Pharm Cardiac

The patient has an international normalized ratio (INR) value of 1.5. In response to this, the nurse could anticipate the health care provider placing which order? A.) Administer an additional dose of warfarin (Coumadin). B.) Hold the next dose of warfarin (Coumadin). C.) Increase the heparin drip rate. D.) Administer protamine sulfate.

(A) A therapeutic INR is 2 to 3. The patient needs more warfarin to reach a therapeutic level.

Which nursing intervention is essential for the patient receiving alteplase (Activase)? A.) Assess for reperfusion dysrhythmias. B.) Monitor liver enzymes. C.) Administer prescribed vitamin K if bruising is observed. D.) Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.

(A) Alteplase (Activase) can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of alteplase. Vital sign changes can alert the nurse to complications; however, a blood pressure below 110 systolic is not, in itself, cause for alarm.

A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? A.) Call the health care provider to switch the medication. B.) Assess the patient for other symptoms of upper respiratory infection. C.) Instruct the patient to take antitussive medication until the symptoms subside. D.) Tell the patient that the cough will subside in a few days.

(A) Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? A.) "I will check my blood pressure daily and take my medication when it is over 140/90." B.) "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." C.) "I will change my position slowly to prevent feeling dizzy." D.) "I will not mow my lawn until I see how this medication makes me feel."

(A) Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates that he will take rest periods and change positions slowly to avoid orthostatic hypotension, he is demonstrating compliance with the treatment regimen.

What is a priority nursing diagnosis for a patient taking an antihypertensive medication? A.) Alteration in cardiac output related to effects on the sympathetic nervous system B.) Knowledge deficit related to medication regimen C.) Fatigue related to side effects of medication D.) Alteration in comfort related to nonproductive cough

(A) Circulation is always a priority over fatigue, pain, and knowledge deficit.

The nurse would question an order for colesevelam (Welchol) if the patient has which condition in the medical history? A.) Impaction B.) Glaucoma C.) Hepatic disease D.) Renal disease

(A) Colesevelam (Welchol) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.

Which assessment finding will alert the nurse to suspect early digitalis toxicity? A.) Loss of appetite with slight bradycardia B.) Blood pressure of 90/60 mm Hg C.) Heart rate of 110 beats per minute D.) Confusion and diarrhea

(A) Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.

Which assessment indicates to the nurse a therapeutic effect of mannitol (Osmitrol) has been achieved? A.) Decreased intracranial pressure B.) Decreased potassium C.) Increased urine osmolality D.) Decreased serum osmolality

(A) Mannitol (Osmitrol) is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

Which intervention is essential before the nurse administers tenecteplase (TNKase)? A.) Perform all necessary venipunctures. B.) Administer aminocaproic acid (Amicar). C.) Have the patient void. D.) Assess for allergies to iodine.

(A) TNKase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A.)Absence of chest pain B.) Decreased swelling in the ankles and feet C.) Patient denies dizziness. D.) Patient states that she feels stronger.

(A) The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.

A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action? A.) Administer ordered dose of digoxin. B.) Hold future digoxin doses. C.) Administer potassium. D.) Call the health care provider.

(A) Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? A.) "Apply the patch to a non-hairy area of the upper torso or arm." B.) "Apply the patch to the same site each day." C.) "If you have a headache, remove the patch for 4 hours and then reapply." D.) "If you have chest pain, apply a second patch next to the first patch."

(A) nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

A patient is ordered furosemide (Lasix) to be given via intravenous push. Which interventions will the nurse perform? (Select all that apply.) A.) Administer at a rate no faster than 20 mg/min. B.) Assess lung sounds before and after administration. C.) Assess blood pressure before and after administration. D.) Maintain accurate intake and output record. E.) Monitor ECG continuously. F.) Insert an arterial line for continuous blood pressure monitoring.

(A,B,C,D) Furosemide (Lasix) can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor ECG since the medication is not cardiotoxic.

Administering a beta-adrenergic antagonist (beta-blocker) to a patient who is receiving a calcium channel blocker may result in which of the following conditions? a. Hypertension and bradycardia b. Hypotension and bradycardia c. Tachycardia and hypertension d. Tachycardia and hypotension

(B)

Angiotensin converting enzyme (ACE) inhibitors work by a. stimulating the release of renin b. blocking the enzyme that converts angiotensin I to angiotensin II c. increasing peripheral resistance d. blocking sympathetic nervous system impulses in the brain

(B)

The patient asks the nurse to explain the difference between dalteparin (Fragmin) and heparin. Which response by the nurse is accurate? A.) "There is no real difference. Dalteparin is preferred because it is less expensive." B.) "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding." C.) "I'm not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor." D.) "The only difference is that heparin dosing is based on the patient's weight."

(B) A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin (Fragmin) is more expensive than heparin and is dosed based on the patient's weight. It is not appropriate to provide the patient with no instruction other than to simply refer to the health care provider.

What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment? A.) Use the fingers to spread the ointment evenly over a 3-inch area. B.) Apply the ointment to a non-hairy part of the upper torso. C.) Massage the ointment into the skin. D.) Cover the application paper with ointment before use.

(B) Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.

Which nursing intervention will decrease the flushing reaction of niacin? A.) Administering niacin with an antacid B.) Administering aspirin 30 minutes before nicotinic acid C.) Administering diphenhydramine hydrochloride (Benadryl) with niacin D.) Applying cold compresses to the head and neck

(B) Administration of an antiinflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with niacin. In addition, avoiding hot beverages, such as coffee, when taking niacin may also prevent flushing.

The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A.) "You can protect it from heat by placing the bottle in an ice chest." B.) "It's best to keep it in its original container away from heat and light." C.) "You can put a few tablets in a resealable bag and carry in your pocket." D.) "It's best to lock them in the glove compartment to keep them away from heat and light."

(B) Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.

Which statement indicates the patient understands discharge instructions regarding cholestyramine (Questran)? A.) "I will take Questran 1 hour before my other medications." B.) "I will increase fiber in my diet." C.) "I will weigh myself weekly." D.) "I will have my blood pressure checked weekly."

(B) Cholestyramine can cause constipation; thus, increasing fiber in the diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption.

Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the nurse act on immediately? A.) Decreased hemoglobin B.) Elevated liver function tests C.) Elevated HDL D.) Elevated LDL

(B) HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver function tests. The nurse should act on this finding immediately. Decreased hemoglobin should be addressed but not immediately. It is most likely not related to the administration of the HMG-CoA reductase inhibitor. Also, while an elevated LDL level must be addressed, it is not as high a priority as the elevated liver function test results. An elevated HDL is a positive finding and an encouraging result.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? A.) Sodium level of 140 mEq/L B.) Fasting blood glucose level of 140 mg/dL C.) Calcium level of 9 mg/dL D.) Chloride level of 100 mEq/L

(B) Hydrochlorothiazide can cause hyperglycemia. Normal calcium level is approximately 8.8-10.3 mg/dL; normal sodium level is 135-147 mEq/L; normal chloride level is 95-107 mEq/L, and normal fasting blood glucose should be 60-110 mg/dL.

A patient diagnosed with hypercholesterolemia is prescribed lovastatin (Mevacor). Based on this medication order, the nurse will contact the health care provider about which reported condition in the patient's history? A.) Chronic pulmonary disease B.) Hepatic disease C.) Leukemia D.) Renal disease

(B) Lovastatin (Mevacor) can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A.) Assess the patient's lung sounds. B.) Decrease the intravenous nitroglycerin by 10 mcg/min. C.) Stop the nitroglycerin infusion for 1 hour and then restart. D.) Continue the infusion and recheck the patient's vital signs in 15 minutes.

(B) Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient? A.) Assessment of blood glucose levels B.) Respiratory assessment C.) Orthostatic blood pressure assessment D.) Teaching about potential tachycardia

(B) Noncardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and teaching about tachycardia will not be priorities.

A patient taking warfarin (Coumadin) asks for an aspirin for a headache. What is the nurse's best action? A.) Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. B.) Teach the patient of potential drug interactions with anticoagulants. C.) Explain to the patient that ASA is contraindicated and administer ibuprofen as ordered. D.) Explain that the headache is an expected side effect and will subside shortly.

(B) Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the patient taking other anticoagulants, unless it is ordered specifically as a low-dose daily therapy. Ibuprofen is not the best choice of medication for the patient receiving Coumadin. Tylenol (acetaminophen) would be preferred for pain relief. Headache is not an expected side effect of Coumadin therapy.

A patient has arrived at the emergency department and requires immediate surgery. He has been receiving heparin. Which intervention is essential? A.) Teach the patient about the phenytoin. B.) Administer protamine sulfate. C.) Assess the INR before surgery. D.) Administer vitamin K.

(B) Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect. Allowing the patient to undergo surgery while receiving heparin would be life-threatening. The situation should be reversed immediately, without the nurse taking the time to assess the INR or administer vitamin K. It is not appropriate to teach the patient about phenytoin since it has not been ordered for the patient.

What is the best information for the nurse to provide to the patient who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? A.) "Moderate doses of two different diuretics are more effective than a large dose of one." B.) "This combination promotes diuresis but decreases the risk of hypokalemia." C.) "This combination prevents dehydration and hypovolemia." D.) "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

(B) Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

A client presents to the clinic with a BP of 159/79 on his third visit. Patients with his pressure are classified as having: A.) Prehypertension as his numbers fall between normal (79) and Stage I (159) B.) Stage I hypertension C.) Normal because he really should have four readings total prior to classification D.) Always Stage II because 159 is indicative of Stage II

(B) Stage I hypertension - memorize the chart and text

A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? A.) Platelet count of 150,000 B.) Activated partial thromboplastin time (aPTT) of 120 seconds C.) INR of 1.0 D.) Blood urea nitrogen (BUN) level of 12 mg/dL

(B) The aPTT value of 120 seconds is too prolonged. The heparin drip should be shut off for an hour. The typical aPTT normal reference range for a patient on anticoagulant therapy is 30 to 85 seconds (range may vary slightly depending on the laboratory used). The normal range for BUN is 7 to 20 mg/dL, and the normal platelet range is 150,000 to 450,000.

The patient taking methyldopa (Aldomet) has elevated liver function tests. What is the nurse's best action? A.) Document the finding and continue care. B.) Notify the health care provider. C.) Immediately stop the medication. D.) Change the patient's diet.

(B) This drug should not be used in patients with impaired liver function. The nurse should notify the health care provider so that the patient can be tapered off the medication. The nurse should not immediately stop this medication as the patient could have a hypertensive crisis. The patient's diet is not the cause of elevated liver enzymes and should not make a difference with therapy.

A patient who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? A.) Vitamin E B.) Vitamin K C.) Protamine sulfate D.) Calcium gluconate

(B) Vitamin K is the antagonist for warfarin.

A patient is started on warfarin (Coumadin) therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? A.) "Your concern is valid. I will call the doctor to discontinue the heparin." B.) "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." C.) "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." D.) "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

(B) Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.

When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? (Select all that apply.) A.) Continuous oxygen saturation B.) Continuous blood pressure C.) Hourly ECGs D.) Presence of chest pain E.) Serum nitroglycerin levels F.) Visual acuity

(B, D) Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure

A nurse is planning to administer HCTZ to a client. The nurse understands that which of the following are concerns related to the administration of this medication? A.) Hypouricemia, hyperkalemia B.) Increased risk of osteoporosis C.) Hypokalemia, hyperglycemia, sulfa allergy D.) Hyperkalemia, hypoglycemia, penicillin allergy

(C)

For treatment of an acute MI, you should expect to administer aspirin. Why? a. To decreased preload b. To break down fibrinogen c. To reduce platelet aggregation d. To reduce myocardial contractility

(C)

The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? A.) The patient who has been on beta blockers for 1 day B.) The patient who is on a beta blocker and a thiazide diuretic C.) The patient who has stopped taking a beta blocker due to cost D.) The patient who is taking a beta blocker and Lasix (furosemide)

(C) Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension. The patient who has just been started on an antihypertensive drug and the patients who are on combinations of antihypertensive drugs will not be as high priorities for assessment since they seem to be complying with treatment. Abruptly discontinuing the drug indicates either a failure to understand the treatment or a noncompliance with treatment.

A nurse is caring for a patient receiving acetazolamide (Diamox). Which assessment finding will require immediate nursing intervention? A.) A decrease in bicarbonate level B.) An increase in urinary output C.) A decrease in arterial pH D.) An increase in PaO2

(C) Acetazolamide (Diamox) causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

The nurse reviews the history for a patient taking atorvastatin (Lipitor). What will the nurse act on immediately? A.) The patient takes medications with grape juice. B.) The patient takes herbal therapy including kava kava. C.) The patient is on oral contraceptives. D.) The patient was started on penicillin for a respiratory infection.

(C) Atorvastatin (Lipitor) increases the estrogen levels of oral contraceptives. The patient's oral contraceptive may need to be altered.

A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? A.) Hypokalemia B.) Dysrhythmias C.) Hypotension D.) Increased intracranial pressure

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

A patient is receiving warfarin (Coumadin) for a chronic condition. Which patient statement requires immediate action by the nurse? A.) "I will avoid contact sports." B.) "I will take my medication in the early evening each day." C.) "I will increase dark-green, leafy vegetables in my diet." D.) "I will contact my health care provider if I develop excessive bruising."

(C) Dark-green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered for the patient to take in the morning.

A nurse is preparing to administer enoxaparin sodium (Lovenox) to a patient for prevention of deep vein thrombosis. Which is an essential nursing intervention? A.) Draw up the medication in a syringe with a 22-gauge, 1½-inch needle. B.) Utilize the Z-track method to inject the medication. C.) Administer the medication into subcutaneous tissue. D.) Rub the administration site after injecting.

(C) Enoxaparin (Lovenox) is a low-molecular-weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method also should never be used to administer enoxaparin sodium (Lovenox). The use of 22-gauge, 1½-inch needle is more appropriate for administration of an IM injection.

A patient with acute pulmonary edema is receiving furosemide (Lasix). What assessment finding indicates to the nurse that the intervention is working? A.) Potassium level decreased from 4.5 to 3.5 mEq/L B.) Improvement in mental status C.) Lungs clear D.) Output 30 mL/hr

(C) Furosemide (Lasix) is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.

The nurse is assessing a patient who is taking furosemide (Lasix). The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? A.) Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. B.) Administer sodium polystyrene sulfonate. C.) Administer 2 mEq potassium chloride per kilogram per day IV. D.) Administer calcium acetate, two tablets three times per day.

(C) Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride. The patient needs chloride replacement. Normal potassium level is 3.5 to 5.2 mEq/L; normal sodium level is 135 to 147 mEq/L, and normal chloride level is 95 to 107 mEq/L. Potassium is never given by rapid infusion.

A nurse is caring for a patient who has been started on ibutilide (Corvert). Which assessment is a priority for this patient? A.) Blood pressure measurement B.) BUN and creatinine C.) ECG D.) Lung sounds

(C) Ibutilide (Corvert) is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm.

Before the nurse administers isosorbide mononitrate (Imdur), what is a priority nursing assessment? A.) Assess serum electrolytes. B.) Measure blood urea nitrogen and creatinine. C.) Assess blood pressure. D.) Monitor level of consciousness.

(C) Isosorbide mononitrate (Imdur) is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

Which patient would the nurse need to assess first if the patient is receiving mannitol (Osmitrol)? A.) A 67-year-old patient with type 1 diabetes mellitus B.) A 21-year-old patient with a head injury C.) A 47-year-old patient with anuria D.) A 55-year-old patient receiving cisplatin to treat ovarian cancer

(C) Mannitol (Osmitrol) is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

A patient is being treated for short-term management of heart failure with milrinone (Primacor). What is the primary nursing action? A.) Administer digoxin via IV infusion with the milrinone. B.) Administer furosemide (Lasix) via IV infusion after the milrinone. C.) Monitor blood pressure continuously. D.) Maintain an infusion of lactated Ringer's with milrinone infusion.

(C) Milrinone lactate (Primacor) is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via IV infusion. Lactated Ringer's does not have to be administered with milrinone.

A patient is taking pravastatin sodium (Pravachol). Which assessment finding requires immediate action by the nurse? A.) Headache B.) Slight nausea C.) Muscle pain D.) Fatigue

(C) Patients who experience severe muscle pain while taking pravastatin sodium (Pravachol) need to report the findings right away, as this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal.

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action? A.) Ask the patient to lie down and rest. B.) Assess the patient's dietary intake of sodium and fluid. C.) Administer phentolamine (Regitine). D.) Administer nitroprusside (Nipride).

(C) Phentolamine (Regitine) is a potent alpha-blocking agent specifically effective for treatment of hypertension associated with pheochromocytoma. The patient's blood pressure is elevated owing to tumor secretion. If the patient lies down, the blood pressure will not necessarily decrease. Increased fluid and sodium is not the cause of hypertension in this condition. Nipride is not the recommended treatment for this condition.

A patient taking spironolactone (Aldactone) has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? A.) Potatoes B.) Lima beans C.) Chicken D.) Strawberries

(C) Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.

A patient taking prazosin (Minipress) has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action? A.) Hold the medication. B.) Call the health care provider. C.) Determine the patient's history. D.) Weigh the patient.

(C) The desired therapeutic effect of prazosin (Minipress) may not fully occur for 4 weeks. The nurse does not know how long the patient has been on this medication. There is no need to hold the medication. It is more important to determine the patient's history prior to weighing the patient or calling the health care provider, since symptoms may be the result of the medication not yet achieving the full therapeutic effect.

What intervention will the nurse perform when monitoring a patient receiving triamterene (Dyrenium)? A.) Assess urinary output every other day. B.) Monitor for side effect of hypoglycemia. C.) Assess potassium levels. D.) Monitor for hypernatremia.

(C) Triamterene (Dyrenium) is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.

A home health care nurse is visiting an older client at home. Lasix is prescribed for the client and the nurse teaches the client about the medication. Which of the following statements, if made by the client, indicates the need for further teaching? A)I will sit up slowly before standing each morning B) I will take my meds every morning with breakfast C) I need to always drink coffee and tea to keep healthy D) I will call my doctor if my ankles swell or my rings get tight

(C) too much caffeine, may cause hypotension

You are preparing Mr. P. for discharge after he has been diagnosed with angina. Which statement by Mr. P. leads you to believe that he has understood your discharge teaching? a. "I will not exercise because it will precipitate angina." b. "As long as I take the medicine, I need to make no changes in my lifestyle." c. "There is no correlation between my hypertension and angina." d. "Heavy meals and cigarette smoking can precipitate angina."

(D)

The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication? A.) Docusate sodium (Colace) B.) Furosemide (Lasix) C.) Morphine sulfate D.) Spironolactone (Aldactone)

(D) ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be administered with an ACE inhibitor.

A patient is prescribed chlorthalidone (Thalitone). What is the most important information the nurse will teach the patient? A.) "Do not drink more than 10 ounces of fluid a day while on this medication." B.) "Take this medication on an empty stomach." C.) "Take this medication before bed each night." D.) "Wear protective clothing and sunscreen while taking this medication."

(D) Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.

Which statement made by the patient indicates to the nurse that understanding about discharge instructions on antihyperlipidemic medications has occurred? A.) "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." B.) "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." C.) "I will stop taking the medication if it causes nausea and vomiting." D.) "I will continue my exercise program to help increase my high-density lipoprotein serum levels."

(D) Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels. The dose should never be doubled if one is missed nor stopped due to side effects.

Which patient's statement indicates a need for further medication instruction about colestipol (Colestid)? A.) "The medication may cause constipation, so I will increase fluid and fiber in my diet." B.) "I should take this medication 1 hour after or 4 hours before my other medications." C.) "I might need to take fat-soluble vitamins to supplement my diet." D.) "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."

(D) Colestipol (Colestid) is a powder that must be well-diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump; it should be left to dissolve slowly for at least 1 minute.

Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? A.) "I will take up to five doses every 3 minutes for chest pain." B.) "I can chew the tablet for the quickest effect." C.) "I will keep the tablets locked in a safe place until I need them." D.) "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

(D) Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 minutes apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.

Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? A.) "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." B.) "I should keep my nitroglycerin in a cool, dry place." C.) "I should change positions slowly to avoid getting dizzy." D.) "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

(D) Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.

The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A.) Blood pressure 110/90 mm Hg B.) Flushing C.) Headache D.) Chest pain

(D) The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What is the correct information to teach this patient? A.) Change the patch daily at the same time. B.) Remove the patch before taking a shower or bath. C.) Do not take other antihypertensive medications while on this patch. D.) Get up slowly from a sitting to a standing position.

(D) This medication can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.

The nurse evaluates that the patient has understood discharge teaching regarding warfarin (Coumadin) based on which statement? A.) "I will double my dose if I forget to take it the day before." B.) "I should keep taking ibuprofen for my arthritis." C.) "I should decrease the dose if I start bruising easily." D.) "I should use a soft toothbrush for dental hygiene."

(D) This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The patient should call the health care provider if experiencing excessive bruising.

A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A.) Blood pressure of 120/80 mm Hg B.) Heart rate of 70 beats per minute C.) ECG without evidence of ST changes D.) Patient stating that pain is 0 out of 10

(D)-The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.

A client in on enalapril (Vasotec) for the treatment of hypertension. The nurse teaches the client that he should seek emergent care if he experiences which adverse effect. A.) Nausea B.) Insomnia C.) Dry cough D.) Swelling of the tongue

(D.) swelling of the tongue indicates angioedema, and potential airway closure, It calls for emergent, emergency care

A patient has a serum potassium level of 3.1 mEq/L. The nurse plans to administer: A. sustained-release potassium tablets (K-Dur). B. foods that are deficient in potassium. C. furosemide (Lasix). D. sodium polystyrene sulfonate (Kayexalate).

Answer: A Rationale: Normal serum potassium levels range from 3.5 to 5.0 mEq/L. Appropriate treatment for hypokalemia would be potassium supplements and foods high in potassium. Furosemide is a loop diuretic that causes hypokalemia. Sodium polystyrene sulfonate is administered for hyperkalemia.

A patient is receiving an angiotensin II receptor blocker (ARB). Which does the nurse recognize as an ARB? A.) Valsartan (Diovan) B.) Amlodipine (Norvasc) C.) Captopril (Capoten) D.) Metoprolol (Lopressor)

Answer: A Rationale: ARBs have a suffix of -sartan. Valsartan (Diovan) is an ARB. Amlodipine is a calcium channel blocker; captopril is an ACE inhibitor with a common suffix of -pril. Metoprolol is a beta blocker with a common suffix of -lol.

A patient who is taking spironolactone (Aldactone) is newly prescribed losartan (Cozaar). The nurse should: A. assess for signs of hyperkalemia. B. observe for a hypertensive crisis. C. administer the medications as scheduled. D. evaluate for first-dose hypotension.

Answer: C Rationale: Spironolactone is a potassium-sparing diuretic. Losartan is an ARB. These medications may be administered together without serious drug interactions; the patient would be observed for hypotension (not first-dose hypotension).

A patient is prescribed spironolactone (Aldactone) for treatment of hypertension. Which foods should the patient be taught to avoid? A. Baked fish B. Low-fat milk C. Salt substitutes D. Green beans

Answer: C Rationale: Spironolactone is a potassium-sparing diuretic. Medications that are potassium sparing, potassium supplements, and salt substitutes should be avoided. High-potassium foods should also be avoided.

Which statement will the nurse include when teaching a patient about loop (high-ceiling) diuretics? A.) Take the medication at bedtime. B.) Take the medication on an empty stomach. C.)Rise slowly from a lying or sitting to standing position to prevent dizziness. D.) Avoid fruit and vegetables in the diet.

Answer: C Rationale: The medication should be taken in the morning, not at bedtime, to prevent sleep disturbances and nocturia; taking the medication at mealtime or with a snack, not on an empty stomach, can prevent nausea from developing, and patients receiving this medication should eat a diet high in fruits and vegetables to prevent hypokalemia.

In reviewing the medication records of the following group of clients, the nurse determines that which client would be at greatest risk for developing hyperkalemia? A) Client receiving furosemide (Lasix) B) Client receiving bumetanide (Bumex) C) Client receiving sprionolactone (Aldactone) D) Client receiving hydrochlorothiazide (HCTZ)

C - Adlactone is K sparing. 1, 2 and 4 could result in hypokalemia

A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, "There are yellow halos around the lights." Which action will the nurse take? A.) Evaluate digoxin levels. B.) Withhold the furosemide. C.) Administer potassium. D.) Document the findings and reassess in 1 hour.

(A) Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient's digoxin levels.

A beta-adrenergic antagonist (beta-blocker) should not be administered when which of the following is assessed in the patient? a. Bilateral wheezing b. A heart beat of 80 beats per minute c. A blood pressure of 120/72 d. A blood pressure of 170/100

(A)

Mr. X. is started on oral niacin to decrease his cholesterol. Which of the following adverse reactions should you be observing for? a. flushing b. tachycardia c. nose bleeds d. diarrhea

(A)

Mr. G., who is receiving Coumadin, has blood in his urinary drainage bag this morning. After reporting her observations to the physician, the nurse will administer a. Amicar b. platelets c. protamine sulfate d. vitamin K

(D)

A patient is taking a potassium-depleting diuretic and digoxin. The nurse expects that hypokalemia could have what effect on digoxin? A.) Increase serum digoxin sensitivity level B.) decrease serum digoxin sensitivity level C.) have no effect on serum digoxin sensitivity level D.) cause a low average serum digoxin sensitivity level

A.) Increase serum digoxin sensitivity level

The patient's serum digoxin level is 3.0ng/mL. What does the nurse know about this serum digoxin level? A.) It's the the high (elevated) range B.) It's in the low (decreased) range C.) It's within the normal range D.) It's in the low average range

A.) It's the the high (elevated) range

A patient with heart failure is prescribed furosemide (Lasix). The nurse should instruct the patient to consume: A. oranges, spinach, and potatoes. B. baked fish, chicken, and cauliflower. C. tomato juice, skim milk, and cottage cheese. D. oatmeal, cabbage, and bran flakes.

Answer: A Rationale: Furosemide may have the adverse effect of hypokalemia. Hypokalemia can be reduced by consuming foods that are high in potassium such as nuts, dried fruits, spinach, citrus fruits, potatoes, and bananas.

The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that heart failure is improving? A.) Pale and cool extremities B.) Absence of peripheral edema C.) Urine output of 60 mL/4 h D.) Complaints of increasing dyspnea

B.) Absence of peripheral edema

A patient takes an initial dose of a nitrate. Which symptom(s) will the nurse expect to occur? A.) Nausea and vomiting B.) Headaches C.) Stomach cramps D.) Irregular pulse rate

B.) Headaches

The health care provider is planning to discontinue a patient's beta blocker. Which instruction will the nurse give the patient regarding the beta blocker? A.) The beta blocker should be abruptly stopped when another cardiac drug is prescribed B.) The beta blocker should not be abruptly stopped; the dose should be tapered down C.) The beta blocker dose should be maintained while taking another antianginal drug D.) Half the beta blocker dose should be taken for the next several weeks

B.) The beta blocker should not be abruptly stopped; the dose should be tapered down

The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of this drug? A.) Increase beta1 and beta2 receptors in cardiac tissue B.) increase the flow of O2 to cardiac tissues C.) Block beta1-adrenergic receptors in cardiac tissues D.) Block beta2-adrenergic receptors in cardiac tissues

C.) Block beta1-adrenergic receptors in cardiac tissues

A patient is prescribed a beta blocker. The nurse acknowledges that beta blockers are as effective as anti-anginals because they do what? A.) Increase oxygen to the systemic circulation B.) Maintain HR and BP C.) Decrease HR and decrease myocardial contractility D.) Decrease HR and increase myocardial contractility

C.) Decrease HR and decrease myocardial contractility

The nurse is assessing a patient for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity? A.) Apical pulse rate of 100 bpm B.) Apical pulse of 72 bpm w/ an irregular rate C.) Apical pulse of 90 bpm w/ irregular rate D.) Apical pulse of 48 bpm and irregular rate

D.) Apical pulse of 48 bpm and irregular rate