Unit 2 Pharmacology

A client asks the nurse how fat is carried in the blood. Which response should the nurse provide?

"Fats travel in the blood on little proteins called lipoproteins."

The nurse has completed the education for a client prescribed gemfibrozil (Lopid). Which statement made by the client indicates an understanding of the information?

"I must take this medication with food or I can have heartburn."

A client is scheduled for insertion of a coronary stent with right groin access. Which teaching points should the nurse include in this client's preoperative teaching plan? Select all that apply

"If you have chest pain during this procedure, please tell the staff when or if this should occur." "You will need to remain flat during the procedure and for 3 to 6 hours after the procedure"

What instructions to the nurse give the client who will be starting a prescription for simvastatin 40 mg/day client? Select all that apply.

"If you miss a dose, take it when you remember." "Report muscle pain or tenderness to your health care provider." "Continue to follow a diet that is low in saturated fats."

Which assessment data obtained from a client receiving a statin is a priority for the nurse to report to the healthcare provider?

"My calves hurt, and I had a hard time walking to the bathroom."

How should the nurse instruct the client with unstable angina to use sublingual nitroglycerin tablets when chest pain occurs?

"Sit down and then take one tablet if pain persists after 5 minutes call 911"

The nurse is teaching a client who has had a myocardial infarction about using nitroglycerin spray. Which information should the nurse include in the teaching plan? Select all that apply

"Spray the medication under the tongue as soon as you have chest pain." "If the chest pain continues after 2 sprays of the medication, wait 5 minutes and use 1 more spray." "Call 911 if chest pain continues after 10 minutes of using the 3 spray."

Which information should the nurse include in the education for a client prescribed niacin to lower lipid levels?

"Take one aspirin 30 minutes before you take your niacin."

The client states to the nurse, "My healthcare provider says I have heart disease and I need to decrease the cholesterol in my diet. I don't understand how this happened." Which response should the nurse provide the client?

"The arteries around your heart are narrowed by low density lipoprotein (LDL) cholesterol buildup in them."

A client tells the nurse they will need a prescription for high cholesterol but does not know which would be best. Which information should the nurse provide the client? Select all that apply

"The bile resins keep cholesterol from being absorbed but have some side effects." "The statin drugs inhibit the making of cholesterol and are considered the best choice." "Fibric acid drugs will decrease triglycerides, but your low density lipoprotein (LDL) will still be high."

A client with chronic heart failure has atrial fibrillation and mistaken warfarin what should the nurse tell the client about the expected outcome of this drug?

"This medication will prevent a clot from forming."

A client with hypertensive emergency is being treated with sodium nitroprusside. In a dilution of 50mg/250mL, how many micrograms of sodium nitroprusside are in each milliliter? Round your answer to a whole number.

200 mcg

A client receiving an IV infusion of heparin sodium at 1,200 units/h. The dilution is 25,000 unites/500mL. How many milliliters per house will this client receive? Round your answer to a whole number

24 mL/h

Furosemide 40 mg intravenous push is prescribed. Furosemide 10 mg/mL is available how much should the nurse administer round your answer to a whole number

4mL

Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drugs desired effect?

5 to 10 minutes

A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial lines is inserted. Which prescription from the healthcare provider should the nurse verify before implementing?

Administer metoprolol 5 mg IV push

An adult comes to the emergency department with crushing substernal chest pain that radiates to the shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Prescriptions include oxygen by nasal cannula at 4L/min, complete blood count, a chest radiography, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate give IV. What should the nurse do first?

Administer the morphine

The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a systolic murmur at the apex. What should the nurse do first?

Assess for changes in vital signs

The nurse is admitting an older adult to the hospital. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed based on this finding, what should the nurse do first?

Assess respiratory status

The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes that cardiac rhythm on the monitor (see the electrocardiogram strip). What should the nurse do first?

Assess the client for changes in the rhythm

Which assessment is a nursing priority for a client receiving cholestyramine (Questran)?

Auscultation of bowel sounds in all four abdominal quadrants

The nurses teaching a client with heart failure how to avoid complications in further hospitalizations. The client has understood the instruction when the client identifies which potential complications? Select all that apply

Becoming increasingly short of breath at rest Weight gain of 2lbs (0.9 kg) or more in 1 day Having to sleep sitting up in the reclining chair

A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nursing administers furosemide and nitroprusside as prescribed. The nurse notices they sit and drop in the pulmonary artery systolic pressure in pulmonary artery wedge pressure. What should the nurse assess next?

Blood pressure

An older client with a history of heart failure is admitted to the emergency department with pulmonary edema. During admission, what should the nurse assess first?

Blood pressure

A client with chest pain is prescribed intravenous nitroglycerin. Which finding is the greatest concern for the nurse initiating the nitroglycerin drip?

Blood pressure 88/46 mm Hg

Good dental care is an important measure in reducing the risk of endocarditis. What information about dental care should the nurse include in the teaching plan for a client with mitral stenosis? Select all that apply.

Brush their teeth at least twice a day Floss the teeth at least once daily Have regular dental checkups

which food should the nurse teach a client with heart failure to limit when following a 2 gram sodium diet?

Canned tomato juice whole wheat bread hamburger

When monitoring client who is receiving tissue plasminogen activator (t-PA), the nurse should assess the client for which changes?

Cardiac arrhythmia a middle-aged client with a history of hypertension reports having indigestion.

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?

Confusion, urine output 15 mL over the last 2 hours, orthopnea

The nurse is assessing a client with a known history for chronic heart failure. Which finding indicates poor perfusion to the tissue?

Cool, pale extremities

The client has been managing angina episodes with nitroglycerin. Which finding indicates that the therapeutic effect of the drug has been achieved?

Decrease chest pain

Metoprolol is added to the pharmacological therapy of a diabetic female diagnosed with stage two hypertension who has been initially treated with furosemide in ramipril. The nurse should evaluate the client for which expected therapeutic effect?

Decrease in heart rate

When preparing a client for a cardiac angiogram, what action should the nurse take? Select all that apply

Determine if the client has an allergy to liquid contrast material Inform he client that an intravenous infusion will be started before the procedure Remind the client to have nothing to eat or drink 8 hours before the procedure Instruct the client to remain still during the procedure

A client with heart failure is taking furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first degree atrioventricular block. What other sign should the nurse assess next?

Digoxin toxicity

When administering a thrombolytic drug to the client who is experiencing a myocardial infarction (MI) and who has premature ventricular contractions, which is the expected outcome of the drug?

Dissolve clots

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving intravenous heparin sodium at 1,000 units per house. During the second post procedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. What should the nurse do first?

Don gloves and apply direct pressure over the site

A client is taking clonidine for treatment of hypertensive. The nurse should teach the client about which common adverse effects of this drug? Select all that apply:

Dry mouth Impotence Sleep disturbance

The patient is receiving cholestyramine (Questran) and complains of constipation. The physician orders bisacodyl (Dulcolax) tablets. When is the best time for the nurse to administer the bisacodyl (Dulcolax) tablets?

Four hours after administration of cholestyramine (Questran).

The nurse has completed nutritional teaching for a client with a high low density lipoprotein (LDL) level. Which menu choice made by the client indicates an understanding of the teaching?

Grilled chicken with rice and broccoli, tossed salad with walnuts and sliced apples, slice of whole-wheat bread, and low-fat chocolate pudding

The client has risk factors for coronary artery disease, including smoking cigarettes, eating a diet high in saturated fat, and leading a sedentary lifestyle. Which coaching strategies from the nurse will be most effective in assisting the client improve his or her health?

Helping the client establish a wellness vision to reduce the health risks

The nurse is providing education about lipids for a client with hyperlipidemia. Which information should the nurse include in the education?

High density lipoprotein (HDL) is called good cholesterol because it removes cholesterol from the body and gets rid of it in the liver.

Which is the priority action of the nurse when caring for a client receiving a statin with elevated creatine kinase (CK) levels?

Hold the prescription and notify the healthcare provider

What is the major goal of nursing care for a client with heart failure in pulmonary edema?

Increase cardiac output

Which is an expected outcome when a client is receiving an IV administration of furosemide?

Increased urine output

A client with angina is taking nifedipine. Which instruction should the nurse give the client?

Inspect gums daily

What information should the nurse provide to the client who is receiving warfarin?

Internationalized normalized ratio (INR) is used to assess effectiveness

The nurse is preparing the client for discharge after mitral valve replacement surgery. Which activity should the client avoid until after the one month post discharge appointment with the surgeon?

Lifting anything heavier than 10 lb (4.5 kg)

The nurse reviewing a client's serum cholesterol levels notes the following: Low density lipoprotein (LDL) = 105 mg/dl High density lipoprotein (HDL) = 37 mg/dl Low density lipoprotein (LDL)/high density lipoprotein (HDL) ratio = 4.1 Which should the nurse identify as the priority outcome in the client's plan of care?

Maintenance of normal lipid levels without the use of pharmacotherapy

A client has mitral stenosis and will have a valve replacement period the nurse is instructing the client about help maintenance prior to surgery. Inability to follow these prescriptions would pose the greatest health hazard to this client at this time?

Medication therapy

After a myocardial infarction, the hospitalized client is taught to move the legs while resting in bed. What is the expected outcome of this exercise?

Prevent throbophlebitis and blood cloth formation

An older adult has chest pain and shortness of breath. The healthcare provider (HCP) prescribes nitroglycerin tablets. What should the nurse instruct the client to do?

Put the tablet under the tongue until it is all absorbed

A client has chest pain rated at 8 out on a 10-point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads, and troponin levels are elevated. What should the nurse do first?

Reduce pain and myocardial oxygen demand

A client with acute chest pain is receiving IV morphine sulfate. Which is an expected effect of morphine? Select all that apply.

Reduces myocardial oxygen consumption Reduces blood pressure and heart rate Reduces anxiety and fear

The nurse is caring for an older adult with mild dementia admitted with heart failure. What nursing care will be helpful for this client in reducing potential confusion related to hospitalization and change in routine? Select all that apply

Reorient frequently to time, place, and situation. Arrange for familiar pictures or special items at bedside. Spend time with client, establishing a trusting relationship

The nurse is evaluating a client who received tissue plasminogen activator (t-PA) following a myocardial infarction (MI). What is the expected outcome of this drug?

Revascularize the blocked coronary artery

The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm showing on the electrocardiogram strip. How should the nurse interpret the rhythm strip?

Sinus tachycardia

Which position is best for client with heart failure who has orthopnea?

Sitting upright (high Fowler's position) with legs resting on the mattress.

The client who experiences angina has been told to follow a low cholesterol diet which meal would be best?

Spaghetti with tomato sauce, salad, and coffee

The nurse connects the client to cardiac monitor, which reveals 8 premature ventricular contractions per minute. What should the nurse do next?

Start an intravenous infusion

Which lipid type is associated with the highest risk for the development of atherosclerosis?

Steroids

Which set of postural vital signs in a client with hypertension should the nurse report to the health care provider (HCP)?

Supine 120/70, 88 bpm Sitting 102/64, 86 bpm Standing 100/60, 92 bpm

A client has a throbbing headache when nitroglycerin is taken for angina. What should the nurse instruct the client to do?

Take acetaminophen or ibuprofen

The nurse notices that a client's heart rate decreases from 63 to 50 bpm on the monitor. What should the nurse do first?

Take the client's blood pressure

Following the diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. What should the nurse instruct the client to do?

Taking nitroglycerin tablet before climbing the stairs

Which is an expected outcome for a client on the second day of hospitalization after a myocardial infarction?

The client can perform personal self-care activities without pain

A client has returned from the cardiac catheterization laboratory after a balloon valvuloplasty or mitral stenosis. Which finding requires immediate nursing action?

The client has become more somnolent

The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply.

The client should report unexpected bleeding or bleeding that lasts a long time. The client may bruise more easily and may experience bleeding gums Clopidogrel works by preventing platelets from sticking together and forming a clot

In preparing a client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, what should the nurse tell the family?

The client will receive medication to relieve pain

A client experiences initial indications of dizziness after having an IV infusion of Iidocaine hydrochloride started. The nurse should further assess the client for which symptoms?

Tinnitus

Which type of lipid serves as fuel for the body when energy is needed?

Triglicerides

A client was admitted with an exacerbation of heart failure breath at 0200. At 0700, which information is most important for the nurse who admitted he client to communicate during the hand-off of care report to the nurse who will next take care of the client?

Urinary output of 120mL

The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which changes noted from the clients chart to the healthcare provider?

Urine output

Which assessment finding for a client receiving a statin is a priority for the nurse to report to the healthcare provider?

Urine output of 20 mL/hour

The healthcare provider prescribes continuous IV nitroglycerin infusion for the client with myocardial infarction. What should the nurse do to ensure safe administration of this drug?

Use an infusion pump for the medication

The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty with femoral artery access. In which order from first to last should the nurse obtain information about the client? All options must be used

Vital signs and oxygen saturation pedal pulse catheterization site color and sensation of extremity

What measures should the nurse take that will be most helpful in preventing wound infection when changing a client's dressing after coronary artery bypass surgery?

Wash hands before changing the dressing

Captopril, furosemide, and metoprolol are prescribed for a client with systolic heart failure. The client's blood pressure is 136 slash Prior to medication administration at oh 900, the nurse reviews the following lab test what should the nurse do 136/82 mm Hg, and the heart rate is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests (see chart) what should the nurse do first?

Withhold the captopril

A client with diabetes who has been maintained on metformin has been scheduled for a cardiac catheterization. The nurse should verify that the health care provider has written which prescriptions for taking the metformin before the procedure?

Withhold the metformin

Three days after mitral valve replacement surgery, the client tells the nurse there is a clicking noise from the chest incision. The nurse response should reflect the understanding that the client may be experiencing:

anxiety related to altered body image

A client receiving a loop diuretic should be encouraged to eat which foods to prevent potassium loss? Select all that apply

banana dried fruit orange juice

A client who has undergone a mitral valve replacement has had a mediastinal chest tube inserted. The client has persistent bleeding from the sternal incision during the early postoperative. What action should the nurse take? Select all that apply

check the post operative CBC INR PTT and platelet levels confirm availability for blood products monitor the mediastinal chest tube draining

the nurse is assessing a client with chronic heart failure who is demonstrating neurohormonal compensatory mechanisms. Which are expected findings on assessment? Select all that apply

decrease cardiac output increased heart rate vasoconstriction and skin, GI tract, and kidneys fluid overload

A client returns from a left heart catheterization. The right groin was used for catheter access. In which location should the nurse palpate the distal pulse on this client?

dorsal surface of the right foot

The nurse should assess the client with left sided heart failure for which findings? Select all that apply.

dyspnea crackles oliguria decreased oxygen saturation

A client is admitted with a myocardial infarction and atrial fibrillation. While auscultating the heart, the nurse notes an irregular heart rate and hears and extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. How should the nurse document these findings?

heart rate irregular with S3

Which are indications that a client with a history of left sided heart failure is developing pulmonary edema? Select all that apply

hoarse crackles tachycardia

A client has had a pulmonary artery catheter inserted in performing hemodynamic monitoring with the catheter, the nurse wedges the catheter. What information will the nurse obtain from this procedure?

left end-diastolic pressure

Which is the most appropriate diet for a client during the acute phase of a myocardial infarction (MI)?

small, easily digested meals

A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) prior to stress test?

troponin level

A client is scheduled for a cardiac catheterization the nurse should do which person preprocedure tasks? Select all that apply

verify the client has stopped taking anticoagulants if instructed by the health care provider check for iodine sensitivity verify that written consent has been obtained withhold food in oral fluids before the procedure

The nurse should teach the client that signs of digoxin toxicity include:

visual disturbances such as seeing yellow spots

which is the most important initial post procedure nursing assessment for a client who has had a cardiac catheterization?

Observe the puncture site for swelling and bleeding.

The nurse teaches a client with heart failure to take oral furosemide in the morning. What is the expected outcome for taking this drug in the morning? The client will:

Obtain more sleep

What instructions should the nurse's discharge teaching plan for the client with heart failure include?

Obtaining daily weights at the same time each day

Which information about the dietary intake of lipids should the nurse provide a client? Select all that apply.

Phospholipids are essential to building plasma membranes. Cholesterol is a building block for estrogen and testosterone. Triglycerides are the major form of fat in the body. Cholesterol is not needed in the diet as the liver synthesizes adequate amounts from other chemicals.

The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse. and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? All options are used

Position electrodes on the chest Take vital signs Administer the prescribed dose of morphine Obtain a history of which drugs the client has used recently

Which client is at greatest risk for coronary artery disease?

A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L)

Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider?

A change in the pattern of chest pain

An older adult had a myocardial infarction (MI) 4 days ago. At 0930, the client's blood pressure is 102/64 mm Hg. After reviewing the client's progress notes (see chart), what should the nurse do first?

Notify the health care provider (HCP)

When caring for a client who has sustained a myocardial infarction (MI), the nurse notes 8 premature ventricular contractions (PVCs) in one minute on the cardiac monitor. The client is receiving an IV infusion of 5% dextrose in water (D5W) at 125 mL/h in oxygen at 2L/min. What should the nurse do first?

Notify the health care provider (PCP)