Pharmacology- Quiz 7

About which patient should the nurse notify the healthcare provider immediately?

A patient who takes oral spironolactone (Aldactone) 25 mg daily and enalpril (Vasotec 5 mg daily with a serum level of 5.5 mEq/L

In what part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?

AV node

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity?

Fatigue, Vomitting and Blurred Vision

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient?

Fatigue, headache and dizziness

Which of the following would be a priority to report to the prescriber of hydralazine (Apresoline)?

Pulse of 120 beats/min

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles?

QRS complex

The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which assessment finding indicates an adverse effect of this drug?

QT prolongation ont he ECG

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective?

"I will rise slowly when changing from a sitting to standing position"

The nurse is providing discharge teaching for a patient with a new prescription for a nitroglycerin transdermal patch. Which statement by the patient indicates a need for further teaching?

"I will limit my alcohol to one drink per day"

An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse?

"Let's discuss this effect with your prescriber. There are other drug available tot manage your blood pressure that many not have the same adverse effect"

A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include?

"Store the tablets in the original container and tightly close it after use"

The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions?

"When I am getting out bed in the morning, I will sit on the side of the bed for several minutes before standing"

Which medications should be used with caution in a hypertensive diabetic patient?

1. Furosemide (Lasix) 2. Metoprolol (Lopressor) 3. Hydrochlorothiazide (HCTZ)

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

"the onset of warfarin is delayed"

Lidocaine (Xylocaine) {a Class IB antidysrhtyhmic) has the following effects on the heart. SELECT ALL THAT APPLY

- Block cardiac sodium channels - increases conduction of the his-purkinje system - DONT KNOW THE ACTUAL ANSWER

A 65-year old white patient has been newly diagnosed with hypertension, with an average blood pressure of 164/92. Which of the following drug groups may potentially be ordered initially for this patient? SELECT ALL THAT APPLY

- Calcium channel blocker - Thiazide diuretics - ACE inhibitors

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication. SELECT ALL THAT APPLY

- Hyperkalemia - persistent cough - Angioedema - Hypotension

A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor?

- Platelets - Activated partial thromboplastin time (aPTT)

The nurse understands patients receiving nitroglycerin are at risk for which adverse effects?

1. Headache 2. Dizziness 3. Tachycardia

Which are the main types of drugs used to prevent or relieve anginal pain?

1. Beta blockers 2. Nitrates 3. Calcium Channel Blockers

A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. What interventions are essential before the nurse administers nitroprusside [Nipride]?

1. Obtain a baseline weight and weigh daily 2. Prepare for arterial line insertion 3. Cover solution with an opaque bag

A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan?

1. Wear a medical alert bracelet 2. check all urine and stool for discoloration 3. Do not start any new medication without first talking to your healthcare provider

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]?

1. Wear sunblock and protective clothing when you are outdoors 2. Check your pulse daily and report excessive slowing to your healthcare provider immediately 3. Immediately notify your healthcare provider of shortness of breath, cough, or chest pain

A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered?

Adenosine (Adenocard)

The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment?

Adjust the intravenous infusion rate to the blood pressure response

A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for management of newly diagnosed stable angina. Which assessment finding would require an immediate nursing intervention?

An increase in the resting heart rate to 110 from baseline of 68-72

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention

Analyze heart rate and rhythm

What is the most common sustained dysrhythmia among the U.S. population?

Atrial Fibrillation

Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)?

Beta blocker and ACE inhibitor

A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed?

BiDil (isosorbide Dinitrate and Hydralazine)

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]?

Blood pressure

The nurse is caring for a patient who is receiving enteral feedings because of dysphagia. The healthcare provider prescribes isosorbide mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the most appropriate action by the nurse?

Call the healthcare provider about an alternate from of nitrate for administration

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate?

Call the healthcare provider to increase the dose

Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent?

Check with your healthcare provider before taking any over the counter medication for gastric acidity

In which situation is dronedarone [Multaq] contraindicated?

Concomitant administration of amitriptyline (Elavil)

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug?

Decreasing level of consciousness

The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug?

Diarrhea

Which medication is not associated with prolongation of the QT interval?

Diltiazem (Cardizem)

Which medication combination is useful in the treatment of variant angina?

Diltiazem (Cardizem) and isosorbide mononitrate

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?

Discolored Urine

The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding?

Dysrythmias should be treat only when they are symptomatically significant

The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension?

Enalapril (Vasotec)

Your patient has been taking warfarin (coumadin) for 3 weeks. They call to report dark, tarry stools and feeling like their heart is racing. The most likely cause is:

GI bleeding

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate?

Give the medication

A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response?

Heparin suppresses coagulation by helping antithrombin perform its natural functions.

The nurse knows that which statement is accurate for enoxaparin [Lovenox]?

It reduces the activity of factor Xa more than the activity of thrombin

A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)?

Lepirudin (Refludan)

The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept?

Many vasodilators cause retention of sodium and water

The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient?

Methyldopa (Aldomet)

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug?

Monitor the ECG

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse?

Vomiting and diarrhea

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication?

Obtain baseline serum thyroid and liver function studies

The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient?

Once a day

The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs?

Potassium level of 5.7 mEq/L

Fondaparinux [Arixtra] is not approved for use in which circumstance?

Prevention of ischemic complications in patients with unstable angina

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication?

Respiratory

Which laboratory result may be a consequence of therapy with a thiazide diuretic?

Serum uric acid level of 10.4 mg/dL

The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this mediacation?

Severe hypertension

A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure?

Sodium nitroprusside

A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient?

Sodium nitroprusside (Nipride)

The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessement data indicate the patient may be experiencing thiocyanate toxicity?

Sudden confusion

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response?

Tachycardia

A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication?

The QT- interval measurement changes from 400 msec to 520 msec

The nurse is caring for a patient receiving nitrates for relief of angina. What pharmacodynamic action is responsible for the relief of anginal pain with nitrates?

Vasodilation leads to decrease preload, which decreases oxygen demand

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure?

Ventricular wall thickening

The home health nurse observes the patient for proper use of topical nitroglycerin ointment. Which action by the patient indicates the need for further teaching?

applies the prescribed ribbon of ointment to the applicator paper and places it on the chest

What is the primary benefit of spironolactone [Aldactone] in patients with heart failure

blockage of aldosterone receptors

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel?

omeprazole (Prilosec)

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose?

to protect against reflex tachycardia