Exam 1

What is the effect of ACEi's on the kidneys?

There is a decrease in renal bloodflow which can lead to renal damage, failure, and proteinuria

What is the effect of ARBs on serum potassium?

There is an overall increase because ARBs interfere with kidney excretion & filtration

Adenosine

antiarrhythmic that slows AV conduction. Used for paroxysmal SVT - side effect: transient flushing, moment of dyspnea, - caffeine and theophylline decrease drug effects

Lisinopril

antihypertensive, ACE inhibitor used for HTN and HF, can cause reflex tachycardia, chest pain, HF arrhythmias, cough, photosensitivity, alopecia, and rash

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following lab values should the nurse monitor for a therapeutic effect of warfarin? a. hgb b. PT c. bleeding time d. aPTT

b. PT - prothrombin time - bleeding time is normally associated with platelet therapy, and aPTT is used to monitor heparin, not warfarin.

CCB (diltiazem, verapamil)

slow AV conduction in the heart; used for angina pectoris, HTN, arrhythmias. - side effect: bradycardia, hypotension, constipation, peripheral edema, gingival hyperplasia Should not be given to those with preexisting heart block

Urokinase

thrombolytic agent. used for catheter occlusion if flush, and heparin does not work and used to destroy pulmonary embolisms and coronary thrombi

What is heparin induced thrombocytopenia? (HIT)

when not enough platelets, RBCs or WBCs are in the blood due to use of the anticoagulant medications

Calcium channel blockers

-dipine -zem -mil

Spironolactone

Inhibits action of aldosterone and increases Na+ excretion & K+ retention. Indicated for the treatment of HTN, edema, HF. Can cause hyperkalemia, endocrine effects (gynecomastia & ED, irregular menses). - should not increase dietary potassium intake

A nurse is obtaining a medical hx from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? a. feverfew b. black cohosh c. echinacea d. flaxseed

a. feverfew - it increases the anticoagulant effect

A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? a. the client follows a low-fat diet to reduce cholesterol b. the client drinks a glass of grapefruit juice every day c. the client sprinkles flax seeds on food 1 hr before taking the drug d. the client uses garlic to lower cholesterol levels

d. the client uses garlic to lower cholesterol levels - grapefruit interferes with statins, flax seed can affect medication absorption and should be taken 1 hour before meds, garlic is a no go

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. the clien'ts INR is 5.2. Which of the following medications should the nurse prepare to administer? a. epinephrine b. atropine c. protamine d. vitamin k

d. vitamin k - the one and only antidote for warfarin. Normal INR for warfarin therapeutic range is 2-3

What is the onset of action for warfarin?

~3 days to reach therapeutic levels and the effects will last 4-5 days

What medications can cause hyperkalemia?

•Non-selective beta-adrenergic blockers •ACE inhibitors 2/2 *inhibition of AT II formation* •ARBs 2/2 *decreased aldosterone secretion* •K+-sparing diuretics (eg, triamterene, amiloride) •Cardiac glycosides (eg, digoxin) •NSAIDs 2/2 *impaired local PG synthesis* → *decreased renin & aldosterone secretion*

Adverse effects of corticosteroids on various body systems

- CNS: vertigo, headache, paresthesias, insomnia, convulsions, psychosis - CV: hypoTN, HF, shock 2ndary to fluid retention, FE, thromboembolism, thrombophlebitis, arrhythmias 2ndary to electrolyte imbalance - MS: muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures - Endocrine: amenorrhea, growth retardation, diabetes - Eyes: infection, glaucoma, cataracts - GI: peptic/esophageal ulcers, pancreatitis, abd. distention, n&v, weight gain - Skin: frail, petechiae, ecchymosis, purpura, striae, subQ fat atrophy - immune: immunosuppression, aggravation or masking of infections, impaired wound healing - electrolye/fluid balance: Na+ & fluid retention, hypokalemia, hypocalcemia, increased BG, increased cholesterol, decreased TH

A nurse is preparing to administer a continuous heparin infusion at 1600 units/hr. There is 25000 units in 500 mL D5W available. The nurse should set the IV pump to deliver how many mL/hr?

1600units * 500mL --------------------- = 32mL 25000units * X mL

A nurse is preparing to administer KCL 20 mEq suspension PO daily. The amoutn available is KCL sus10mEq/mL. How many mL should the nurse administer? (round to nearest tenth/whole #)

2 mL - we need 20mEq & in one mL is 10 meq.

A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300mg PO tid. Which of the adverse effects should the nurse inform? a. constipation b. metallic taste c. headache, d. muscle spasms

A. constipation - nurse should inform the client to increase fluids and fiber and that a stool softener or laxative may be needed

Amiodarone

Antiarrhythmic used to treat life-threatening ventricular arrhythmias - is the preferred drug in advanced cardiac life support protocol, v-fib & pulseless ventricular tachycardia - has been associated with potentially fatal liver toxicity, ocular abnormalities, lung fibrosis, & serious cardiac arrhythmias - administered PO & IV

What is the difference between antiplatelet and anticoagulant medications?

Anticoagulant: prevents & slows clot formation Antiplatelet: interferes with clumping of platelets that form the plug

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? a. take aspirin if headache develop b. eat foods that contain plenty of potassium c. expect some swelling in the hands and feet d. take the medication at bedtime

B. eat foods that contain plenty of potassium - furosemide can increse effects of aspiring/anticoagulants, should reduce swelling, and should be taken early in the day to avoid nocturia.

A nurse is caring for a client whose serum K+ level is 5.3 mEq/L. Which of the following scheduled meds should the nurse administer? a. lisinopril b. digoxin c. furosemide d. potassium iodide

C. furosemide - lisinopril decreases aldosterone production causing kidneys to retain sodium, digoxin competes with potassium binding sites, potassium iodide is for grave's disease and would increase K+ levels.

Antidote for hypermagnesemia

Calcium gluconate

Warfarin

Coumadin, an anticoagulant - inhibits clotting factors and is used for Afib, VT, PE - PT & INR should be monitored - contraindicated in pregnancy - antidote: vitamin K + FFP

Bicarbonate

HCO3- (22-26) used for acid base imbalance

What is a life threatening adverse effect of ACEi?

Heart failure and renal insufficiency

How does insulin work to lower potassium levels?

Insulin lowers K+ levels by activating a pump that causes an influx of K+ into cells insulin & glucose should be given together

Enoxaparin

Lovenox, an anticoagulant and low-molceular-weight heparin. Used prophylactically for DVT

Why must long-term corticosteroids be tapered off?

The body's natural mechanism of adrenal gland function to release hormones similar to corticosteroids has been suppressed by the use of the medication

Why must the IV site be monitored when IV KCL is infusing?

There can be possible infiltration that would cause sloughing and necrosis. If this happens, the IV infusion should be stopped, extremity elevated and medicate as needed

Rivaroxaban

Xarelto Anticoagulant - PO only, used for DVT that can cause PE in pts undergoing hip or knee replacement surgery

Alteplase

a thrombolytic agent that dissolves thrombosis associated with MI, acute PE, acute stroke. - increases risk for bleeding and is contraindicated in cerebral hemorrhage - antidote: aminocaproic acid

epinephrine

adrenergic agonist indicated for treatment of shock when increased BP & <3 contractility are necessary; can cause headache, sweating, anxiety, HTN, arrhythmias, hypokalemia & renal shut down

Furosemide

lasix, loop diuretic - indicated for HF, pulmonary edema, and acute renal failure - work in loop of Henle to inhibit reabsorption of sodium and potassium - rapid injection can cause serious ototoxicity. Can also cause gout, dehydration, hypocalcemia, hypokalemia, and orthostatic hypoTN

Atropine

muscarinic antagonist that is administered to patients when they have bradycardia or cardiac arrest. - side effects: tachycardia, dry mouth, urinary retention

Prednisone

an intermediate acting corticosteroid that is given PO for replacement therapy for adrenal insufficiency and allergic/inflammatory disorders

Lidocaine

- a local anesthetic that when administer IV blocks Na+ channels to treat ventricular dysrhythmias - side effect: paresthesia, seizure, respiratory depression, fatigue, drowsiness. - should not be given with epinephrine

Digoxin Toxicity treatment

- activated charcoal - normalize K+ imbalance - digibine - mg sulfate or lidocaine to control HR - last cardiac pacing

Heparin

- fast acting anticoagulant that is used prophylactically for DVT - can cause hemorrhage, thrombocytopenia - monitor aPTT (normal is 25-35 seconds) - safe during pregnancy - antidote: protamine sulfate

Digoxin toxicity

-Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision halos around light, arrhythmias, AV block. -Can lead to hyperkalemia, which indicates poor prognosis.

Beta bolockers

-olol - decrease HR & contractility, peripheral vascular resistance, and decrease renin release - used for HTN, HF, angina pectoris - not to be given for asthma and <3 block patients - can mask signs of hypoglycemia and should not be abruptly stopped

Ace inhibitors

-pril - block RAAS system - indicated for HF, HTN - can cause dry cough, hypotension, hyperkalemia, angioedema - should be taken on an empty stomach and should not be taken with allopurinol, NSAIDs, other ACEis or ARBs - slowly change positions and do not abruptly stop

Angiotensin Receptor Blockers (ARBs)

-sartan - used to manage HTN, diabetic nephropathy & HF, in patients that cannot tolerate ACEi's - can lead to angioedema and are contraindicated in patients with renal artery stenosis and pregnancy

A nurse is preparing to administer heparin 2000 units by IV bolus. There is 5000 units/mL available. How many mL should the nurse administer?

0.4 mL

A nurse is preparing to administer D5W 150 mL IV to infuse over 3 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (round to nearest whole #)

10gtt * 150mL * 1hr ------------------ =8 gtt/min 1mL * 3hr * 60min

What is the max infusion rate of KCL?

10mEq/hr

Methylprednisolone

Medrol Corticosteroid drug given IV, PO, & IM for treatment of allergic and inflammatory disorders; can cause upset stomach, n&v, heartburn, headache, trouble sleeping, increased sweating, changes in appetite

Which agent may be effective in terminating paroxysmal SVT? a. adenosine b. methoxamine c. propranolol d. all of the above

a. adenosine

A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? a. bananas b. cooked carrots c. cheddar cheese d. 2% milk

a. bananas - banas, orange juice, and spinach have high amounts of potassium

A nurse is caring for a client who has CHF and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? a. check the clien'ts vitals b. request a dietitian consult c. suggest that the client rests before eating the meal d. request an order for an antiemetic

a. check the client's vital signs - nausea may be caused by digitalis toxicity to assess BP & HR because bradycardia is a symptom of DT. HR <60bpm = hold med

A nurse is caring for a client who has difficulty swallowing meds and is prescribed enteric-coated aspirin PO daily. The client asks if the med can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? a. crushing the medication might cause you to have a stomachache or indigestion b. crushing it is a good idea and i can mix it in ice cream c. crushing the med would release all the medication at once d. crushing is unsafe as it destroys the ingredient in the medication

a. crushing the medication might cause you to have a stomachache or indigestion - enteric coating prevents breakdown in the stomach and decreases possibility of GI distress so it should not be crushed.

A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? a. decreased blood pressure b. increase of HDL cholesterol c. prevention of bipolar manic episodes d. improved sexual function

a. decreased BP - lisinopril= an ACEi used for HTN & CHF and the therapeutic effect is a decreased BP

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? a. do not use salt substitutes while taking this medication b. take the medication w/ food c. count your pulse rate before taking d. expect to gain weight while taking this

a. do not use salt substitutes while taking this medication - captopril is another ACEi that can cause hyperkalemia due to K+ retention by the kidney & salt substitutes are high in potassium. This should be taken on an empty stomach.

Aspirin

an anti-inflammatory and antiplatelet that inhibits platelet aggregation. - prevents thrombotic events, treats general pain, reduces fever - can cause GI ulcers, systemic bleeding, and Reye's syndrome in kids <18y/o

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? a. i have started taking ginger root to treat my joint stiffness b. i take this medication at the same time each day c. i eat a green salad every night with dinner d. i had my INR checked three weeks ago

a. i have started taking ginger root to treat my joint stiffness - ginger root interferes with the blood clotting effect of warfarin and puts the client at risk for bleeding

A nurse in a coronary care unit is admitting a client who has had CPR following cardiac arrest. The client is receiving lidocaine IV at 2mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that is has which of the following actions? a. prevents dysrhythmias b. slows intestinal motility c. dissolves blood clots d. relieves pain

a. prevents dysrhythmias - it is an antidysrhythmic that delays conduction in the heart & reduces automaticity of heart tissue. it does not have anticholinergic properties. Topical lidocaine is a local anesthetic.

A nurse is monitoring a client who received epinephrine for angioedmea after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? a. respirations are unlabored b. client reports decreased groin pain of 3 on 1-10 scale c. the client's BP when arising is at premedication levels d. the client tolerates a 2nd dose of med w/ no >1+ peripheral edema

a. respirations are unlabored - angioemeda is swelling of tongue, glottis and pharynx limiting airway passage/clearance and cause extreme respiratory distress

A nurse is teaching a client about taking diphenhydramine. the nurse should explain to the client that which of the following is an adverse effect of this medication? a. sedation b. constipation. c. hypertension d. bradycardia

a. sedation - benadryl - it can cause sedation/drowsiness, diarrhea, hypotension and palpitations

A nurse is assessing a client who is receiving dopamine IV to treat LVF. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? a. systolic BP is increased b. CO is reduced c. apical HR is increased d. urine output is reduced

a. systolic bP is increased. - dopamine causes peripheral vasoconstriction and should increase systolic BP and it increases urine output and cardiac output at therapeutic levels

A nurse is preparing to transfuse 1 unit of PRBC to a client who experienced a mild allergic rxn during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses? a. urticaria b. fever c. fluid overload d. hemolysis

a. urticaria (aka hives) - antihistamines can prevent rxns such as that but will not prevent fever, fluid overload or hemolysis

A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? a. vitamin K b. heparin c. warfarin d. ferrous sulfate

a. vitamin K - PT of 30 seconds indicates a prolonged time and could result in bleeding so vitamin k should be given.

A nurse is caring for a client who has DVT and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO w/o discontinuing heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? a. warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level b. i will call the provider to discontinue heparin c. heparin & warfarin work together d. IV heparin increases effects of warfarin & decreases hospital stay

a. warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level - both the drugs decrease clotting ability of the blood and prevent thrombus formation. But they work at different lengths

norepinephrine

adrenergic agonist used to stimulate the heart and increase BP after cardiac arrest and during anaphylaxis. A complication is decreased renal blood supply, headache, sweating, HTN, nausea, arrhythmias.

Diphenhydramine

aka benadryl is used for relief of seasonal and perennial allergies. Completely blocks H1 receptor sites, has a sedative effect. Can be given PO, IM, & IV

Fexofenadine

allegra, a 2nd generation antihistamine that provides relief of seasonal and perennial allergies without the sedative effects. PO only

Sodium polystyrene sulfonate adverse effects

also known as Kayexalate - constipation, confusion, unusual bleeding, muscle weakness, abdominal pain, seizures, fast pounding or irregular heartbeat

Dopamine

an adrenergic agonist indicated for the treatment of shock; it stimulates heart contractility and blood pressure; can cause arrhythmias, HTN, palpitations, headache, N&V - does not cause renal shut down

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? a. hyperglycemia b. adrenocortical insufficiency c. severe drhydration d. rebound pulmonary congestion

b. adrenocortical insufficiency - prenisone is a corticosteroid similar to cortisone that is released by the adrenal gland. Having this medication can suppress the adrenal gland function while taking so it should not be stopped abruptly. Fluid retention is an adverse effect of prednisone. Hyperglycemia is an adverse effect that should stop with the stop of taking med.

A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphendydramine? a. administer the med with food b. chew on sugarless gum or suck on hard candies c. place a humidifier at your bedside every evening d. discontinue the med and notify your provider

b. chew on sugarless gum or suck on hard candies - this helps keep the mouth moist.

A nurse is reviewing a health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40mg bid. Which of the following findings in the history should the nurse report to the provider? a. the client has a history of hypothyroidism b. the client has a history of bronchial asthma c. the client has a history of HTN d. the client has a history of migraine headaches

b. client has a hx of bronchial asthma - propranolol is a b-blocker and b-blcokers can cause bronchospasms so it is contraindicated. It can be used to treat HTN and prevent migraine headaches. it can mask symptoms of hyperthyroidism

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? a. aspirin PO b. enoxaparin SubQ c. heparin infusino d. warfarin PO

b. enoxaparin SubQ - a low molecular weight heparin used for preventative measures for post-surgical situations; warfarin will be start with enoxaparin (works slower than enoxaparin). The other two are used for existing DVT

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? a. hypernatremia v. hyperuricemia c. hypercalcemia d. hyperchloremia

b. hyperuricemia - hyperuricemia is excess uric acid. In excess the uric acid can crystallize in the joints and cause joint pain. The client should notify HCP of any tenderness or swelling in the joints. all the other imbalances would occur in the opposite direction with the use of furosemide

A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? a. hyperthermia b. hypotension c. ototoxicity d. muscle pain

b. hypotension - verapamil is a CCB that is used to control SVTs and decrease BP making that a major adverse effect.

Why are antihistamines used to manage anaphylaxis?

because they decrease the allergic response

Carvedilol

beta blocker - nonselective blocking agent used for HTN and HF

What effect do ARBs have on blood vessels?

bind to angiotensin receptors in smooth muscle of vessels & adrenal cortex to prevent vasoconstriction & release of aldosterone

A nurse is caring for a client who has a prescription for KCL 20mEq PO bid. The nurse reviews the client's most recent labs and finds the K+ level to be 5.2 mEq/L. Which of the following actions should the nurse take? a. give KCL as prescribed b. omit KCL dose and document as not given c. call prescribing physician and inform of the client's K+ levels d. call teh lab to verify the client's result

c. call prescribing physician and inform her of the client's K+ levels - normal range for K+ is 3.5-5.0. The client has hyperkalemia and should not be given KCL.

A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following prescriptions for this client? a. aspirin b. clopidogrel c. enoxaparin d. alteplase

c. enoxaparin - lovenox is used prophylactically to prevent formation of VTE.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? a. it usually takes heparin at least 2-3 days to reach a therapeutic level b. a pharmacist is the person to answer that question c. heparin does not dissolve clots, it stop new clots from forming d. the oral med you will take after this will dissolve the clot

c. heparin does not dissolve clots, it stop new clots from forming - heparin is an anticoagulant not an antithrombolytic

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? a. use a 22-gauge needle to inject the medication b. use a 1-inch needle c. inject the medication into the abdomen above the level of the iliac crest d. massage the injection site after administration

c. inject the medication into the abdomen above the level of the iliac crest - a 25- or 26- gauge and 3/8in or smaller needle should be used. never massage injection site

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? a. iron b. glucagon c. protamine d. vitamin k

c. protamine.

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? a. check the pulse after med admin b. take the med w/ meals c. rinse the mouth after admin d. limit caffeine intake

c. rinse the mouth after admin - to prevent fungal overgrowth & oral thrush. this drug does not cause cardiac effects, only oral glucocorticoids should be taken with food, caffeine is not contraindicated

A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for KCL 20mEq ER PO daily. Which of the instructions should the nurse provide about the new prescription? a. take ER tablets on an empty stomach b. add an antacid if the mediation causes indigestion c. take the ER tablets whole d. expect urinary output to decrease while on this medication

c. take the ER tablets whole - ER tablets should not be broken, crushed, or chewed, should be taken with or after meals, should not take OTC meds w/o HCP approval, and a decrease in urinary output should be notified immediately

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? a. insert needle at a 45 degree angle b. aspirate for a blood return before depressing plunger c. the nurse should not expel the air bubble in the prefilled syringe d. administer the medication 2.54 cm from the umbilicus

c. the nurse should not expel the air bubble in the prefilled syringe -

Digoxin

cardiac glycoside used for HF & A-fib that has a positive inotropic effect meaning it increases myocardial contraction and allows more Ca2+ to enter cell during depolarization. Can cause bradycardia, fatigue. Should not be given to patients with hypokalemia

A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? a. bad breath b. decreased alertness c. breast enlargement d. bleeding gums

d. bleeding gums - it can suppress coagulation and cause spontaneous bleeding

A nurse is completing a medication Hx for a client who reports using OTC calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this med? a. decrease bulk in the diet to counteract the adverse effect of diarrhea b. take the med w/ dairy products to increase absorption c. reduce Na+ intake d. drink a class of water after taking this med

d. drink a glass of water after taking this med. - major adverse effect is constipation and bulk should be increased. Dairy products can cause milk alkali syndrome; reduction of sodium is for clients taking aluminum hydroxide - drinking a full glass of water before and after taking an antacid increases it's effects

Adverse effects of KCl administration

fever, nausea, abdominal pain, diarrhea, infection, redness, pain or swelling @ injection site

Valsartan

indicated for the use of HTN, HF, & left ventricular dysfunction post MI