Perfusion meds (final)

1,3,4,5

ATI: A nurse is planning care for a client who is receiving furosemide IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? 1. assess for tinnitus 2. report urine output 50mL/hr 3. monitor serum K levels 4. elevate the HOB slowly before ambulation 5. recommend eating a banana daily

a (Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved)

A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: A Decreased arterial blood flow secondary to vasoconstriction B Decreased arterial blood flow leading to hyperemia C Atherosclerotic obstruction of the arteries D Trauma to the lower extremities

1,2,3,5 (chlorothiazide causes increased urination and decreased swelling (edema) and weight loss. It is important to check and record weight two to three times per week at the same time of day with similar clothing. Clients should not drink alcohol or take other meds without the approval of the HCP. Reducing Na intake in the diet helps the diuretic drugs to be more effective and allows smaller doses to be taken. Smaller doses are less likely to produce adverse effects, and therefore excessive table salt as well as salty foods should be avoided. Chlorothiazide is a diuretic that is prescribed for lower BP and may cause dizziness or faintness when the client stands up suddenly. Instruct to change position slowly. If dizziness is severe notify HCP. Diuretics may cause sensitivity to sunlight, hence the need to avoid prolonged exposure, use sunscreen, protective clothing. Do not change dosage without HCP, and take in am to prevent sleep disturbances)

A client diagnosed with primary (essential) HTN is taking chlorothiazide. The nurse determines teaching about this medication is effective when the client makes which statement? "I will..... select all that apply 1. take my weigh daily at the same time each day 2. not drink alcohol while on this med 3. reduce salt intake in my diet 4. reduce my dosage if I have severe dizziness 5. use sunscreen if I have prolonged exposure to sunlight 6 take the drug late in the evening

1 (before starting heparin infusion, it is essential for the nurse to know the clients baseline blood coagulation values (hct, hgb, RBC and Plt counts). In addition, the partial thromboplastin time (PTT) should be monitored closely during the process. The clients stool would be tested only if internal bleeding is suspected. Although monitoring VS such as apical pulse is important in assessing potential signs and symptoms of hemorrhage or potential adverse reactions to the medication, VS are not the most important data to collect before administering heparin. Intake and output are not important assessments for heparin administration unless the client has fluid and volume problems or kidney disease)

A client has an acute arterial occlusion. The healthcare provider has prescribed IV heparin. Before starting the medication, the nurse should: 1. review the blood coagulation laboratory values 2. test the clients stools for occult blood 3. count the clients apical pulse for 1 min 4. check the 24 hour urine output record

4 (Heparin dosage is usually determined by the HCP based on the clients aPTT and INR lab values. Therefore the nurse monitors these values to prevent complications. Administering aspirin when the client is on heparin in contraindicated. Green leafy veges are high in Vit K and therefore are not recommended for clients receiving heparin. Monitoring the clients PT is done when the client is receiving warfarin sodium)

A client is admitted with a diagnosis of thrombophlebitis and DVT of the right leg. A loading dose of Heparin has been given in the ER., and IV heparin will be continued for the next several days. The nurse should develop a plan of care for this client that will involve: 1. adminstering aspirin as prescribed 2. encouraging leafy green vegetables in the diet 3. monitoring the clients prothrombin time (PT) 4. monitoring the clients activated partial thromboplastin tims (aPTT) and international normalized ratio (INR)

c (The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.)

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: A The same as the client's own baseline level B Lower than the needed therapeutic level C Within the therapeutic range D Higher than the therapeutic range

4 (Based on the laboratory findings prothrombin time and INR are at acceptable anticoagulation levels for the treatment of DVT. However, the platelets are below the acceptable level. Clients taking enoxaparin are at risk for thrombocytopenia. Because of the low platelet level, the nurse should withhold the enoxaparin and contact the HCP. The nurse should not administer the drug until the HCP has been contacted. The HCP not the pharmacy will make a decision about the dose of enoxaparin. The decision about administering the drug will be based on laboratory results , not evidence of bruising or bleeding.)

A client is being treated for DVT in the left femoral artery. The healthcare provider has prescribed 60 mg of enoxaparin SC. Before adminstering the drug, the nurse checks the clients laboratory results, noted below PTT 12.5 s INR 2.0 s Plt 50,000 Based on these results what should the nurse do? 1. Contact the pharmacist for a lower dose of the medication 2. Administer the medication as prescribed 3. Assess the client for signs of bruising on the extremities. 4. Withhold the dose of the medication and contact the HCP

d

A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? A "Eat foods high in potassium." B "Take daily potassium supplements." C "Discontinue sodium restrictions." D "Avoid salt substitutes.

1,3,5 (Clonidine is central acting adrenergic antagonist. It reduces sympathetic outflow from the CNS. Dry mouth, impotence, and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are NOT anticipated with use of this drug)

A client is taking clonidine for treatment of HTN. The nurse should teach the client about which common adverse effects of this drug? Select all that apply 1. dry mouth 2. hyperkalemia 3. impotence 4. pancreatitis 5. sleep disturbance

4 (pentoxifylline can potentiate the effect of theophylline and increase the risk of theophylline toxicity. Therefore the nurse should monitor the clients theophylline level. Pentoxifylline does not interact with digoxin. Pentoxifylline can interact with heparin, and the clients PTT would need to be monitored closely if the client was taking heparin. It doesnt affect cholesterol levels.)

A client is with peripheral artery disease, coronary artery disease and COPD takes theophylline 200 mg. twice daily every day and digoxin 0.5 mg once a day. The HCP now prescribes pentoxifylline. To prevent adverse effects, the nurse should monitor: 1. digoxin level 2. partial thromboplastin time (PTT) 3. serum cholesterol level 4. theophylline level

3 (Warfarin is an anticoagulant which is used in the treatment of atrial fibrillation and decrease ventricular ejection fraction (<20%) to preven thrombus formation and release of emboli into the circulation. The client may also take other medications as needed to manage heart failure. Warfarin does not reduce circulatory load or improve myocardial workload. Warfarin does not affect cardiac rhythm.)

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15 %. The client is taking warfarin. The expected outcome of this drug is to: 1. decrease circulatory overload 2 improve the myocardial workload 3. prevent thrombus formation 4. regulate cardiac rhythm

2,3,4 (Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit, and oranges are examples of foods high in K. Angel food cake and peppers are low in K)

A client recieving a loop diuretic should be encouraged to eat which foods? Select all that apply: 1. angel food cake 2. banana 3. dried fruit 4. orange juice 5. peppers

b (Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited)

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: A Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. B Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. C Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. D Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

1,2,4,6 (metoprolol is a beta-adrenergic blocker indicated for HTN, angina and myocardial infarction. The tablets should be taken with food at the same time each day; they should not be chewed or crushed. The HCP should be notified if pulse falls below 50 for several days. Blood glucose should be checked regularly during therapy since increased episodes of hypoglycemia may occur. It may mask evidence of hypoglycemia such as palpitations, tachycardia, and tremor. Use of all OTC decongestants, asthma and cold remedies and herbal preparations must be avoided. Fainting spells may occur due to excercise or stress, and the dosage of the drug may be reduced or discontinued)

A client who has diabetes is taking metoprolol for HTN. What should the nurse instruct the client to do? Select all that apply 1. take the tablets with food at the same time each day 2. do not crush or chew the tablets 3. notify the HCP if pulse is 82 bpm 4. Have a blood glucose level drawn every 6-12 months during therapy 5. use an appropriate decongestant if needed 6. Report any fainting spells to the HCP

3 (the client is experiencing a rebound tachycardia from abrupt withdrawal of the beta blocker. The beta blocker should be restarted due to the tachycardia, history or HTN, and the desire to reduce the risk of postoperative myocardial morbidity. The bypass surgery should correct the claudication and need for pentoxifylline. The furosemide and increase in fluids are not indicated since the urine output and BP are satisfactory and there is no indication of bleeding. The nurse should also determine the K level before starting furosemide)

A client with a history of HTN and peripheral vascular disease underwent an aorto-bifemoral bypass graft. Preop meds include pentoxifylline, metoprolol, and furosemide. On post op day 1, the 1200 VS are as follows: T 98.9 F, HR 132, RR 20, and BP 126/78. Urine output is 50-70 mL/hr. The hemoglobin and hematocrit are stable. The meds have not been prescribed for administration after surgery. Using the SBAR technique for communication, the nurse contacts the HCP and recommends to : 1. continue the pentoxifylline 2. increase the IV fluids 3. restart the metoprolol 4. resume the furosemide

2 (Angina is an adverse reaction to pentoxifylline, which should be used cautiously in clients with CAD. The nurse should report the clients symptoms to the HCP. who may prescribe nitroglycerin and possibly D/C the pentoxifylline. The client should rest until the chest pain subsides. It is not necessary at this point in time to initiate the rapid response team, or start an IV infusion. The clients reports of symptoms should never be dismissed.)

A client with a history of coronary artery disease (CAD) has been diagnosed with peripheral artery disease. The HCP started the client on pentoxifylline once daily. Approximately 1 hour after recieving the initial dose of pentoxifylline the client reports having chest pain, the nurse should first: 1. initiate the rapid response team 2. contact the HCP 3. have the client rest in bed 4. start an IV infusion of NS

3 (thrombolytic agents such as streptokinase are used for clients with history of thrombus formation, CVA's, and chronic atrial fibrillation. The thrombolytic agents act by dissolving emboli. Thrombolytic agents do not directly improve perfusion or increase vascular permeability, nor do they prevent cerebral hemorrhage)

A client with cerebral embolus is receiving streptokinase. The nurse should evaluate the client for which expected therapeutic outcomes of this drug therapy? 1. improved cerebral perfusion 2, decreased vascular permeability 3. dissolved emboli 4. prevention of cerebral hemorrhage

3 (dyspnea is a manifestation of HF and adverse of mannitol, so hold med and notify)

A nurse is caring for a client who has increased ICP and is receiving mannitol. Which finding should the nurse report to the HCP? 1. blood glucose 150 2. urine output 40 ml/hr 3. dyspnea 4. bilateral equal pupil size

2,3,5

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations of the adverse effects of daily aspirin therapy? 1. hypertension 2. coffee-ground emesis 3, tinnitus 4. paresthesias of the extremities 5. nausea

1 5 6 4 3 2 (following the 2015 AHA guidlines for CPR the rescuer would attempt to awaken the victim, then activate the emergency response system, and get an AED or appoint another person to do this. Past guidlines include checking for a pulse, however current guidelines move the pulse check later in the sequence. This stops people from wasting time trying to find a pulse that may not be there. The next step is to give 30 chest compressions. Next the rescuer opens the airway with the head tilt chin maneuver and checks for breathing. If no breathing detected give 2 rescue breaths, check for pulse, and immediately resume chest compressions. The rescuer will use the AED as soon as it arrives)

A nurse is presenting health information at a community organization when one of the attendees passes out. The nurse assesses the attendee as being unresponsive. Indicate how the nurse would respond by placing the following actions in chronological order. All options must be used. 1. appoint a person to call 911 2. check for a pulse 3. deliver two rescue breaths 4. check for normal breathing 5. perform chest compressions 6. perform a head tilt-chin lift maneuver

a,b,c,f

A patient diagnosed with heart failure has been prescribed digoxin (Lanoxin). Which of the following will the healthcare provider include when teaching the patient about this medication? Choose all answers that apply: A "You should keep a record of your daily weights." B "If your pulse is less than 60 beats per minute, do not take the medication." C "Call our office if you experience nausea or lack of appetite." D "If you miss a dose, you should double the dose next time." E "Increase dietary sodium to maintain your fluid balance." F "Report any visual changes to our office immediately."

d (Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls.)

A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? Choose 1 answer: Choose 1 answer: A "I should not worry if I experience a dry cough when taking this medication." B "I might experience swelling in my legs when taking this medication." C . "This medication might cause me to have a decrease in my appetite." D "It is important for me to change positions slowly because I might become dizzy.

a (Furosemide may cause hypokalemia, which increases the risk of digoxin toxicity.)

A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? Choose 1 answer: Choose 1 answer: A Serum potassium B Serum troponin C Serum sodium D Blood urea nitrogen (BUN)

d (The levels of calcium channel blockers are increased when grapefruit or grapefruit juice is consumed, potentially causing hypotension.)

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid? Choose 1 answer: Choose 1 answer: A Eggs B Bananas C Oranges D Grapefruit

d (Because thiazide diuretics produce an increase in urine output, the patient should avoid taking the medication in the evening. Potassium is lost in the urine along with sodium and chloride, so the patient should be instructed to include potassium-rich foods in the diet to avoid hypokalemia.)

A patient is prescribed a thiazide diuretic for the treatment of hypertension. When teaching the patient about the medication, which of the following will the healthcare provider include? Choose 1 answer: A "Take this medication each day with a large glass of water after your evening meal." B "I'll teach you how to take your radial pulse before taking the medication." C "Stop taking this medication if you notice changes in how much you urinate." D "Be sure to include a number of foods that are rich in potassium in your diet."

d

A patient tells the healthcare provider, "I stopped taking my medication because it kept me up at night with a dry cough." When reviewing the patient's medical record, which of these antihypertensive medications will the healthcare provider identify as the likely cause of this patient's report? Choose 1 answer: Choose 1 answer: A Beta blocker B Calcium channel blocker C Loop diuretic D Angiotensin-converting enzyme (ACE) inhibitor

3

ATI: A nurse is caring for a hospitalized client who is receiving IV heparin for a DVT. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? 1. vitamin K 2. atropine 3. protamine 4. calcium gluconate

2 (calcium channel blocker verapamil can increase digoxin levels.. Antacids may decrease absorption and decrease effectiveness)

ATI: A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other meds. The nurse should recognize that concurrent use of which of the following medications places the client at a risk for digoxin toxicity? 1. phenytoin 2. verapamil 3. warfarin 4. aluminum hydroxide

3

ATI: A nurse is monitoring a client who is receiving spironolactone. Which of the following findings should the nurse report to the HCP? 1. NA 144 2. Urine output 120 mL in 4 hr 3. K 5.2 4. BP 140/90

3 (neutropenia is a serious adverse effect that can occur with an ACE inhibitor. The nurse should monitor the CBC amd teach the client to report indications of infection to the provider. HYPERKALEMIA is a risk. ACE inhibitors cause excretion of Na and water. TACHYCARDIA is an adverse effect of ACE inhibitors)

ATI: A nurse is caring for a client who has a new prescription for captopril for HTN. The nurse should monitor the client for which of the following adverse effects of this medication? 1. hypo K 2. hyper Na 3. neutropenia 4. bradycardia

2 (put the bubble to the back of the syringe to seal in med, DO NOT aspirate!!, Inject into abdomen at least 2 inches away from umbilicus)

ATI: A nurse is planning to admin SC enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? 1. expel the air bubble from the prefilled syringe prior to injecting 2. insert the needle completely into the clients tissue 3. administer the injection in the clients thigh 4. aspirate carefully after inserting the needle into the clients skin

1,3,5 (fatigue and weakness are early CNS signs that can indicate toxicity. N/V/D (not constipation are GI manifestations of toxicity. Rash is not an indication. Visual changes such as diplopia and yellow tinged vision are manifestations of dig toxicity)

ATI: A nurse is providing teaching to a client who has a new prescription for digoxin. The urse should instruct the client to monitor and report which of the following adverse effects that is a manifestation of digoxin toxicity? Select all that apply. 1. fatigue 2. constipation 3. anorexia 4. rash 5. diplopia

1 (take with food)

ATI: A nurse is proving information to a client who has a new prescription for hydrochlorothiazide. Which of the following information should the nurse include? 1. take the med with food 2. plan to take the med at bed time 3. expect increased swelling around the ankles 4. fluid intake should be limited in the morning

1 (propanolol is a nonselective beta blocker that can block beta receptors in the lungs which causes bronchoconstiction)

ATI: A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? 1. asthma 2. glaucoma 3. hypertension 4. tachycardia

1 (the client should contact the HCP for a HR less than 60 bpm. The client should check pulse rate for 1 full minute before each dose. The client should reduce Na and avoid excess fluids. The client should report nausea to the provider because it is a manifestation of dig toxicity)

ATI: A nurse is teaching a client who has a new prescription for digoxin to treat her HF. Which of the following instructions should the nurse include in the teaching? 1. contact the HCP if heart rate is <60/min 2. check pulse rate for 30 seconds and multiply result by 2 3. increase intake of Na 4. take with food if nausea occurs

1 (increasing dietary fiber intake can help prevent constipation, and adverse effect of verapamil. Clients SHOULD NOT drink grapefruit juice. )

ATI: A nurse is teaching a client who has a new prescription for verapamil to control HTN. Which of the following instructions should the nurse include? 1. increase dietary fiber 2. drink grapefruit juice to increase vitamin C 3. decrease the amount of Ca in the the diet 4. withhold food for 1 hr after the med is taken

1,2,3,5 ( Maintaining skin integrity is important in preventing chronic ulcers and infections. The client should be taught to inspect the skin on a daily basis. The client should reduce weight to promote circulation; a diet lower in calories and fat is appropriate. Because the client is receiving warfarin the nurse should suggest the client use an electric razor. The client with decreased arterial blood flow should be encouraged to participate in ADL's. In fact, the client should be encouraged to consult an exercise physiologist for a program that enhances aerobic capacity of the body)

An obese client taking warfarin has dry skin due to decreased arterial blood flow. What should the nurse instruct the client to do? Select all that apply 1. apply lanolin or petroleum jelly to intact skin 2. follow a reduced calorie, reduced fat diet 3. inspect the involved areas daily for new ulcerations 4. limit activities of daily living 5. use an electric razor to shave

1,2,4,5 (Beta-blockers treat a variety of conditions including HTN, HF, glaucoma and migraines. Beta blockers are used to slow down the HR, to reduce the force of the hearts contractions, and to reduce blood vessel contraction. Important client instructions include: taking the med at the same time daily, DAILY WEIGHTS, changing positions slowly because of hypotension, and apical pulses for a full minute. A side effect of the medication is sexual difficulties, such as difficulty getting an erection, Monitor the BP not the glucose each morning)

An obese male client with a history of HF is prescribed a Beta Blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply 1. take your med at the same time each day 2. contact the HCP if you have difficulty getting or maintaing an erection 3. weigh yourself weekly with the same amount of clothes on as the previous time 4. change positions between sitting and standing carefully 5. check your pulse for a full minute before administering your medication 6. monitor blood glucose readings every morning

c

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principal effects are produced by: A Antispasmodic effect on the pericardium B Causing an increased myocardial oxygen demand C Vasodilation of peripheral vasculature D Improved conductivity in the myocardium

d

Before receiving the morning​ report, the nurse makes rounds on assigned clients. At the bedside of one​ client, the nurse notes an ampule of vitamin K. What should the presence of this medication indicate to the​ nurse? a The client is receiving intravenous heparin. b The client is receiving​ low-molecular-weight heparin injections. c The client is receiving​ high-dose aspirin therapy. d The client is receiving warfarin.

3 (The nurse should withhold the dose of captopril; captopril is an ACE inhibitor, and a side effect of the medication is hyperkalemia. The BUN and creatinine which are normal, should be viewed prior to administration since renal insufficiency is another potential side effect of an ACE-1. The HR is within normal limits. The nurse should question the dose of metoprolol if the clients HR is bradycardic. The hbg and hct are normal for a female. The nurse should report the high K level and that the captopril was withheld. FUROSEMIDE WASTES K)

Captopril, furosemide, and metoprolol are prescribed for a client with systolic hear failure. The clients BP is 136/82 and the HR is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests: NA 140 K 6.8 BUN 18 Creat 1.0 Hgb 12 Hct 37% What should the nurse do first? 1. Administer the medications 2. Call the HCP 3. Withhold the captopril 4. Question the metoprolol dose

1 (After IV injection of furosemide, diuresis normally begins in about 5 min. and reaches its peak within about 30 mins. Medication effects last 2-4 hrs. When furosemide is given IM or orally , drug action begins more slowly and lasts longer than when given IV)

Furosemide is administered IV to a client with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? 1. 5-10 min 2. 30-60 min 3. 2-4 hrs 4. 6-8 hrs

d (The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.)

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? A Vitamin K B Aminocaproic acid C Potassium chloride D Protamine sulfate

1 (The effect of a beta blocker is a decrease in HR, contractility and afterload, which leads to a decrease in BP.. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output)

Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension who has been initially treated with furosemide and ramipril. An expected therapeutic effect is: 1. decrease in HR 2. lessening of fatigue 3. improvement in blood sugar level 4. increase in urine output

c (Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.)

One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? A Hypocalcemia B Hypermagnesemia C Hypokalemia D Hypernatremia

3 (Hyperkalemia is a common adverse effect of both ACE inhibitors and potassium-sparing diuretics. The other laboratory values may be affected by these medications but are not as likely or as potentially life threatening. Focus: Prioritization)

You are caring for a hospitalized client with heart failure who is receiving captopril (Capoten) and spironolactone (Aldactone). Which laboratory value will be most important to monitor? 1. Sodium level 2. Blood urea nitrogen level 3. Potassium level 4. Alkaline phosphatase level

1 (although pentoxifylline 's precise mechanism of action in unknown, its therapeutic effect is to increase blood flow, and the client should have improved circ in the legs as evident by less pain. The client does not have nerve impairment and should be able to wiggle the toes. Urination is not improved by taking this med. Dizziness is a side effect of this drug not an intended outcome)

The client is receiving pentoxifylline for intermittant claudication. The nurse should determine the effectiveness of the drug by asking if the client: 1. has less pain in the legs 2. can wiggle the toes 3. is urinating more frequently 4. is less dizzy

4 (diltiazem is a calcium channel blocker that blocks the influx of Ca into the cell. In this situation the primary use of diltiazem is to promote vasodilation and prevent spasms of the arteries. As a result of vasodilation, blood, O2, and nutrients can reach the muscles and tissues. )

The client with peripheral artery disease is prescribed diltiazem (Calcium Channel Blocker). the nurse should determine the effectiveness of this medication by assessing the client for: 1. relief of anxiety 2. sedation 3 vasoconstriction 4. vasodilation

2 (Since proton pump inhibitors such as omeprazole affect the metabolism of clopidogrel and decrease its effectiveness, the health care provider may want to discontinue the omeprazole in this client with unstable angina. The other medications should also be verified, but current national guidelines for clients with unstable angina indicate that providers should consider avoiding proton pump inhibitors in those who require clopidogrel. Focus: Prioritization)

The health care provider telephones you with new prescriptions for a client with unstable angina who is already taking clopidogrel (Plavix). Which medication is most important to clarify further with the health care provider? 1. Aspirin (Ecotrin) 162 mg daily 2. Omeprazole (Prilosec) 20 mg daily 3. Metoprolol (Lopressor) 50 mg daily 4. Nitroglycerin patch (Nitrodur) 0.4 mg/hr

c,e,f

The healthcare provider is administering an angiotensin converting enzyme (ACE) inhibitor to a patient diagnosed with heart failure. Which of the following describe the ways in which the ACE inhibitor is therapeutic for the patient who has heart failure? Choose all answers that apply: A Increases peripheral vascular resistance B Increases myocardial contractility C Decreases myocardial remodeling D Decreases cardiac output E Decreases cardiac preload F Decreases cardiac workload

a

The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time? Choose 1 answer: Choose 1 answer: A Digoxin immune fab (DigiFab) B Potassium chloride (K-tab) C Furosemide (Lasix) D An increased dose of digoxin (Lanoxin)

3 ( weakness, dizziness and headache are common adverse effects of clopidogrel, and the client should report these to the HCP. If they are problematic; in order to decrease the risk of clot formation, the drug must be taken regularly and should not be stopped or taken intermittently. The main adverse effect of clopidogrel is bleeding when brushing teeth. Clopidogrel is well absorbed, and while food may help decrease potential stomach upset the drug may be taken with or without food. Clopidogrel is an antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary syndrome.)

The nurse is caring for a client with peripheral artery disease who has recently been prescribed clopidogrel. The nurse understands that more teaching is necessary when the client states: 1. I should not be surprised if I bruise easier or if my gums bleed a little when brushing my teeth 2. it does not really matter if I take this medicine with or without food, whatever works best for my stomach 3. I should stop taking this medicine if it makes me feel weak or dizzy 4. The doctor prescribed this medicine to make my platelets less likely to stick together and helps prevent clots from forming

1 (furosemide is a diuretic often prescribed for clients with HTN or HF. The drug should not affect the clients ability to drive safely. Furosemide may cause orthostatic hypotension and clients should be instructed to be careful when changing position. Diuretics should be taken in the morning if possible to prevent sleep disturbances due to the need to get up to void. Furosemide is a loop diuretic that is not potassium sparing; clients should take prescribed K supplements and have serum K levels checked at prescribed intervals)

The nurse is discussing medications with a client with HTN who has a prescription for furosemide daily. The client needs further education when the client states: 1. I know I should not drive after taking furosemide 2. I should be careful not to stand up too quickly when taking furosemide 3. I should take the furosemide in the morning instead of before bed. 4. I need to be sure to also take the potassium supplement that the Dr. prescribed along with my furosemide.

1,2,5 (spironolactone is used to treat HTN and edema by removing excess fluids. Spironolactone is known as a K sparing diuretic. Confusion, fatigue and weakness are signs of hyperkalemia, an adverse affect of spironolactone. Leg cramps are a sign of HYPOkalemia. Urinary retention would be sign of anticholinergics)

The nurse is preparing teaching to a client about prescribed spironolactone and to monitor for adverse effects of the drug. The nurse would instruct the client about which adverse effect? Select all that apply 1. confusion 2. fatigue 3. hypertension 4. leg cramps 5. weakness 6. urinary retention

1 (atenolol is a beta-adrenergic antagonist indicated for mngmt of HTN. Sudden D/C of the drug is dangerous because it may exacerbate symptoms. The med should not be D/C without a prescription. BP needs to be monitored more frequently than annually in a client who is newly diagnosed and treated for HTN. Clients are not usually placed on a 2-g Na diet for HTN.)

The nurse is teaching the client with HTN about taking atenolol. The nurse should instruct the client to: 1. avoid sudden D/C of the drug 2. monitor BP annually 3. follow a 2-g Na diet 4. D/C the med if severe headaches develop

3 (ticlopidine inhibits platelet aggregation by interfering with adenosine diphosphate release in the coagulation cascade and therefore, is used to prevent thromboembolic stroke. Allopurinol is an antigout medication used to reduce uric acid. Claritin is an OTC allergy medication. Methylprednisolone, a steroid with anticoagulant properties, is not used to treat thromboembolic stroke)

The nurse is working in an internal medicine office. A daughter brings her elderly mother to the Dr. appt. Upon reviewing the medication list, the daughter states, "which medication is prescribed to prevent a stroke?" The nurse is correct to answer which medication? 1. allopurinol 2. claritin 3. ticlopidine 4. methyprednisolone

2

The nurse notes bilateral ankle edema on a client diagnosed with peripheral vascular disease (PVD). The nurse knows this is due to: 1 Decreased blood volume 2 Increased venous pressure 3 Decreased muscular activity 4 Increased venous blood flow

3 (colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abd pain, anorexia, N/V are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrythmias, such as atrial fibrillation or bradycardia. Rash, increase appetite and elevated BP are not associated with digoxin toxicity.)

The nurse should teach the client that signs of digoxin toxicity include: 1. rash over the chest and back 2. increased appetitie 3. visual disturbances such as seeing yellow spots 4. elevated BP

a

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: A Headache B High blood pressure C Shortness of breath D Stomach cramps

3 (Research indicates that mortality is decreased when clients with heart failure use beta-blocking medications such as carvedilol. When beta-blocker therapy is started for clients with heart failure, heart failure symptoms may initially become worse for a few weeks, so increased fatigue, activity intolerance, weight gain, and edema are not indicative of a need to discontinue the medication at this time. However, the slow heart rate does require further follow-up, because bradycardia may progress to more serious dysrhythmias such as heart block. Focus: Prioritization)

Two weeks ago, a 63-year-old client with heart failure received a new prescription for carvedilol (Coreg its a Beta Blocker) 3.125 mg orally. When evaluating the client in the cardiology clinic, you obtain the following data. Which finding is of most concern? 1. Reports of increased fatigue and activity intolerance 2. Weight increase of 0.5 kg over a 1-week period 3. Sinus bradycardia at a rate of 48 beats/min 4. Traces of edema noted over both ankles

a (Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.)

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B Increases norepinephrine secretion and thus decreases blood pressure and heart rate. C Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. D Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II

b (Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.)

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: A Moderate doses of two different types of diuretics are more effective than a large dose of one type B This combination promotes diuresis but decreases the risk of hypokalemia C This combination prevents dehydration and hypovolemia D Using two drugs increases osmolality of plasma and the glomerular filtration rate

b (One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.)

Which of the following effects of calcium channel blockers causes a reduction in blood pressure? A Increased cardiac output B Decreased peripheral vascular resistance C Decreased renal blood flow D Calcium influx into cardiac muscles

c

Which of the following factors can cause blood pressure to drop to normal levels? A Kidneys' excretion of sodium only B Kidneys' retention of sodium and water C Kidneys' excretion of sodium and water D Kidneys' retention of sodium and excretion of water

d

Which of the following parameters is the major determinant of diastolic blood pressure? A Baroreceptors B Cardiac output C Renal function D Vascular resistance

c (Pentoxifylline​ (Trental) is used to decrease blood viscosity and improve RBC flexibility in clients with PVD. Aspirin and clopidogrel​ (Plavix) are medications that inhibit platelet aggregation. Cilostazol​ (Pletal) is a medication that inhibits platelets and vasodilates.)

Which pharmacologic therapy is used to decrease blood viscosity and improve red blood cell​ (RBC) flexibility in clients with peripheral vascular disease​ (PVD)? a Clopidogrel​ (Plavix) b Cilostazol​ (Pletal) c Pentoxifylline​ (Trental) d Aspirin

4 (Anticoagulant medications are high-alert medications and require special safeguards, such as double-checking of medications by two nurses before administration. Although the other medications require the usual medication safety procedures, double-checking is not needed. Focus: Prioritization)

You are preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? 1. Famotidine (Pepcid) 20 mg IV 2. Furosemide (Lasix) 40 mg IV 3. Digoxin (Lanoxin) 0.25 mg PO 4. Warfarin (Coumadin) 2.5 mg PO

a (ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.)

ß blockers should be avoided in which of the following conditions? A Bronchoconstriction B Hypertension C Angina D Myocardial infarction