test4

normal aPTT while on heparin

60-80 sec want PTT 120-140

Knowing the high incidence and prevalence of heart failure among the elderly, a nurse educator has organized a workshop on the identification of early signs and symptoms of heart failure. Which teaching point is most accurate?

A) Cognitive changes can often accompany heart failure in the elderly. Pulmonary edema is a later sign and they are less likely to display coughing, chest pain of flushed skin and fever. (Norris, 10th ed., 2019, pp. 818-820)

The nurse has just received an order for tenecteplase (TNKase) for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: by bolus injection. by infusion pump over 24 hours. slowly over 90 minutes.

ANS: ATenecteplase (TNKase) is given by bolus injection. Tissue plasminogen activator (tPA) must be infused over 90 minutes. Because tenecteplase (TNKase) is given by bolus injection, an infusion pump is not required. Although the patient should be monitored, tenecteplase (TNKase) does not require a prolonged infusion time.

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? Aspirin, clopidogrel, omeprazole Aspirin, heparin, abciximab (ReoPro) Enoxaparin (Lovenox), prasugrel (Effient), warfarin (Coumadin) Heparin, alteplase, abciximab (ReoPro)

ANS: B Abciximab, combined with ASA and heparin, is approved for IV therapy for patients undergoing PCI.

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in 3color. A stat CBC shows a platelet count of less than 100,000 mm . The nurse will: administer oxygen and notify the provider. discontinue the heparin and notify the provider. request an order for protamine sulfate. request an order for vitamin K (phytonadione).

ANS: B This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need continued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparin is not a vitamin K inhibitor.

A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the pain intensifies. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing: a. an angiotensin-converting enzyme (ACE) inhibitor. b. intravenous nitroglycerin and a beta blocker. c. ranolazine (Ranexa) and quinidine. d. supplemental oxygen and intravenous morphine.

ANS: B This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.

A nurse is providing discharge teaching instructions for a patient taking cholestyramine (Questran). Which statement made by the patient demonstrates a need for further teaching? "I will take warfarin (Coumadin) 1 hour before my medicine." "I will increase the fluids and fiber in my diet." "I can take cholestyramine with my hydrochlorothiazide." "I will take digoxin 4 hours after taking the cholestyramine."

ANS: C Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine.

A nurse is reviewing a patient's medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____. level of gemfibrozil; increased level of gemfibrozil; reduced anticoagulant effects; increased anticoagulant effects; reduced

ANS: C Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may need to be reduced.

A hospitalized patient complains of acute chest pain. The nurse administers a 0.3 mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step? Apply a nitroglycerin transdermal patch. Continue dosing at 10-minute intervals. Give a second dose of nitroglycerin in 5 minutes. Request an order for intravenous nitroglycerin.

ANS: C An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.

A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy? "Fibrinolytics are effective when the first dose is given up to 24 hours after symptom onset." "Fibrinolytics should be given once cardiac troponins reveal the presence of STEMI." "Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident." "Patients should receive either an anticoagulant or an antiplatelet agent with a fibrinolytic drug."

ANS: C Patients with a history of cerebrovascular accident (CVA) should not receive fibrinolytic agents because of the increased risk of intracranial hemorrhage. Fibrinolytics are most effective when given within 30 minutes of arrival in the emergency department. Because cardiac troponins are not detectable until 2 to 4 hours after the onset of symptoms, fibrinolytics should be administered before these laboratory values are available. Patients receiving fibrinolytics should receive both an anticoagulant and an antiplatelet drug.

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order: digoxin (Lanoxin) to slow the heart rate. immediate discontinuation of the nitroglycerin. periods of rest when the heart rate increases. verapamil as an adjunct to nitroglycerin therapy.

ANS: D Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.

A 55-year-old patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? Aspirin is useful only for preventing a second myocardial infarction. She should ask her provider about using a P2Y12 ADP receptor antagonist. She should take one 81 mg tablet per day to prevent myocardial infarction. There is most likely no protective benefit for patients her age.

ANS: D ASA is used for primary prevention of MI in men and in women older than 65 years. This patient has no previous history of MI, so the use of ASA is not indicated. ASA is useful for primary prevention, but only when indicated by cardiovascular risk, based on age, gender, cholesterol levels, blood pressure, and smoking status. A P2Y12 ADP receptor antagonist is used as secondary prevention. This patient should not begin taking ASA unless her risk factors change, or until she is 65 years old.

A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers: a. dilate arterioles to improve myocardial circulation. b. improve cardiac contractility, which makes the heart more efficient. c. increase arterial pressure to improve cardiac afterload. d. increase the time the heart is in diastole.

ANS: D Beta blockers increase the time the heart is in diastole, which increases the time during which blood flows through the myocardial vessels, allowing more oxygen to reach the heart. Beta blockers do not dilate arterioles. They do not increase cardiac contractility; they decrease it, which reduces the cardiac oxygen demand. They do not increase arterial pressure, which would increase the cardiac oxygen demand.

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a repeat aPTT to be drawn immediately. analgesic medication. changing heparin to aspirin. protamine sulfate.

ANS: D Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.

A patient who has taken warfarin (Coumadin) for a year begins taking carbamazepine. The nurse will anticipate an order to: decrease the dose of carbamazepine. increase the dose of warfarin. perform more frequent aPTT monitoring. provide extra dietary vitamin K.

B Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement best describes this phenomenon?

B) Increased pressure in the aorta and other arteries constitutes a greater amount of afterload work. This situation is not indicative of increased preload or impaired contractility. Systolic impairment is not a recognized characterization of inadequate cardiac performance. (Norris 2019, 10th ed., p. 701)

how do beta blockers work in angina

C) Beta-blockers reduce anginal pain primarily by decreasing cardiac oxygen demand, principally through blockade of beta1 receptors in the heart, which decreases heart rate and contractility. Beta-blockers reduce oxygen demand further by causing a modest reduction in arterial pressure (afterload). In addition to decreasing oxygen demand, beta-blockers help increase oxygen supply. By slowing heart rate, they increase time in diastole, and thereby increase the time during which blood flows through myocardial vessels. (Recall that blood does not flow in these vessels during systole.) (Burchum & Rosenthal, 10th ed., p. 115, p. 124)

drugs to be on until diagnosed with MI

MONA B morphine oxygen nitrate aspirin beta blocker

A patient has been taking nifedipine (Procardia) 20 mg three times daily. He says that following his medication, he gets palpitations and feels dizzy. Because of these symptoms, the medication is changed to nifedipine extended-release (Procardia XL) 60 mg daily. The patient is concerned that with the same medication and the same total dose symptoms will be unchanged. Which statement would offer reassurance to this patient that his symptoms will improve?

Nifedipine is well absorbed following oral administration but undergoes extensive first-pass metabolism. As a result, only about 50% of an oral dose reaches the systemic circulation. With the IR formulation, effects begin rapidly and peak in 30 minutes; with the SR formulation, effects begin in 20 minutes and peak in 6 hours. The slow release will minimize the reflex changes caused by nifedipine. Nifedipine is fully metabolized before excretion in the urine. It is not appropriate to tell a patient that we using trial and error to find out what works. (Burchum and Rosenthal, 10th ed, 501)

in angina, ranolazine cannot be given with

azithromycin (macrolides) because it will cause QT prolongation

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to touch. The nurse will anticipate giving which medication? Aspirin Clopidogrel (Plavix) Enoxaparin (Lovenox) Warfarin (Coumadin)

enoxaparin ANS: CEnoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.

A patient is administered METOPROLOL. Which NEW assessment one (1) hour later would be cause for alarm?

crackles in all lung fields A) Major adverse effects involve the heart. Like propranolol, metoprolol can cause bradycardia, reduced cardiac output, AV heart block, and rebound cardiac excitation following abrupt withdrawal. Also, even though metoprolol is approved for treating heart failure, it can cause heart failure if used incautiously. In contrast to propranolol, metoprolol causes minimal bronchoconstriction and does not interfere with beta2-mediated glycogenolysis. (Burchum & Rosenthal, 10th ed, p. 168.)

A patient has been prescribed an antidysrhythmic drug that prolongs the QT interval on ECG. Which symptom would suggest that a torsades de pointes may be occuring?

feeling faint

Beta blocker mechanism of action

decrease contractility and HR (decrease workload of heart) increase time spent in diastole

if you're on fibrinolytic, what drugs are you on

fibrinolytic (altepase or TPA) heparin (anticoagulant) aspirin + clopidogrel (antiplatelet) ace inhibitor alt to heparin: fonlaparinux

if you're getting PCI what adjunct drugs

heparin aspirin + clopidogrel ace glycoprotein IIb/IIIa if high risk bleed: bivalirudin

covelesalam can cause what to occur to blood sugar

low blood sugar

A patient is receiving heparin. The following lab results were flagged on a patient's report as abnormal.\n\nWhich one result would cause the greatest concern?

low platelet count

Which new symptom suggests hypomagnesemia when a patient is prescribed a thiazide or high-ceiling diuretic?

muscle weakness or tremor lasix can cause hypomag

fibrinolytic is most effective when

patient presents early if pain present longer than 12 hours not given (needs to be within 4-6 hours) best for patient under 75

calcium channel blockers

relax arterioles to reduce after load reduces peripheral resistance decreases AV conduction, contractility

once diagnosed with MI,

repercussion therapy! PCI within 90 minutes fibrinolytic within 30 minutes

A nurse practitioner admits a patient who has used reserpine for several months for hypertension. The patient is admitted to hospital for a non-cardiac/hypertensive reason. Which assessment is most important?

reserpine is an adrenergic neuron blocking agent monitor CNS C) The primary indication for reserpine is hypertension. The side effect of greatest concern is severe depression. eserpine can produce severe depression that may persist for months after the drug is withdrawn. Suicide has occurred. All patients should be informed about the risk of depression. Also, they should be educated about signs of depression (e.g., early morning insomnia, loss of appetite, change in mood) and instructed to notify the prescriber immediately if these develop. Because of the risk of suicide, patients who develop depression may require hospitalization. Reserpine is contraindicated for patients with a history of depressive disorders. The risk of depression can be minimized by keeping the dosage low (0.25\u202fmg/day or less). (Burchum & Rosenthal, 10th ed., p. 177)

what medication has a brown discoloration

sodium nitroprusside

A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The advanced nurse practitioner has been talking with him about his diagnosis and treatment and answering the numerous questions he has about his health problem. Which teaching point should the NP include in this patient's teaching?

the top chambers of your heart and the bottom chambers are communicating effectively to pump blood C) A third-degree AV block is characterized by independent, and thus uncoordinated, pacemaker action for the atria and for the ventricles. It can be either congenital or acquired, and ventricular contraction tends to be slow, not fast. Manifestations tend to be those associated with decreased cardiac output, and it is not necessarily associated with a large increase in stroke or MI risk. (Norris, 10th ed., 2019, p. 849)

A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. How would the nurse practitioner explain this?

your son is experiencing a rentery rhythm in his right atrium