the charge nurse and asks for a vial of Epinephrine 1:10,000 to be brought to a client's room STAT. The charge nurse knows that what situation is likely occurring in the client's room? A. Hemorrhaging B. Cardiac arrest C. Respiratory distress D. Anaphylactic reaction

B. Epinephrine 1:10,000 is used in the event of a cardiac arrest and is given IV. In anaphylactic reactions, Epinephrine 1:1,000 concentration is used and is given IM.

A client is found unresponsive and is connected to the defibrillator and the monitor reveals a rhythm of asystole. The nurse knows that which of the following medications should be given? A. Atropine B. Epinephrine C. Magnesium D. Amiodarone

B. Epinephrine is the only drug used in PEA/Asystole algorithm. Epinephrine causes an increase in heart rate, muscle strength, and blood pressure.

Which of the following is considered a contraindication for administration of furosemide (Lasix)? A. Facial swelling B. Decreased urine output C. 4+ pitting edema in the lower extremities D. Hypertension

B. Furosemide (Lasix) is a diuretic medication that can be given to induce the elimination of excess fluid from the body. Furosemide is typically used when a client has excess fluid because of such diseases as heart failure or when pulmonary edema is present. It is contraindicated in a client who has decreased urine output or is unable to urinate.

A nurse administers digoxin (Lanoxin) to a client with heart failure. Based on the nurse's knowledge of this drug, which intervention should the nurse perform before administering it? A. Monitor the client's oral intake B. Assess for pitting edema C. Check the client's heart rate D. Assess the client's lung sounds

C. Digoxin is a medication used in the treatment of heart failure, and it works by affecting sodium and potassium inside heart cells. This helps the heart maintain a normal, steady and strong heartbeat, reducing strain on the heart muscle. The nurse should not give the drug without first checking the client's pulse. After administering digoxin, the nurse monitors the client for a slowed heart rate.

Calcium channel blockers reduce high blood pressure by which of the following mechanisms? A. Dilating peripheral veins and decreasing preload B. Inhibiting angiotensin converting enzyme C. Increasing the water loss by the kidneys D. Dilating coronary and peripheral vessels

D. Calcium channel blockers dilate coronary arteries and arterioles and peripheral vessels, thus decreasing vascular resistance.

The client is taking an angiotensin II receptor blocker for blood pressure control. You explain to the client that giving this drug helps reduce blood pressure through which mechanism? A. It reduces the production of aldosterone B. It lessens the renin produced by the kidneys C. It prevents angiotensin binding for less vasoconstriction D. It directly increases resorption of sodium in the kidneys

C. Angiotensin II inhibitors block angiotensin II from binding to receptors on blood vessel walls, reducing blood pressure.

A nurse is reviewing orders for a client on the floor and notes that a thrombolytic drug is ordered. Which of the following medications on the client's medication record would warrant a call to the provider? A. Acetaminophen B. Ondansetron C. Clopidogrel D. Atorvastatin

C. Clopidogrel affects platelet function, and any drug that affects platelet function is a contraindication to giving a thrombolytic drug.

A nurse is caring for a client with pulseless electrical activity (PEA/asystole). The nurse knows that according to the the PEA/asystole algorithm, which of the following actions are expected? A. No shock is needed B. 1 minute of CPR, then shock C. Immediately defibrillate the client D. 2 minutes of CPR, then shock

A. No shock is warranted, only medication (epi) & CPR. This is not a shockable rhythm.