143 Module 3 - Pharm (PRACTICE QUESTIONS)

A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge? A. The patch should be worn for 12 hours and then removed for 12 hours. B. You do not need the effects of nitroglycerine while you sleep. C. The medication patch causes headaches so you should remove it daily. D. Skin irritation is common when the patch is worn for more than 12 hours.

A. A transdermal nitroglycerin patch is prescribed for the prevention of angina pectoris. Nitroglycerin transdermal patches are typically applied for 12 to 14 hours, and then removed for the same amount of time. Though it is true that common adverse effects of nitroglycerin are headaches and contact dermatitis and that there is less demand on the heart when the client rests, these are not the reasons for applying and removing the patch for the same length of time in a 24-hour period.

A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A) Atropine B) Pseudoephedrine C) Propranolol (Inderal) D) Bethanechol (Urecholine)

A. Atropine will reverse the muscarinic effectsof cholinergic crisis. Pseudoephedrine will not affect bradycardia in this patient. Propranolol (Inderal) will not affect the bradycardia. Bethanechol will increase the bradycardia.

A client is admitted to the emergency department with severe chest pain. The emergency department health care provider orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which assessment? A. Blood pressure B. Blood urea nitrogen (BUN) C. Heart rate D. Urinary output

A. Before administering IV nitroglycerin, the nurse should first assess blood pressure to make sure that the client does not have hypotension and to establish a baseline blood pressure. It is also important to assess the heart rate and urinary function (urinary output and BUN). However, in the case of administering intravenous nitroglycerin, the nurse would first assess the blood pressure.

A patient is taking cholestyramine (Questran)to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which of the following medications? A) Digoxin (Lanoxin) B) Ibuprofen (Motrin) C) Aspirin D) Acetaminophen (Tylenol)

A. Bile acid sequestrants may decreaseabsorption of digoxin (Lanoxin). Cholestyramine will not decrease the ibuprofen, aspirin, or acetaminophen.

A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take? A. Omit the dose and contact the health care provider. B. Reduce the dose and contact the health care provider. C. Omit the dose and inform the oncoming nurse at the next shift change. D. Give the dose and contact the health care provider.

A. Bradycardia is a potential adverse effect of digoxin. Nurses should assess the client's apical pulse before each dose. If the rate is lower than 60 bpm in an adult client, the nurse should omit the dose and notify the provider.

A patient is administered atropine to increase the heart rate. What is the action of atropine? A) It blocks the parasympathetic vagal stimulation. B) It exacerbates the parasympathetic vagal stimulation. C) It provides long-acting antihistamine blockage. D) It blocks cell wall synthesis of gram-negative bacilli.

A. Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is oppositethe effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.

A patient is diagnosed with erectile dysfunction. He asks what effect sildenafil (Viagra) has because he is taking nitroglycerin for chest pain. What is the bestexplanation for why nitrates are contraindicated with sildenafil (Viagra)? A) Nitroglycerin and Viagra cause a severe decrease in blood pressure. B) Nitroglycerin and Viagra can lead to prostate cancer. C) Nitroglycerin decreases the effect of Viagra for erectile dysfunction. D) Nitroglycerin and Viagra will diminish the effectiveness of chest pain relief.

A. Nitrates and phosphodiesterase enzyme type 5inhibitors decrease blood pressure, and the combined effect can produce profound, life- threatening hypotension.

A male patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important? A) Call his physician if he develops muscle pain. B) It is unacceptable to eat dietary fats. C) Decrease the dose if lethargy occurs. D) Eat two eggs per day to increase protein stores.

A. Patients should be advised to notify their health care provider if unexplained muscle pain or tenderness occurs. The patient shouldavoid saturated fats when taking statins but should not entirely eliminate fats from his diet. The patient should not decrease the doseof statins without the physician's knowledge. The patient should not increase the intake of eggs due to the increase in cholesterol.

A client with a diagnosis of heart failure is started on a beta-blocker. What is the nurse's priority role during gradual increases in the client's dose? A. Educating the client that symptom relief may not occur for several weeks B. Stressing that symptom relief may take up to 4 months to occur C. Making adjustments to each day's dose based on the blood pressure trends D. Educating the client about the potential changes in LOC that may result from the drug

ANS: A Rationale: An important nursing role during titration is educating the client about the potential worsening of symptoms during the early phase of treatment and stressing that improvement may take several weeks. Relief does not take 4 months, however. The nurse monitors blood pressure, but changes are not made based on short-term assessment results. Beta-blockers rarely affect LOC.

A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. B. Administer atropine as a continuous infusion until symptoms resolve. C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. D. Administer atropine 1.0 mg sublingually.

ANS: A Rationale: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.

A client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect? A. Reducing the heart's workload by decreasing heart rate and myocardial contraction B. Preventing platelet aggregation and subsequent thrombosis C. Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart D. Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain

ANS: A Rationale: Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. Antiplatelet and anticoagulation medications are given to prevent platelet aggregation and subsequent thrombosis, which impedes blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and, in higher doses, the arteries.

A client with heart failure has met with the primary care provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the client begins treatment, the nurse would prioritize which assessment? A. Blood pressure B. Level of consciousness (LOC) C. Nausea D. Oxygen saturation

ANS: A Rationale: Clients receiving ACE inhibitors are monitored for hypotension, hyperkalemia (increased potassium in the blood), and alterations in renal function. ACE inhibitors do not typically cause alterations in LOC. Oxygen saturation must be monitored in clients with heart failure, but this is not particular to ACE inhibitor therapy. ACE inhibitors do not normally cause nausea.

A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug? A. Ibuprofen B. Clopidogrel C. Dipyridamole D. Acetaminophen

ANS: B Rationale: Because of the risk of thrombus formation within the stent, the client receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.

A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the client about what potential adverse effects? A. Nervousness or paresthesia B. Throbbing headache or dizziness C. Drowsiness or blurred vision D. Tinnitus or diplopia

ANS: B Rationale: Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy.

A client with a history of atrial fibrillation has contacted the clinic reporting an accidental overdose on prescribed warfarin. The nurse should recognize the possible need for which antidote? A. Intravenous immunoglobulins (IVIG) B. Factor IX C. Vitamin K D. Factor VIII

ANS: C Rationale: Vitamin K is given as an antidote for warfarin toxicity. IVIG is a form of immunosuppressive therapy given to treat immune thrombocytopenic purpura and to counteract hemolytic transfusion reaction and neutralizing antibodies (inhibitors) that develop in response to factor replacement therapy in clients with hemophilia. IVIG is not used as an antidote for warfarin toxicity. Factors VIII and IX are clotting factors that are deficient in clients with hemophilia due to a genetic defect; these clients may receive recombinant forms of these factors to treat their condition.

A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin. When assessing the therapeutic response to this medication, which action by the nurse is the most appropriate? A. Assess for signs of myelosuppression. B. Review the client's platelet level. C. Assess the client's capillary refill time. D. Review the client's international normalized ratio (INR).

ANS: D Rationale: The INR and activated partial thromboplastin time serve as useful tools for evaluating a client's clotting ability and monitoring the therapeutic effectiveness of anticoagulant medications. The client's platelet level is not normally used as a short-term indicator of anticoagulation effectiveness. Assessing the client for signs of myelosuppression and assessing capillary refill time do not address the effectiveness of anticoagulants.

A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement by the client should the nurse address? A. I take aspirin to help with the pain of my arthritis. B. I take vitamin C when I feel like I'm getting a cold. C. My plan following discharge is to walk 2 miles a day. D. I drink a glass of wine with dinner some evenings.

Ans: A Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the client to stop taking aspirin. Walking, taking vitamin C, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.

A patient is admitted with thrombophlebitis and sent home on enoxaparin (Lovenox). Which statement indicates a good understanding of why enoxaparin is being administered? A) Enoxaparin inhibits the formation of additional clots. B) Enoxaparin eliminates certain clotting factors. C) Enoxaparin decreases the viscosity of blood. D) Enoxaparin will dissolve the existing clots.

Ans: A Low molecular weight heparins prevent the development of additional clots. They do not eliminate clotting factors. LMWHs do not dissolve the clot or decrease the viscosity of blood.

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering: A. Protamine sulfate B. Urokinase C. Vitamin K D. Drotrecogin alfa

Ans: A Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C-reactive protein that has anticoagulant effects.

A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors? A) Vitamin K B) Vitamin E C) Protamine sulfate D) Acetylsalicylic acid (Aspirin)

Ans: A Vitamin K is the antidote for warfarin overdose. In this case, the patient may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdose. Protamine sulfate is used as an antidote to heparin or low molecular-weight heparin. Acetylsalicylic acid (Aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

A client is receiving warfarin. The nurse would expect to administer this drug by which route? A. Intravenous B. Oral C. Intramuscular D. Subcutaneous

Ans: B

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a blood thinner like warfarin. What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? A) Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. B) Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. C) Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation. D) Antiplatelet agents have fewer adverse effects than anticoagulants.

Ans: B Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for DVT prophylaxis? A) The man is morbidly obese. B) The man has a diagnosis of ulcerative colitis. C) The man had a myocardial infarction 18 months ago. D) The man has a diagnosis of type 2 diabetes mellitus.

Ans: B GI ulcerations contraindicate the use of heparin. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 0800 dose. The results show that the aPTT is at 3.5 times the control value. What is the nurse's priority action? A. Check the client's vital signs prior to administering the dose. B. Hold the dose and call the primary health care provider. C. Give a dose larger than is prescribed to the client. D. Give the dose as prescribed and chart the results.

Ans: B The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The client's value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the primary health care provider.

A patient who has been prescribed digoxin (Lanoxin) is also taking furosemide (Lasix) 20 mg daily. Which of the following electrolyte imbalances will precipitate the development of digoxin toxicity? A) Hyperkalemia B) Hypokalemia C) Hypermagnesemia D) Hyponatremia

Ans: B. Hypokalemia will contribute to the patient developing digoxin toxicity. Hyperkalemia, hypermagnesemia, and hyponatremia will notcontribute to the development of digoxin toxicity.

A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) After a certain period of time, you must start warfarin and heparin together. B) You will need both warfarin and heparin for several days. C) Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin. D) Warfarin cannot be given without heparin due to the amount of clotting you need.

Ans: C Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statement After a certain period of time, you must start warfarin and heparin together does not explain clearly the reason for the two medications concurrently. The statement You will need both warfarin and heparin for several days does not explain clearly the reason for the two medications. The statement Warfarin cannot be given without heparin due to the amount of clotting you need is not accurate.

A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance? A. Aminocaproic acid (Amicar) B. Platelets C. Vitamin K D. Protamine sulfate

Ans: C Vitamin K is the antidote for warfarin.

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's: A. heart rate and pulse. B. sodium and potassium levels. C. blood glucose level. D. aPTT.

Ans: D Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.

A client with acute coronary syndrome is prescribed clopidogrel. Which additional medication will the nurse expect to be prescribed for this client? A. ibuprofen B. digoxin C. acetaminophen D. aspirin

Ans: D Clopidogrel is an adenosine diphosphate receptor antagonist used to prevent platelet aggregation. In acute coronary syndrome, clopidogrel is given with aspirin to prevent thrombus formation. Clopidogrel does not need to be given with digoxin, ibuprofen, or acetaminophen.

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect? A. By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa B. By inhibiting the action of vitamin K at its sites of action C. By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis D. By inactivating clotting factors and thus stopping the coagulation cascade

Ans: D Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel (Plavix). The nurse is most justified is suspecting that this man has a history of A) hemorrhagic cerebrovascular accident. B) hemophilia A. C) idiopathic thrombocytopenic purpura (ITP). D) myocardial infarction.

Ans: D Indications for use of Plavix include reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's: A. presence of skin-related disorders. B. blood glucose level. C. presence of breathing disorders. D. intake of vitamin K.

Ans: D It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin? A. Antihypertensives B. Antibiotics C. Antiarrhythmics D. NSAIDs

Ans: D NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet? A) Eggs B) Dairy products C) Apples D) Spinach

Ans: D Spinach is a green leafy vegetable that is high in vitamin K and will interact to prevent adequate levels of anticoagulant therapy. Eggs, dairy products, and apples are not contraindicated with warfarin.

A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction? A. Hypotension B. Stomach pain C. Headache D. Tarry stools

Ans: D Tarry stools would be an indication of gastrointestinal bleeds. The most common adverse effect of heparin is bleeding.

A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain? A) Joint thrombosis B) Torn medial meniscus C) Degenerative joint disease caused by her medication D) Bleeding

Ans: D The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medial meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

A patient is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse? A) Give the next two doses at the same time. B) Give the dose and chart the patient response. C) Check the patient's vital signs and give the dose. D) Hold the dose and call the aPTT result to the physician's attention.

Ans: D The normal control value is 25 to 35 seconds; therefore, therapeutic values are 45 to 70 seconds, approximately. A result of 92 seconds is a risk for bleeding, and the dose should be held until approval to administer is provided by the physician. The nurse should not give the next two doses at the same time. The nurse should not give the dose and document the patient's response. The nurse should not check the patient's vital signs and give the dose.

A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician? A) Aminocaproic acid (Amicar) B) Platelets C) Protamine sulfate D) Vitamin K

Ans: D Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

A patient is prescribed a beta blocker for hypertension. Which medication education should the nurse provide? 1. Let me know if this medication causes you to have a headache. 2. This medication's main side effect is dizziness, so be careful when you first sit up. 3. Some people get a mild skin rash for a few days after starting this therapy. 4. You should avoid eating foods high in vitamin K while on this medication.

Answer: 2 Explanation: 1. Headache is not an expected side effect of carvedilol. 2. Carvedilol is a beta-blocker medication used to treat heart failure and hypertension. The main side effect is dizziness. 3. Skin rash is not an expected adverse effect of this medication. 4. There is no reason to avoid foods high in vitamin K when taking Carvedilol.

A patient presents to the emergency department and says, I am so dizzy that it is scaring me. Monitoring reveals the patient's blood pressure is 78/52 mmHg and heart rate is 44 beats per minutes. Which nursing intervention is indicated? 1. Administer antianxiety medication. 2. Administer atropine. 3. Instruct the patient to cough forcefully. 4. Monitor the patient while contacting the primary care provider.

Answer: 2 Explanation: 1. The patient's anxiety is likely due to fear of the unknown. Antianxiety medication is not indicated. 2. Sinus bradycardia is not treated unless the person experiences symptoms of decreased cardiac output, such as syncope, hypotension, and angina. Symptomatic sinus bradycardia is treated by administering atropine because it blocks the parasympathetic innervation to the sinoatrial (SA) node, allowing normal sympathetic innervation to gain control and increase SA node firing. The patient is symptomatic so atropine is indicated. 3. Forceful coughing will not reverse this patient's symptoms. 4. The patient requires intervention.

A patient is admitted for a severe headache and is found to have a blood pressure of 185/115 mm Hg. The nurse would prepare to manage administration of which drug most likely to be prescribed? 1. Clonodine 2. Oral furosemide 3. Nitroprusside 4. Captopril

Answer: 3 Explanation: 1. Clonodine would be used for hypertensive urgency. This situation represents hypertensive emergency. 2. IV furosemide would be used for this patient who is experiencing hypertensive emergency. Oral furosemide is given for hypertensive urgency. 3. Nitroprusside is an IV medication that can be titrated and is used for hypertensive emergency. 4. Captopril is an oral agent used for hypertensive urgency. This patient is experiencing hypertensive emergency.

A patient with heart failure tells the nurse that she is allergic to angiotensin-converting enzyme (ACE) inhibitors because they make her cough all of the time. What does this information suggest to the nurse? 1. The patient should not take an angiotensin receptor blocker because of the ACE inhibitor allergy. 2. The patient's asthma has been exacerbated by the use of ACE inhibitors. 3. The patient experienced a side effect of the ACE inhibitor, which is a cough. 4. The patient's cough is due to long-standing heart failure.

Answer: 3 Explanation: 1. Patients who cannot tolerate ACE inhibitors often are prescribed angiotensin receptor blockers since they do not cause the side effect of a cough. 2. There is no evidence to suggest that this cough is related to asthma. 3. Cough is a side effect of ACE inhibitors, not an allergy. Coughing is the result of the release of kinins that cause coughing with prolonged therapy. 4. This cough is not likely to be due to heart failure.

A male patient has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin.What is a potential disadvantage of statins that the care provider should consider? Select all that apply. A) Statins are nephrotoxic. B) Statins are expensive. C) Statins are contraindicated in patients with a history of myocardial infarction. D) Statins require regularly scheduled blood work. E) Statins have an immunosuppressive effect.

B, D. Because liver enzymes may be elevated during atorvastatin use, patients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MIis an indication for their use, not a contraindication.

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A. Digoxin B. Metoprolol C. Nitroprusside D. Furosemide

B. A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as metoprolol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.

A patient is prescribed lisinopril. What adverse effect should the patient be instructed on that can occur with angiotensin- converting enzyme (ACE) inhibitors? A) Sedation B) Persistent cough C) Tachycardia D) Rash

B. A persistent cough can develop with the use of ACE inhibitors. Sedation, tachycardia, and rash are not noted with ACE Inhibitors.

A patient is admitted to the emergency department with chest pain that is unrelievedwith sublingual organic nitrates. What medication will most likely be administered? A) Intravenous morphine sulfate B) Intravenous nitroglycerin C) Oral nonsteroidal anti-inflammatory agents D) Duragesic topical patch

B. Intravenous nitroglycerin is used to manage angina that is unresponsive to organic nitratesvia other routes. The use of intravenous morphine sulfate will decrease pain but will not increase blood flow. Oral nonsteroidal anti-inflammatory agents will not assist in decreasing pain or increasing blood flow. Theapplication of a Duragesic patch will not increase blood flow.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A. Nitroglycerine causes headaches, but removing the patch decreases the incidence. B. Removing the patch at night prevents drug tolerance while keeping the benefits. C. Contact dermatitis and skin irritations are common when the patch remains on all day. D. You do not need the effects of nitroglycerine while you sleep.

B. Tolerance to antianginal effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerin are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while the client rests, there is less demand on the heart but not the primary reason for removing the patch.

A nurse is giving discharge instructions to a client receiving nitroglycerin for angina. The nurse recognizes the client needs additional information when the client makes what statement? A. I will keep my medication in the original container. B. I will take a pill every 15 minutes until the pain subsides. C. I may get a headache after I take this medication. D. Before I take my medication, I will lie down.

B. When experiencing angina, the client may take one pill every five minutes times three doses. Nitroglycerin needs to be stored in its original dark container and may cause a headache. It is important the client lie down prior to taking nitroglycerin because it may cause hypotension.

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A. Diltiazem B. Metoprolol C. Clopidogrel D. Isosorbide mononitrate

C. Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.

A patient who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low- densitylipoprotein remains elevated. What medication will be added to the medication regimen? A) Digoxin (Lanoxin) B) Vitamin D C) Cholestyramine (Questran) D) Calcium carbonate

C. Cholestyramine is administered to patients toreduce LDL cholesterol in patients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D isnot given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.

A patient is diagnosed with acute supraventricular tachycardia, and a critical care nurse is contributing to his plan of care.Which of the following class IV calcium channel blockers is exclusively administered to treat acute supraventricular tachycardia? A) Bethanechol chloride (Urecholine) B) Chlorambucil (Leukeran) C) Diltiazem (Cardizem) D) Midazolam hydrochloride

C. Diltiazem is administered intravenously totreat acute supraventricular tachycardia. Bethanechol is used to treat neurogenic bladder. Chlorambucil (Leukeran) is an antineoplastic agent used to treat chronic lymphocytic leukemia. Midazolam hydrochloride is administered to reduce anxiety.

A nurse is caring for a client with left-sided heart failure. What should the nurse anticipate using to reduce fluid volume excess? A. oxygen. B. antiembolism stockings. C. diuretics. D. anticoagulants.

C. Diuretics, such as furosemide, reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venous stasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess.

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? A. Amiodarone B. Lidocaine C. Atropine D. Dobutamine

C. I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation.

A patient is taking warfarin (Coumadin) toprevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored? A) RBC B) aPTT C) PT and INR D) Platelet count

C. The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count isnot indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? A. The medication helps the kidneys produce more urine. B. The medication increases the heart rate. C. The medication causes the kidneys to retain fluid and increase intravascular volume. D. The medication increases the force of the myocardial contraction.

D. A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine.

A patient started taking lisinopril earlier in the week for the treatment of hypertension. At herlatest clinic visit, she has stated that she now has a nagging, dry cough. How should the nurse best follow up the patient's statement? A) Inform the patient that the drug should be immediately discontinued. B) Inform the patient that this is an adverse effect of the medication that may lead to pneumonitis. C) Explain why it will be necessary to obtain a sputum sample. D) Explain that drugs like ramipril often cause a cough.

D. ACE inhibitors may precipitate a cough and may necessitate discontinuation of the drug. This is not, however, an emergency or an indication of lung infection or lung inflammation.

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? A. pentoxifylline or acetaminophen. B. penicillin V or erythromycin. C. aspirin or acetaminophen. D. aspirin or clopidogrel.

D. After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? A. IV nitroglycerin B. Amlodipine C. Atenolol D. IV morphine

D. IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.

A patient with a diagnosis of cardiovascular disease is taking atorvastatin calcium (Lipitor)to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a patient taking atorvastatin calcium (Lipitor)? A) 100 to 115 mg/dL B) 75 to 85 mg/dL C) Less than 60 mg/dL D) Less than 100 mg/dL

D. In patients with a diagnosis of cardiovasculardisease, the goal of therapy is an LDL below 100 mg/dL.

A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. Theman is currently taking clopidogrel (Plavix). The nurse is most justified is suspecting that this man has a history of A) hemorrhagic cerebrovascular accident. B) hemophilia A. C) idiopathic thrombocytopenic purpura (ITP). D) myocardial infarction.

D. Indications for use of Plavix include reductionof myocardial infarction, stroke, and vascular death in patients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

A patient is admitted to the emergency room with a ventricular dysrhythmia associated with an acute myocardial infarction. The physician has ordered a bolus of lidocaine IV.What assessment should the nurse make prior to administering this medication? A) Assess for lidocaine administration in the patient's history. B) Determine the patient's ability to swallow. C) Assess the patient's nutritional history for allergies. D) Determine if the patient has had a reaction to local anesthesia.

D. Lidocaine is contraindicated in patients allergic to local anesthetic agents. It is important to determine if the patient has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the patient's ability to swallow. However, swallowing can be impaired after administration and should be assessed. It is not necessary to do a nutritional assessment at this time.

A 52-year-old client who experienced a myocardial infarction has an order for discharge. Part of the discharge teaching includes prior administration of nitroglycerin for chest pain. Which statement by the client indicates understanding of the teaching provided? A. I will take three tables every 5 minutes until the chest pain subsides. B. I will take one tablet and lay down for an hour. C. I will take two nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health care provider. D. I will take three nitroglycerin tablets 5 minutes apart, and if I do not have any relief I will seek emergency care immediately.

D. The client with stable or unstable angina will be prescribed sublingual nitroglycerin to relieve chest pain symptoms. The client may take up to three tablets of sublingual nitroglycerin 5 minutes apart. If the chest pain is unrelieved, the client needs to seek emergency medical care immediately.

A nurse is caring for a client who experienced an MI. The client is ordered to receive metoprolol. The nurse understands that this medication has which therapeutic effect? A. Decreases platelet aggregation B. Increases cardiac output C. Decreases cholesterol level D. Decreases resting heart rate

D. The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.

A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What isthe patient at risk for developing with this combination of medications? A) Hyperkalemia B) Hyperglycemia C) Tachycardia D) Digoxin toxicity

D. When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The patient is at risk for hypokalemia, not hyperkalemia. The patient isnot at a particular risk for hyperglycemia or tachycardia.

A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored? A) RBC B) aPTT C) PT and INR D) Platelet count

The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) A. Treatment chronic stable angina pectoris. B. Relieve the pain of acute anginal attacks. C. Prevent angina attacks. D. Increase high-density lipoproteins (HDL). E. Decrease serum triglyceride.

A, B, C. Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.

A nurse is preparing to administer a prescribed nitrate to a client with angina. The nurse understands that nitrates are available in which dosage forms? Select all that apply. A. Sublingual B. Parenteral C. Rectal D. Transdermal

A, B, D. Nitrates are available in the following dosage forms: sublingual, translingual spray, transdermal, and parenteral. Respiratory medications such as bronchodilators and corticosteroids are given in inhalation form. Suppositories to reduce fever and relieve constipation are given rectally.

After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? A. Decreased cardiac output and decreased systolic and diastolic blood pressure B. Decreased peripheral vascular resistance C. Decreased blood pressure with reflex tachycardia D. Increased cardiac output and increased systolic and diastolic blood pressure

A. As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia? A. Atropine B. Nitroglycerin C. Nesiritide D. Nifedipine

A. Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity.

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A. To decrease workload of the heart B. To decrease homocysteine levels C. To prevent angiotensin II conversion D. To dilate coronary arteries

A. Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? A. Decreases the sinoatrial node automaticity B. Increases the atrioventricular node conduction C. Increases the heart rate D. Creates a positive inotropic effect

A. Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

A patient has begun taking cholestyramine. Which of the following are noted as the most common adverse effects? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Fatigue and mental disorientation D) Hiccups, nasal congestion, and dizziness

A. Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness,flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem.

The nurse would avoid administering nitrates to clients using which medication? A. Sildenafil B. Simvastatin C. Lisinopril D. Albuterol

A. Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs.

Which single drug class is known to be mosteffective in reducing the major types of dyslipidemia? A) Statins B) Bile acid sequestrants C) Fibrates D) Niacin

A. For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, afibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

A 59-year-old male patient has a long history of heavy alcohol use and was diagnosed with liver cirrhosis several months earlier. The patient's medical history includes numerous other health problems, including angina. When considering the use of nifedipine in the management of this patient's angina, what consideration should the nurse be aware of? A) The patient is likely to experience an increased effect of the medication. B) This patient will require a higher dose C) Nifedipine is contraindicated because it is highly hepatotoxic. D) The patient's increased albumin levels will negate the therapeutic effect.

A. In patients with cirrhosis, bioavailability of oral drugs is greatly increased and metabolism (of both oral and parenteral drugs) is greatly decreased. Both of these effects increase plasma levels of drug from a given dose (essentially an overdose).

A 59-year-old man with a history of coronary artery disease is undergoing cardiac catheterization. The procedure has been proceeding as planned, but the patient suddenly begins exhibiting ventricular tachycardia. What drug should the nurse most likely prepare for administration? A) Lidocaine B) Magnesium sulfate C) Digoxin D) Epinephrine

A. Lidocaine is the drug of choice for treating serious ventricular dysrhythmias associated with acute myocardial infarction, cardiac catheterization, cardiac surgery, and digitalis-induced ventricular dysrhythmias. Digoxin, MgSO4 , and epinephrine are not used in this clinical situation.

A patient is admitted with thrombophlebitis and sent home on enoxaparin (Lovenox). Which statement indicates a good understanding of why enoxaparin is being administered? A) Enoxaparin inhibits the formation of additional clots. B) Enoxaparin eliminates certain clotting factors. C) Enoxaparin decreases the viscosity of blood. D) Enoxaparin will dissolve the existing clots.

A. Low molecular weight heparins prevent the development of additional clots. They do noteliminate clotting factors. LMWHs do not dissolve the clot or decrease the viscosity of blood.

amiodarone (Cordarone) is normally reserved for use in patients with life-threatening dysrhythmias. In some cases, however, low- dose amiodarone may be used to prevent recurrence of A) atrial fibrillation. B) angina pectoris. C) ventricular hypertrophy. D) mitral valve regurgitation.

A. Low-dose amiodarone may be a pharmacologic choice for preventing recurrent atrial fibrillation after electrical or pharmacologic conversion. Potassium channelblockers are not used to prevent valvular disorders, ventricular hypertrophy, or angina.

After teaching a client about a prescribed beta blocker therapy, the nurse determines that additional teaching is needed when the client relays which statement? A. I can stop the drug anytime I feel any problems. B. I need to get up slowly from the bed or a chair. C. I should learn how to check my blood pressure. D. I should notify my doctor if I have trouble breathing.

A. More teaching is needed when the client states that they can stop the drug at any time. Most of these drugs require that the dosage be gradually decreased to prevent precipitation or worsening of adverse effects. Getting up slowly from the bed or a chair minimizes the risk for orthostatic hypotension. Trouble breathing may suggest developing heart failure and needs to be reported. Learning how to check one's blood pressure is helpful in monitoring the effectiveness of the drug.

When prescribed for angina, how does oral nifedipine achieve a therapeutic effect? A. inhibiting the influx of calcium through slow channels. B. binding extracellular sodium ions with chloride ions C. potentiating the effect of B-type natriuretic peptide D. preventing the outflow of intracellular potassium

A. Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. None of the other options accurately describes the action of nifedipine.

Clients who are taking nifedipine should be monitored for which of the following adverse effects? A. Peripheral edema B. Asthma C. Hyperkalemia D. Tetany

A. Nifedipine is a calcium channel blocker. Of the four choices offered, only peripheral edema is an adverse effect of this drug class.

A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent plateletaggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A) 80 mg B) 180 mg C) 325 mg D) 650 mg

A. The dose of aspirin given depends mainly onthe condition being treated. Low doses (325 mg initially and 80 mg daily) are used for thedrug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? A. The registered nurse administering atropine sulfate intravenously B. The registered nurse stating to administer all medications except those which are cardiotonics C. The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute D. The registered nurse stating to administer digoxin

A. The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? A. Count the respiratory rate for bradypnea. B. Measure urinary output for dehydration. C. Measure the blood pressure for hypertension. D. Check the radial pulse for dysrhythmias.

A. The nurse should always check the respiratory rate prior to administering morphine sulfate. The drug should be withheld, and the health care provider notified, if the respiratory rate is below 16 breaths/minute.

A nurse is assessing a client with angina who has received diltiazem. Which finding should the nurse prioritize and notify the health care provider for further instructions? A. Pulse rate is 45 beats per minute B. Significant weight loss C. Systolic pressure is 110 mm Hg D. Lightheadedness

A. The nurse should withhold the drug and notify the health care provider when the client's pulse rate is 45 beats per minute. When calcium channel blockers are administered, there may be a fall in the pulse rate. When the pulse rate falls below 50 beats per minute, the nurse should notify the health care provider. When the systolic pressure falls below 90 mm Hg, the nurse should notify the primary health care provider. Weight gain, and not weight loss, occurs with the use of calcium channel blockers. The nurse should report weight gain. Lightheadedness is a common central nervous system adverse reaction occurring after taking the drug, and the nurse should instruct the client to lie down until the symptoms pass.

The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? A. Administer the third sublingual nitroglycerin tablet. B. Hold any further treatment until the client's blood pressure increases. C. Wait ten minutes after the second tablet to assess pain. D. Notify the health care provider of the chest pain.

A. The nurse will need to administer the third sublingual nitroglycerin tablet. Nitroglycerin is given as three doses for chest pain as the client's blood pressure can tolerate it. The health care provider will be notified after three tablets. The nurse should not hold any further treatment if the client has chest pain. The dosing of nitroglycerin is a five-minute wait.

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? A. Hypotension B. Urinary incontinence C. Hyperactive bowel sounds D. Hypertension

A. The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.

A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will beadministered to assist in the development of clotting factors? A) Vitamin K B) Vitamin E C) Protamine sulfate D) Acetylsalicylic acid (Aspirin)

A. Vitamin K is the antidote for warfarin overdosage. In this case, the patient may be atthe therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low molecular-weight heparin. Acetylsalicylic acid (Aspirin) is usedto decrease coagulation as a preventive measure for myocardial infarction.

A patient is experiencing chest pain and administers her nitroglycerin sublingually. When should the patient expect to notice relief of her chest pain? A) 1 to 3 minutes B) 5 to 10 minutes C) 15 to 20 minutes D) 30 to 60 minutes

A. When given sublingually, nitroglycerin is absorbed directly into the systemic circulationand acts within 1 to 3 minutes. If the medication has not produced an effect in 5 minutes, it should be repeated. The nitroglycerin tablets have an onset of action of 1 to 3 minutes, not 5 to 60 minutes.

The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. The nurse should anticipate the administration of what medication? A. Epinephrine 1 mg IV push B. Lidocaine 100 mg IV push C. Amiodarone 300 mg IV push D. Sodium bicarbonate 1 amp IV push

ANS: A Rationale: Epinephrine should be given as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists.

The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. Which medication would the nurse anticipate administering to this client? A. A beta-adrenergic blocker B. An antiplatelet aggregator C. A calcium channel blocker D. A nonsteroidal anti-inflammatory drug (NSAID)

ANS: A Rationale: Several medications are routinely prescribed for systolic heart failure, including ACE inhibitors, beta-blockers, diuretics, and digitalis. Calcium channel blockers, antiplatelet aggregators, and NSAIDs are not commonly prescribed.

The nurse is caring for an adult client with heart failure who is prescribed digoxin. When assessing the client for adverse effects, the nurse should assess for which of the following signs and symptoms? Select all that apply. A. Confusion B. Shortness of breath C. Numbness and tingling in the extremities D. Chest pain E. Bradycardia F. Diuresis

ANS: A, E Rationale: A key concern associated with digitalis therapy is digitalis toxicity. Symptoms include anorexia, nausea, visual disturbances, confusion, and bradycardia. The other listed signs and symptoms are not characteristic of digitalis toxicity.

The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why they have to take an aspirin every day if they don't have any pain. Which rationale for this intervention would be the best? A. To help restore the normal function of the heart B. To help prevent blockages that can cause chest pain or heart attacks C. To help the blood penetrate the heart more freely D. To help the blood carry more oxygen than it would otherwise

ANS: B Rationale: An aspirin a day is a common nonprescription medication that improves outcomes in clients with coronary artery disease due to its antiplatelet action, which helps to prevent clots that can lead to chest pain or heart attacks. It does not affect oxygen-carrying capacity or perfusion. Aspirin does not restore cardiac function.

The nurse is caring for a client who is scheduled to undergo mechanical valve replacement. Client education would include coverage of which intervention? A. Use of client-controlled analgesia B. Long-term anticoagulant therapy C. Steroid therapy D. Use of IV diuretics

ANS: B Rationale: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and client-controlled analgesia may or may be not be used in the immediate postoperative period.

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which item should the nurse integrate into the management of this client's hypertension? A. Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. B. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

ANS: B Rationale: Older adults have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more, antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.

The nurse is educating an 80-year-old client diagnosed with heart failure about the medication regimen. Which instruction would the nurse give this client about the use of oral diuretics? A. Avoid drinking fluids for 2 hours after taking the diuretic. B. Take the diuretic in the morning to avoid interfering with sleep. C. Avoid taking the medication within 2 hours consuming dairy products. D. Take the diuretic only on days when experiencing shortness of breath.

ANS: B Rationale: Oral diuretics should be given early in the morning so that diuresis does not interfere with the client's nighttime rest. Discussing the timing of medication administration is especially important for older adult clients who may have urinary urgency or incontinence. The nurse would not teach the client about the timing of fluid intake. Fluid intake does not need to be adjusted and dairy products are not contraindicated.

An adult client is admitted to the ED with chest pain. The client states that there was unrelieved chest pain for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? A. Thrombolytics (fibrinolytics), oxygen administration, and nonsteroidal anti-inflammatories B. Morphine sulphate, oxygen, and bed rest C. Oxygen and beta-adrenergic blockers D. Bed rest, albuterol nebulizer treatments, and oxygen

ANS: B Rationale: The client with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.

The nurse is caring for an adult client whom the nurse suspects has digoxin toxicity. In addition to physical assessment, the nurse should monitor what assessment information? A. Skin turgor B. Potassium level C. White blood cell count D. Peripheral pulses

ANS: B Rationale: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. Skin turgor, white cell levels, and peripheral pulses are not normally affected in cases of digitalis toxicity.

The nurse is caring for a client with systolic heart failure whose previous adverse reactions rule out the safe use of angiotensin-converting enzyme (ACE) inhibitors. The nurse should anticipate that the prescriber may choose which combination of drugs? A. Loop diuretic and antiplatelet aggregator B. Loop diuretic and calcium channel blocker C. Combination of hydralazine and isosorbide dinitrate D. Combination of digoxin and normal saline

ANS: C Rationale: A combination of hydralazine and isosorbide dinitrate may be an alternative for clients who cannot take ACE inhibitors. Antiplatelet aggregators, calcium channel blockers, and normal saline are not typically prescribed.

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. Which topic should the nurse include in health education? A. Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B. Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C. Use of strategies to prevent falls stemming from orthostatic hypotension D. Limiting exercise to avoid injury that can be caused by increased intracranial pressure

ANS: C Rationale: Older adults have impaired cardiovascular reflexes and are more sensitive to orthostatic hypotension. The nurse teaches clients to change positions slowly when moving from lying or sitting positions to a standing position and counsels older clients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, are strongly recommended. Increasing fluids in older clients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk, and activity should not normally be limited.

The nurse is reviewing the medication administration record of a client who possesses numerous risk factors for stroke. Which of the client's medications carries the greatest potential for reducing her risk of stroke? A. Naproxen 250 PO b.i.d. B. Calcium carbonate 1,000 mg PO b.i.d. C. Aspirin 81 mg PO o.d. D. Lorazepam 1 mg SL b.i.d. PRN

ANS: C Rationale: Research findings suggest that low-dose aspirin may lower the risk of stroke in clients who are at risk. Naproxen, lorazepam, and calcium supplements do not have this effect.

The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels? A. Partial thromboplastin time (PTT) within normal reference range B. Prothrombin time (PT) 8 to 10 times the control C. International normalized ratio (INR) between 2 and 3 D. Hematocrit of 32%

ANS: C Rationale: The INR is most often used to determine whether warfarin is at a therapeutic level; an INR of 2 to 3 is considered therapeutic. Warfarin is also considered to be at therapeutic levels when the client's PT is 1.5 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, whereas lower values indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. Hematocrit does not provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage.

The ED nurse is caring for a client with a suspected MI. What drug should the nurse anticipate administering to this client? A. Oxycodone B. Warfarin C. Morphine D. Acetaminophen

ANS: C Rationale: The client with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-blocker, and other medications as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.

An older adult client with heart failure is being discharged home on an ACE inhibitor and a loop diuretic. The client's most recent vital signs prior to discharge include oxygen saturation of 93% on room air, heart rate of 81 beats per minute, and blood pressure of 94/59 mm Hg. When planning this client's subsequent care, what nursing concern should be identified? A. Altered tissue perfusion risk related to arrhythmia B. Excess fluid volume risk related to medication regimen C. Altered breathing pattern risk related to hypoxia D. Falls risk related to hypotension

ANS: D Rationale: The combination of low BP, diuretic use, and ACE inhibitor use constitutes a risk for falls. There is no evidence, or heightened risk, of dysrhythmia. The client's medications create a risk for fluid deficit, not fluid excess. Hypoxia is a risk for all clients with heart failure, but this is not in evidence for this client at this time.

The client is learning to self-administer heparin daily. The home care nurse draws blood every 2 to 3 days to monitor the client's platelet levels. What platelet count would the nurse report to the health care provider as a critical laboratory result? A. 90,000 B. 150,000 C. 160,000 D. 400,000

Ans: A Daily visits by a home care nurse may be needed if the client or a family member is unable or unwilling to inject the medication. Platelet counts should be obtained before therapy and every 2 to 3 days during heparin therapy. Heparin should be discontinued if the platelet count falls to less than 100,000 or to less than half the baseline value.

Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy? A. A 45-year-old corporate executive with peptic ulcer disease B. A 62-year-old with a history of prior cerebrovascular accident 5 years ago C. A 31-year-old with a history of DIC D. A 25-year-old with a history of hypertension

Ans: A Heparin is also contraindicated in clients with thrombocytopenia, bleeding disorders, and active bleeding other than DIC. This drug should be used with caution in clients with the potential for hemorrhage (e.g., immediately after surgery, with peptic ulcer disease, and with liver disease).

DELETE To monitor possible intermittent claudication, the nurse will assess for a thrombus lodging in what specific location? A. the legs B. the brain C. the lungs D. the heart

Ans: A In peripheral arteries, a thrombus in peripheral circulation may cause intermittent claudication (pain in the legs with exercise) or acute occlusion. Assessment would focus on the legs, rather than any of the other presented options.

A stable daily dose of warfarin is reached when which parameter is achieved? A. The PTT is within the therapeutic range. B. The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding. C. The INR is between 1 and 2, and the dose does not cause bleeding. D. The INR is between 4 and 5.

Ans: B When warfarin is started, PT and INR should be assessed daily until a stable daily dose is reached (the dose that maintains PT and INR within therapeutic ranges and does not cause bleeding).

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital? A. cilostazol B. vitamin K C. heparin D. clopidogrel

Ans: C Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

The nurse is caring for a client who is going home on warfarin. What laboratory test will the nurse inform the client will be used to evaluate therapeutic effects of the drug? A. prothrombin time (PT) and activated partial thromboplastin time (APTT) B. activated partial thromboplastin time (APTT) C. prothrombin time (PT) and international normalized ratio (INR) D. platelet levels

Ans: C PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT are 1.3 to 1.5 times the control value, and the ratio of PT to INR is 2 to 3.5. The other tests do not evaluate the therapeutic effects of warfarin.

The black box warning associated with warfarin concerns its risk of causing what condition? A. DIC B. Severe coagulopathy C. Major or fatal bleeding D. Hypotension

Ans: C The FDA has issued a black box warning for warfarin due to its risk of causing major or fatal bleeding.

The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect? A. Regulate PT, INR B. Increase coagulation C. Regulate PTT D. Prevent extension of clots already present

Ans: D Anticoagulant drugs are given to prevent formation of new clots and extension of clots already present.

The primary health care provider orders a 300-mg dose of clopidogrel for a client. The client then is to receive 75 mg/day. The nurse interprets the 300-mg dose to be which type of dose? A. Initial dose for treatment of stroke B. Maintenance dose C. Dose for treating myocardial infarction D. Loading dose

Ans: D Clopidogrel 300 mg should only be administered as a single loading dose. Maintenance dose is medication taken on schedule to maintain a level or effect. Thrombolytic drugs are used to treat myocardial infarction and stroke caused by clot formation.

The nurse explains to a client that angina can be caused by a thrombus forming in which anatomical location? A. the lungs B. the brain C. the legs D. the heart

Ans: D In coronary arteries, a thrombus may precipitate myocardial ischemia (angina or infarction). Assessment would focus on the coronary system, rather than any of the other presented options.

The nurse administers warfarin to a client. Which expected effect should the drug have on the body? A. increase in production of prothrombin B. increase in production of vitamin K-dependent factors in the liver C. increase in production of procoagulation factors D. decrease in production of vitamin K-dependent clotting factors

Ans: D Warfarin, an oral anticoagulant drug, causes a decrease in the production of vitamin K-dependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the client is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin K-dependent factors in the liver, or procoagulation factors.

It is determined that a patient has poor cardiac contractility. The nurse would anticipate administering which type of drugs to improve contractility? Select all that apply. 1. Cardiac glycosides 2. Loop diuretics 3. Sympathomimetic agents 4. Phosphodiesterase inhibitors 5. Angiotension-converting enzyme (ACE) inhibitors

Answer: 1, 3, 4 Explanation: 1. Cardiac glycosides such as digoxin are positive inotropes and improve cardiac contractility. 2. Diuretics are given to decrease the workload on the heart by decreasing fluid overload. They are not given to specifically improve cardiac contractility. 3. Dopamine and dobutamine are sympathomimetic agents given to improve cardiac contractility. 4. Phosphodiesterase inhibitors such as inamrinone and milrinone improve cardiac contractility. 5. ACE inhibitors affect afterload and preload, but do not directly affect myocardial contractility.

The nurse is providing medication education for a patient who has been prescribed atorvastatin (Lipitor). Which information should be included? 1. This is one of the few medications that will not need to be monitored with periodic blood tests. 2. Contact your physician if you develop muscle pain. 3. It will take about 6 months before this medication will improve your low-density lipoprotein level. 4. This medication helps your kidneys eliminate LDL, the less desirable kind of cholesterol.

Answer: 2 Explanation: 1. Liver function tests should be monitored when taking this medication at weeks 6 and 12 and periodically thereafter, especially when the dose is changed. 2. Lipitor is a medication that works on the low-density lipoprotein receptors in the liver. Major side effects include muscle pain. The patient should be instructed to contact the physician if muscle pain occurs. 3. This medication will lower lipid levels within 2 to 4 weeks. 4. Lipitor is a medication that increases the low-density lipoprotein receptors in the liver. The LDL from the blood is brought into liver cells where it is further broken down.

A patient is being treated in the hospital for a femoral fracture and is scheduled to receive his daily dose of metoprolol (Lopressor) that he has been taking for the treatment of hypertension for several years. Prior to administering this drug, the nurse should assess and document which of the following?Select all that apply. A) Oxygen saturation level B) Heart rate C) Potassium level D) Blood pressure E) Capillary refill

B, D. Beta-blockers reduce heart rate and blood pressure; both parameters should be assessedprior to administration. Beta- blockers do not significantly affect potassium levels, oxygen levels, or peripheral circulation.

The nurse is teaching a client with heart failure about digoxin. What statements by the client indicate the teaching is effective? Select all that apply. A. Digoxin therapy requires monthly drug levels. B. If I take my digoxin I should have limited episodes of shortness of breath. C. The digoxin will increase my appetite, so I should weight myself daily. D. I will watch my urine output to be sure that the medication is not affecting my kidneys. E. The medication will increase my heart rate and my blood pressure.

B, D. Digoxin is excreted by the kidneys and causes renal failure, so the client should monitor urine output. Digoxin therapy will increase ventricular output, so it can be effective in decreasing heart failure symptoms like shortness of breath. Digoxin toxicity may can anorexia, not increased appetite. Digoxin therapy will slow AV conduction, not increase heart rate or blood pressure. A client taking digoxin therapy will have levels drawn if symptoms of toxicity or renal function changes are present.

A nurse has administered a scheduled dose of50-mg atenolol PO for the treatment of angina. Following administration, the nurse should prioritize what assessment? A) Level of consciousness B) Blood pressure C) SaO2 D) Oral temperature

B. Atenolol and other beta-blockers have an antihypertensive effect. They are unlikely to affect temperature, LOC, or oxygen saturation levels.

A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for thetreatment of unstable angina. When performing health education to promote adherence to his medication regimen, the nurse should emphasize which of the following? A) The fact that the patient will likely need medications until he no longer experiences the signs of angina B) The fact that the patient should take his medications as ordered even if he feels well in the short term C) The fact that inconsistent medication use will likely cause the onset of hypertension D) The fact that he should gauge his day's dose based on how he feels that morning

B. Being asymptomatic may contribute to nonadherence to a medication regimen. Manypatients begin to feel better with the initiationof therapy and then discontinue medications altogether or miss individual doses. Patients and their families should be educated about adherence to medication regimens and taught to not skip doses, even if they feel well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hypertension.

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart? A. Increase the heart rate B. Decrease the heart rate C. Constrict the heart D. Prevent normal sinus rhythm

B. Beta blockers decrease (not increase) heart rate and dilate blood vessels (not the heart itself). Beta blockers do not prevent normal sinus rhythm.

Ms. Quinn is admitted to the surgical intensive care unit after open heart surgery. The health care provider prescribes IV nitroglycerin, according to a hospital protocol for titration of the drug. Which factor would be most important when determining increases or decreases in the dose? A. Susceptibility of the client to intracranial pressure B. Current blood pressure C. Current respiratory rate D. Susceptibility of the client to renal insufficiency

B. For a client receiving IV nitroglycerin, the nurse must monitor the blood pressure and presence of continued chest pain while the IV therapy continues. If chest pain continues, the IV dose can be increased; however, due to the vasodilation effects of the drug, if the blood pressure drops below a certain point, the dose cannot be further increased. It is important to assess for alcohol intoxication if giving high doses for a prolonged period. A client's susceptibility to renal insufficiency and intracranial pressure is not likely to be affected by the IV therapy and therefore need not be monitored closely. The GI tract is also not likely to be affected by the IV therapy.

A patient with a history of heart failure is beign treated with digoxin. The nurse knows that this medication increases the foorce of contractions of the heart. What effect improves the contractiliy of the heaert? A) Positive chronotropic effect B) Positiive inotrropic effect C) Negative innotropic effect D) Negative dromotropic effect

B. In heart failurer, digoxin exerts cardiotonic or positive inotropic effect that improves the contracility and pumping ability of the heart. A positive chronnotropic effect accelerates the rate of the heaert, which is not recommended in a patient with heart failure. eA negative inotropic effect accelerates the heart, which is not recommended in a patient with heart failure. A negative dromotropic effect changes the conductivity of muscle fiiber, increasing heart rate.

A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine? A) Pallor B) Flushing C) Edema D) Incontinence

B. Large doses of atropine cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are notcaused by dilation of blood vessels in the neck.

A medical nurse has administered an oral doseof 30 mg nifedipine long-acting to a patient with a diagnosis of angina. What principle should guide the nurse's follow-up assessment after administering this drug? A) Nifedipine has the potential to induce prodysrhythmic effects. B) Nifedipine does not affect heart rate, so assessment after administration is not normally necessary. C) The patient's heart rate will be at its lowest approximately 45 minutes to 1 hour after oral administration of nifedipine. D) The patient's blood pressure, heart rate, and oxygen saturation level should be assessed 30 minutes after administration of nifedipine.

B. Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. However, the drug hasa minimal effect on the sinoatrial and atrioventricular nodes. Therefore, it does not affect the heart rate.

After teaching a group of nursing students about antianginal drugs, the instructor determines that the teaching was successful when the students correctly choose which drugs as a calcium channel blocker? A. Hydralazine B. Nifedipine C. Isosorbide D. Minoxidil

B. Nifedipine is a calcium channel blocker used to treat angina. Minoxidil and hydralazine are peripheral vasodilators. Isosorbide is a nitrate.

A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, They did not work all that well. The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? A. Ativan 1 mg orally B. Nitroglycerin SL C. Chest x-ray D. Serum electrolytes

B. Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired, and the nurse should anticipate administering nitroglycerin to assess whether the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the client's chest pain.

A patient has experienced the formation of clots and has bruising. It is determined that there is a depletion of the patient's coagulation factors and widespread bleeding.Which of the following medications will be administered? A) Aminocaproic acid (Amicar) B) Heparin C) Warfarin (Coumadin) D) Protamine sulfate

B. The development of clots and widespread bleeding is indicative of disseminated intravascular coagulation. The patient should be administered heparin to slow the formationof clots. The goal of heparin therapy in DIC isto prevent blood coagulation long enough for clotting factors to replenish and control hemorrhage. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Warfarin is administered orally to decrease clot formation. Protamine sulfate would not be administered.

A patient is administered amiodarone (Cordarone) intravenously. Which of the following assessments should the nurse consequently prioritize? A) Assess urine output every 5 minutes. B) Assess blood pressure at least every 5 minutes. C) Assess for increased bronchovesicular lung sounds. D) Assess for muscle rigidity.

B. The nurse should assess the blood pressure every 5 minutes with the IV administration ofamiodarone and other antidysrhythmics. It is important to assess urine output, but it is not necessary to assess it every 5 minutes. Amiodarone may diminish lungs sounds, butit will not cause an increase in lung sounds. The effect of amiodarone is to decrease muscle strength, not cause rigidity.

A client arrives at the urgent care center reporting chest pain. After diagnosis, the health care provider prescribes amlodipine for the client's condition. The nurse understands that this drug is indicated for which condition? A. Cardiogenic shock B. Prinzmetal angina C. Atrioventricular (AV) block D. Sick sinus syndrome

B. The nurse should identify Prinzmetal angina as the condition for which amlodipine is indicated. Prinzmetal angina is a vasospastic angina for which calcium channel blockers are used for treatment. Cardiogenic shock, sick sinus syndrome, and AV block are the conditions for which amlodipine is contraindicated.

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A. Urine output B. Prothrombin time (PT) or international normalized ratio (INR) C. Hourly IV infusion D. Vascular sites for bleeding

B. The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.

A patient is being administered heparin IV and has been started on warfarin (Coumadin).The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) After a certain period of time, you must start warfarin and heparin together. B) You will need both warfarin and heparin for several days. C) Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin. D) Warfarin cannot be given without heparin due to the amount of clotting you need.

C. Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statementAfter a certain period of time, you must start warfarin and heparin together does not explain clearly the reason for the two medications concurrently. The statement Youwill need both warfarin and heparin for several days does not explain clearly the reason for the two medications. The statementWarfarin cannot be given without heparin due to the amount of clotting you need is not accurate.

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take? A. Assess the blood pressure B. Administer half of the dose C. Notify the health care provider D. Administer medication

C. Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the provider. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages.

Which would be considered a therapeutic effect of digoxin? A. Decreased cardiac output B. Increased heart rate C. Increased force of contraction D. Decreased renal perfusion

C. Digoxin increases the force of myocardial contraction, increases cardiac output and renal perfusion, and slows the heart rate.

A patient is beginning therapy with isosorbide dinitrate (Isordil). When will the nurse know that the patient has maximal tolerance? A) When nausea develops B) When halos are seen around lights C) When a headache develops D) When the heart rate increases to 100

C. Isosorbide dinitrate's effective dose is usually determined by increasing the dose until the patient experiences a headache, which will indicate maximum tolerable dose. The development of nausea does not indicate maximum tolerable dose. The patient should not see halos around lights with isosorbide dinitrate. The patient will not have an increase in heart rate.

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A. Isosorbide mononitrate (Isordil) B. Nitroglycerin transdermal patch C. Morphine sulfate (Morphine) D. Meperidine hydrochloride (Demerol)

C. Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? A. More blood returns to the heart. B. It increases myocardial oxygen consumption. C. Preload is reduced. D. It functions as a vasoconstrictor.

C. Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, thereby decreasing ischemia and relieving pain.

A patient with a history of angina has sustained a mild head injury in a motor vehicle accident. He has nitroglycerin tabletsfor chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerin have on the patient's current status? A) Nitroglycerin will raise the patient's blood pressure. B) Nitroglycerin will cause decreased cerebral edema. C) Nitroglycerin will increase intracranial pressure. D) Nitroglycerin will decrease blood glucose.

C. Nitroglycerin should be used cautiously in thepresence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lowerblood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose.

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? A. diltiazem B. bumetanide C. lisinopril D. cholestyramine

C. Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors such as lisinopril, beta-blockers, and diuretics such as bumetanide. Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival. Calcium channel blockers such as diltiazem are no longer recommended for patients with HF because they are associated with worsening failure. Cholestyramine is used to lower cholesterol.

A patient has an elevated BUN and creatinine.The patient has been prescribed digoxin (Lanoxin) for heart failure. What aspect of care is the priority regarding this patient? A) The patient should be taught to increase sodium in her diet. B) The dose should be increased when her heart rate is below 60. C) The dose should be decreased in this patient. D) The dosage should be 1.0 mg PO daily.

C. The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading todrug accumulation and toxicity. The patient should be taught to limit sodium intake in the diet. The patient's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a patient with altered renal function.

When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A) Inflammation is relieved. B) Core body temperature is reduced. C) Pain is relieved. D) Platelet aggregation is inhibited.

D. At low doses, aspirin blocks the synthesis ofthromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet.

A woman is admitted to the emergency department with a diagnosis of sinus bradycardia. The patient has been prescribed atropine 0.5 mg IV. How often can atropine be administered? A) Every 24 hours B) Every 6 hours C) Every 30 minutes D) Every 3 to 5 minutes

D. Atropine 0.5 mg should be administered IV every 3 to 5 minutes and may be repeated upto 3 mg. Atropine can be administered every24 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be administered every 6 hours,but this administration is not the recommended therapy for bradycardia. Atropine can be given in 30 minutes, but this administration is not the recommended therapy for bradycardia.

The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? A. diltiazem B. nadolol C. atenolol D. atropine sulfate

D. Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltiazem is a calcium channel blocker used to treat angina or slow the heart rate.

Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism? A. Increasing conduction to the atrioventricular node, thereby increasing cardiac output B. Increasing blood pressure, which increases the amount of blood returned to the heart C. Increasing cardiac output, thereby increasing the oxygen supplied to the heart D. Decreasing the heart rate, allowing for longer filling time and increased blood to the heart

D. Beta-blockers prevent the beta-adrenergic receptors from being stimulated. These drugs have multiple effects on the heart and cardiovascular system, including slowing the heart rate, depressing atrioventricular (AV) conduction, decreasing cardiac output, and reducing systolic and diastolic blood pressure at rest and during exercise. These effects decrease the oxygen demands of the heart and thereby decrease angina.

A patient has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the patient has been prescribed cholestyramine (Prevalite, Questran). What change in this patient's lipidprofile will the nurse identify as the most likely goal of therapy? A) Reduction in triglycerides B) Reduction in total serum cholesterol levels C) Increase in HDL levels D) Reduction in LDL cholesterol levels

D. Cholestyramine (Prevalite, Questran), the prototype bile acid sequestrant, has the abilityto reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? A. Vasculitis B. Flexion contractures C. Enlargement of joints D. nausea and vomiting

D. Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints.

A patient is diagnosed with heart failure. Sheasks the nurse for further details about heart failure. Which of the following statements is most accurate? A) Heart failure can be caused by atherosclerotic plaque due to high-fat diets. B) Hypothyroidism will result in decreased heart rate and development of heart failure. C) The administration of diuretics increases blood volume, causing symptoms to abate. D) The use of digoxin will slow heart rate to make your heart more efficient.

D. Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction thatfurther narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in patients whose heart cannot pump blood to meet tissue needs. A high-fat diet does not directly cause heart failure.

A client is prescribed metoprolol extended-release PO for heart failure. What assessment finding would suggest an exacerbation of the client's underlying diagnosis? A. upward trend in blood pressure B. chest pain on exertion C. bradycardia D. adventitious breath sounds

D. Extended release PO metoprolol is prescribed for the treatment of heart failure. Exacerbation of heart failure often causes pulmonary and/or peripheral edema. Hypertension and arrhythmias are less likely indications for this medication. Chest pain on exertion suggests angina pectoris, which is not an indication for extended-release metoprolol.

The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A. Blood vessels B. Bronchi C. Uterus D. Heart

D. Metoprolol works at beta1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.

Mrs. James has been taking a diuretic and a beta-blocker for the treatment of hypertensionfor the past several months. During her latest clinic visit, she states that she has been measuring her blood pressure regularly at her local drug store and she claims that it is usually in the range of 130/80 mm Hg. As a result, she states that she has cut down on her doses of both drugs. Mrs. James' actions should indicate what nursing diagnosis to the nurse? A) Risk for poisoning related to unilateral changes to medication regimen B) Acute confusion related to the necessity for medication adherence C) Readiness for enhanced decision making related to management of drug therapy D) Deficient knowledge related to self- management of drug regimen

D. Mrs. James is evidently unaware of the needto take her medications consistently. She is presuming that symptom control means that the medication is no longer indicated. The nurse should address this lack of knowledge.There is no associated risk of poisoning, andthe patient's decision making is deficient, a fact that she may or may not be willing to address. Acute confusion denotes a deficit in cognitive processes, not a lack of information.

The nursing instructor explains to students that positive inotropic action affects the heart in which way? A. Decreased venous return B. Decreased ventricular pressures C. Increased heart rate D. Increased myocardial contraction

D. Positive inotropic activity occurs with an increase in the force of the contraction. Conduction is slowed through the heart and there is a decrease, not an increase, in the heart rate.

A patient is admitted to the emergency department in ventricular fibrillation. The patient is administered amiodarone hydrochloride (Cordarone). What is a major effect of this medication? A) It produces skeletal muscle relaxation. B) It decreases automaticity in the ventricles. C) It stimulates the sympathetic nervous system. D) It slows the process of repolarization.

D. Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong therefractory period in both the atria and ventricles. Amiodarone blocks the effects of the sympathetic nervous system instead of stimulating it. Amiodarone and the other potassium channel blockers do not directly decrease automaticity.

While teaching a patient about sublingual nitroglycerin, the nurse explains proper use and storage. When the patient asks whether the medication ever expires, the nurse should respond that it: A. should be replaced annually. B. has an indefinite shelf life. C. should be replaced monthly. D. should be replaced every six months.

D. Sublingual nitroglycerin tablets should be replaced every 6 months because they become ineffective over time.

A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: A. Hyperkalemia B. Hypokalemia C. Hypertension D. Hypotension

D. When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension

A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which of the following statements indicates successful patient teaching? A) If I miss a dose, I will take two doses. B) I will avoid herbal remedies. C) I will eat spinach or broccoli daily. D) I will discontinue my other medications.

Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The patient should never double up on dosing related to a missed dose. The patient should avoid green leafy vegetables due to vitamin K. The patient should not discontinue his or her medications.