306 Exam 5

A client with chronic renal failure is prescribed subcutaneous epoetin alpha. Which information will the nurse include when teaching the client about this medication?

"Avoid shaking the medication vial." "Do not place the vial in the freezer." "Take the prescribed iron supplement with fruit juice that has vitamin C."

The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse?

"Because your liver is injured and cannot make clotting factors."

A 50-year-old client is reporting that the client's oral B12 is not working. The nurse knows that the vitamin may have a decreased absorption rate when taken with other substances. The nurse would begin the history by asking which questions?

"Do you use neomycin?" "Do you drink alcohol?" "Do you take colchicine?"

Which assessment question should the nurse ask to monitor the client for the medication's adverse effects?

"Have you experienced any dizziness?" "Have you been testing your stool for occult blood?" "Would you say your hearing has been affected?" Are you experiencing any heartburn or indigestion?" Adverse aspirin effects include hyperpnea, fever, coma, and CV collapse; nausea, dyspepsia, heartburn, epigastric discomfort, GI bleeding, occult blood loss, dizziness, tinnitus, difficulty hearing, anaphylactoid reaction, skin rash

A client, prescribed diltiazem, asks how this drug works. What is the nurse's best response?

"It dilates peripheral arteries and relaxes vascular smooth muscle." Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers BP and decreases myocardial oxygen consumption.

The nurse has been teaching a class on dysrhythmias to a group of patients with this disorder. The nurse determines that teaching has been effective when a patient makes which statement?

"Our sodium, potassium, and calcium levels must be okay for our hearts to have an electrical impulse."

A clinic nurse is developing a teaching handout for patients who are prescribed warfarin therapy. Which statement should be included in this information? Select all that apply.

"Tell your dentist you are taking warfarin prior to any procedures." "Avoid potential injury causing activities."

The therapeutic serum digoxin level is

0.5 to 2 ng/mL.

normal aptt of pt without drugs

25 -35 seconds

A client presenting with which clinical situation is a candidate for enoxaparin therapy?

A post-surgical hip replacement A post-surgical gastric resection History of unstable angina Post non-Q-wave myocardial infarction

Cardiotonic drugs are used in clients with persistent symptoms, recurrent hospitalization, or as indicated in conjunction with

ACEIs, loop diuretics, and beta blockers in clients with heart failure.

Class 3 antiarrhythmics

AIDS. Amiodarone, Ibulitide, Dofetilide, Sotalol.

The nurse is writing a care plan for a patient who has been started on an antiarrhythmic drug for complaints of chest pain and palpitations. The patient says, "I can't do what I once did. I just do not have any energy." Which nursing diagnoses would the nurse likely include in this care plan?

Activity Intolerance Decreased Cardiac Output

The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio (INR) is 2.7. Which action should the nurse implement?

Administer the medication as ordered.

The patient has a deep vein thrombosis (DVT) and is admitted for initial heparin therapy. Which orders would the nurse want to validate with the physician?

Advil as needed (PRN) for headaches Heparin 1000 units intravenous (IV) every 6 hours Low vitamin K diet

order for rescue inhaler should be

Albuterol inhaled doses PRN

A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death?

An African American client taking salmeterol

The pt with uncontrolled hypertension has experienced heart failure. nurse notes pt if receiving nifedipine ,calcium channel blocker. What is priority assessment indicative of heart failure for nurse? A. Assess level of orientation B. Auscultate breath sounds for crackles C. Review recent lab results for hypokalemia D. Assess urinary output

B. Auscultate breath sounds for crackles

A nurse is assessing a client and suspects that the client is experiencing arrhythmia. what client assessment would support this condition? A. polyuria B. hypotension C. mental confusion D. shortness of breath E. leg pain

B. hypotension C. mental confusion D. shortness of breath

After administering digoxin, what assessment finding would indicate the drug was having desired effect? A. increased heart size B. increased urinary output C. increased heart rate D. decreased respiratory rate

B. increased urinary output

Class 2 antiarrhythmics

Beta Blockers Propranolol, Esmolol, Metoprolol Reduce HR and Contractility. Slows conduction impulse. Reduce spontaneous depolarization w/ pacemaker activity (reverse adrenergic disease) Prolonged repolarization AE: bradycardia, hypotension, Contraindicated in CHF, bradycardia, heart block, hyperactive airway.

After reviewing antiarrhythmics drugs, a group of nursing students demonstrate understanding of the drugs when they identify which class 2 antiarryhtymic? A. Acebutolol B. Amiodarone C. Propanolol D. Ibutilide E. Verapamil

C. Propanolol A. Acebutolol

The use of a sympathomimetic would be contraindicated or only used with great caution in clients with what disorders?

Cardiac disease Diabetes mellitus Peripheral vascular disease Before administering a sympathomimetic, the nurse should assess for possible contraindications or cautions that include any known allergies to any drug in this class, cigarette use, cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism.

The client is a 39-year-old male seen in the clinic for anemia. The nurse knows that ESAs are drugs used to treat anemia associated with which conditions?

Chronic kidney disease Chemotherapy for cancer treatment AZT therapy for HIV Postsurgical blood replacement in place of allogenic transfusions

The nurse is caring for a patient who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously? A)Liver failureB)Renal failureC)Respiratory failureD)Heart failure

D) Heart failure

A client is administered diltiazem IV, followed by propanolol IV. The nurse should assess for what potential side effect of this medication combination? A. hypertensive crisis B. anaphylaxis C. valve regurgitation D. impaired myocardial contractility

D. impaired myocardial contractility

A client presents to the ED with wheezing and blood tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely: A. cardiomyopathy B. right ventricular failure C. valvular heart disease D. left ventricular failure

D. left ventricular failure

The nurse is working with a client who has heart failure. What compensatory mechanisms will this client's body be implementing?

Decreased cardiac output stimulates the baroreceptors in the aortic arch and the carotid arteries, causing a sympathetic stimulation. This sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an increase in blood volume (through the release of aldosterone)

Which physiological conditions are common triggers for the development of cardiac arrhythmias?

Faulty sinoatrial (SA) node Metabolic acidosis Respiratory distress Potassium imbalance Electrolyte disturbances, decreases in the oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products can trigger arrhythmias. A decrease in blood volume results in hypotension and ultimate cardiac arrest. Reference:

recognize that when baseline platelet count drops greater than 50 percent or below 150 -->

HEPRAIN INDUCED THROMBOCYTOPENIA H.I.T.

The nurse is caring for a pediatric client with hemophilia (blood cant clot) who receives antihemophilic factor several times a year. What should this client be regularly screened for?

HIV Hepatitis Anemia

Adverse effects associated with the use of inhaled steroids include

Headache Rebound congestion Irritability

The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?

Heparin

Which anticoagulants block the formation of thrombin from prothrombin?

Heparin Argatroban Bivalirudin

What are expected adverse drug reactions caused by erythropoiesis-stimulating agent (ESA's)

Hypertension Headache Rashes Fatigue

Heart failure may result from

Impaired myocardial contraction during systole Impaired relaxation and filling of ventricles during diastole A combination of systolic and diastolic dysfunction Cardiomyopathy

The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger?

Increased force of heart contraction

The client has chronic atrial fibrillation. Which discharge teaching should the nurse discuss with the client?

Instruct the client to use a soft-bristle toothbrush. A client diagnosed with chronic atrial fibrillation will be taking an anticoagulant to help prevent clot formation.

The nurse provides care for numerous children with asthma. The nurse should expect to administer what drugs? Select all that apply.

Long-acting inhaled steroids Leukotriene-receptor antagonists Beta-agonists

The client had stomach cancer and a surgical removal of his stomach several years ago. The physician prescribed cyanocobalamin. The client stopped this drug several months ago. What will the nurse most likely assess in this client?

Memory loss, numbness in the limbs, and depression

A client with asthma should always carry a rescue inhaler or quick-relief medication with them at all times. Which of the following are considered quick-relief medications?

Metaproterenol (Alupent) Albuterol (Proventil) Short-acting beta agonists (SABAs) are used as rescue treatment for asthma

The nurse is caring for a client who has a history of atrial fibrillation (AF) and whose condition has recently worsened. The client is awaiting cardioversion. In addition to cardiac monitoring, what assessment should the nurse prioritize?

Monitor the client for signs of pulmonary embolism. In clients with AF, there is a substantial risk that clots or emboli will be pumped into the ventricles and then into the lungs (from the right auricle), which could lead to pulmonary emboli, or to the brain or periphery (from the left auricle), which could cause a stroke or occlusion of peripheral vessels. Fluid balance and electrolytes are relevant, but secondary, concerns. AF does not directly affect coronary circulation.

The nurse recognizes an altered ability for the blood to carry oxygen in a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply.

Monitor the client's Hgb and hematocrit. Assess the client for numbness and tingling. Allow for rest periods during the day for the client.

When describing the effects of antiarrhythmics, which is associated with all antiarrhythmic medications?

New arrhythmias Worsen existing arrhythmias All antiarrhythmics can cause new arrhythmias or worsen existing arrhythmias. Increased blood pressure results from the use of increased sodium in the diet, drinking more water, use of compression hose and medications, or orthostatic hypertension such as fludrocortisone. Increased blood glucose is the result of ineffective pancreas function seen in diabetes. Increased body temperature is seen in dehydration and heat exhaustion.

Which is part of the nurse's evaluation of anti-arrhythmic drug therapy?

No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist.

The nurse is caring for a client admitted to the telemetry unit with atrial fibrillation on the electrocardiogram (ECG) monitor. The nurse should perform which assessment(s) for safe administration of the first dose of quinidine?

Obtain a history of allergies to medications and specific reactions. Assess if the client has systemic lupus erythematosus or myasthenia gravis. Check baseline renal and hepatic function before administering drug. After administration, assess for tinnitus, hearing loss, headache, and vertigo.

The nurse is managing care for a group of patients receiving antidysrhythmic medication. Which assessment data will the nurse discuss with the prescriber as adverse effects of these medications?

Palpitations, chest pain, weakness, and fatigue

The nurse is scheduled to administer the following medications at 0900: heparin subcutaneous, cefazolin IVPB, and atenolol po. The morning labs are platelets 150,000 mcL, WBC 10,000 mcL, APTT 100 seconds. Which is the nurse's priority in this situation?

Place the client in supine position with legs elevated for BP 88/50.

The client complains of constipation while receiving ferrous sulfate. What is the best plan by the nurse to assist the client in resolving this common side effect?

Plan to teach the client to increase fluids and high-fiber foods in the diet.

Indications for the nurse to administer heparin include what?

Prevention and treatment of pulmonary emboli Treatment of atrial fibrillation with embolization Prevention and treatment of venous thrombosis Diagnosis and treatment of disseminated intravascular coagulation (DIC)

iron levels increase when

RBC are damaged or ruptured

The nurse is caring for a client receiving digoxin. The nurse would intervene for possible digoxin toxicity when the client exhibits which symptoms?

Refusal to eat Anorexia, which is a reported feeling of a decreased or absent appetite, is the first symptom of possible digoxin toxicity. Later symptoms include nausea, vomiting, headache, confusion, bradycardia, tachycardia arrhythmias, and visual disturbances: Blurred vision and halos over dark objects, and disturbances in yellow and green vision.

A 6-year old client is prescribed lidocaine to treat a ventricular arrhythmia after cardiac surgery. Which nursing intervention is especially important for the safety of this client as long as the therapy is continued?

Regular monitoring of serum lidocaine levels Continuous cardiac monitoring The dosage of all antiarrhythmic agents prescribed for children are determined by age and weight. Allergies and developmental regression should be assessed and monitored for any hospitalized child.

A premature newborn diagnosed with respiratory distress syndrome(RDS) has received surfactant therapy. The infant's nursing care plan should include which monitoring interventions to evaluate the effectiveness of the therapy? Select all that apply.

Respirations Adventitious breath sounds Endotracheal tube placement Chest movement

The nurse should monitor a client receiving lidocaine (Xylocaine) IV closely for which issues?

Respiratory depression Mental status changes Convulsions Bradycardia hypotension

Class 1 Antiarrhythmics

Sodium channel blockers

A nurse is developing a discharge-teaching plan related to medications for a client diagnosed with heart failure. Which interventions should be included in the plan? Select all that apply.

Teach the client how to count the radial pulse when taking digoxin. Report any unusually slow or irregular pulse to your healthcare provider. The client should notify the HCP of weight gain of more than 2 or 3 pounds in 1 day. The client should not take digoxin, a cardiac glycoside, if the radial pulse is less than 60. The client should report any changes in heart rate or new irregular heart rhythms. The color of the urine should not change to a dark color; if anything, it might become lighter, and the amount will increase with diuretics. Instruct the client to take the loop diuretic furosemide in the morning to prevent nocturia.

A client is prescribed albuterol, 2 puffs every 6 hours. After teaching the client about the drug and its administration, the nurse determines that the teaching was successful when the client states that he will allow how much time between each puff?

The client should allow 3-5 minutes to elapse between each puff of the inhaled medication.

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached?

The client's hemoglobin values have risen. The client reports enjoying a walk with family for the first time in months. The client reports less shortness of breath on exertion.

A client has been prescribed a inhaled steroid for the treatment of asthma. What information should the nurse include when providing medication education to the client?

The medication is not intended to treat an acute asthma attack Abruptly stopping any previously prescribed systemic steroid could cause an adrenal insufficiency Rebound nasal congestion is a adverse effect of this form of medication Promptly report a fever or any other indication of infection to your health provider

A male client, age 68 years, presents to the primary care office for follow-up for pernicious anemia. The nurse takes a history and finds that the client had the anemia for six months before starting treatment. Based on the history, which body system would the nurse include in the assessment?

The neurological system with a focus on the spinal cord Vitamin B12 deficiency causing pernicious anemia progressing for more than three months can cause degenerative lesions of the spinal cord.

Aerosols are often the drugs of choice to treat asthma because of what characteristics?

They act directly on the airways. They can usually be given in smaller doses. They produce fewer adverse effects than oral or parenteral drugs. They relieve symptoms quickly.

The nurse educator is reviewing the process of hemostasis. Place the steps of hemostasis in the order they occur.

Vessel spasms Platelets become sticky Additional platelets are attracted to the site Blood flow is further reduced Fibrin strands form

Mrs. Houston is a 78 y/o woman who resides in a an assisted living facility. Her provider prescribed digoxin at her last visit to the clinic and she has approached the nurse about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? a. importance of having required lab work performed on time b. need to take med at same time each day regardless of heart rate c. correct technique for using home blood pressure cuff d. timing household activities to coincide with administration times of her digoxin

a. importance of having required lab work performed on time

Iron can cause

allergic reaction Nausea, vomiting, and dark stools are adverse reactions of iron

A client prescribed an anticoagulant should be instructed in what to do if bleeding does occur:

apply constant, firm pressure to site and contact a health care provider immediately. Pressure on a pulse site as described would be more effective for arterial bleeding.

pernicious anemia is caused by

body lacking intrinsic factor which blocks ability to absorb vitamin b12

nurse teaching for client to monitor when beginning an antidysrhythmic drug regimen? a. Diarrhea b. Gastric upset c. Syncope d. Dry mouth

c. Syncope (loss of consciousness due to low blood pressure)

Which adverse effect might occur with client receiving milrinone(IV only)? a. hypoglycemia b. confusion c. hypotension d. hyperkalemia

c. hypotension

92 y/o male client is being sent home on disopyramide for a ventricular arrhythmia. The client asks why he must continue to take this drug. The nurse's best response would be that a ventricular arrhythmia may: a. lead to the formation of clots in the legs b. result in the atria beating independently c. result in death d. cause edema in the extremities

c. result in death

Class 4 Antiarrhythmic

calcium channel blockers (verapamil, diltiazem)

Drugs that increase the effects of heparin include

cephalosporins Digoxin, tetracycline, and antihistamines decrease the effectiveness of heparin.

the patient with heart failure is receiving furosemide, loop diuretic. The nurse assess pt for hypokalemia. What does priority assessment findings include? a. Diarrhea and projectile b. General irritability and increased urine output c. Confusion and decreased urine output d. Palpitations and paresthesia

d. Palpitations and paresthesia

human B-type natriuretic peptides

decreased venous return, peripheral resistance, and cardiac workload. They also suppress the body's response to the stress hormones, leading to increased fluid loss and a further decrease in cardiac workload.

Calcium channel blockers like verapamil

depressing the depolarization phase 4.

The nurse is teaching a patient who is to receive epoetin alfa about possible adverse effects. Which would the nurse include? (Select all that apply.)

diarrhea, hypertension, asthenia, vomiting, and edema.

The cardiotonics are contraindicated in the presence of

digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block.

Hypokalemia, hypomagnesemia, and hypercalcemia increase the risk of dysrhythmia in clients taking

digoxin

Thrombolytic agents are used to

dissolve thrombi with the goal of reestablishing blood flow and limiting tissue damage in selected thromboembolic disorders. Dissolve thrombi Limit tissue damage Reestablish blood flow

A client with chronic renal failure has a low hemoglobin level. Which medication(s) will the nurse anticipate being prescribed for this client?

epoetin alfa epoetin beta darbepoetin alfa

Vitamin B12 is essential to

growth, cell reproduction, and the manufacture of myelin, and blood cells. Vitamin B12 does not repair broken bones or vitreous humor

protamine sulfate reversal agent for

heparin

The nurse knows that antiarrhythmic drugs are contraindicated in clients with

hypotension, aortic stenosis, and cardiogenic disturbances Arrhythmic drugs are used cautiously and not contraindicated in clients with electrolyte disturbances and renal or hepatic disease.

The pharmacological actions of digitalis are

increased cardiac output, decreased heart rate, and retarding conduction velocity. Digitalis increases cardiac output by positive inotropic action. It does not have negative inotropic action. It decreases the heart rate through negative chronotropic effect. In atrial fibrillation, rapid atrial contractions are seen. Digitalis is used to treat atrial

cardiac glycoside

increases the force of contraction of the heart. improve cardiac output will improve renal perfusion. (digoxin: always take pulse) (toxicity-->color vision changes)

Cytokines participate actively in the processes of

inflammation, tissue repair, cellular differentiation, and antibody production

(iron can be low and ferritin can normal value)

iron so if pt has new iron deficiency it will not show iron deficiency (iron can be low and ferritin can normal value)

The general mode of action of class IC antiarrhythmic drugs includes

marked depression of phase 0, slight effect on repolarization, and profound slowing of conduction

Hepatic impairment has little effect on digoxin clearance therefore

no dosage to digoxin adjustments are needed in pt with cirrhosis

An older adult client, diagnosed with chronic obstructive pulmonary disease (COPD), is being considered for corticosteroid therapy. The nurse should anticipate that these drugs may be administered by what routes?

oral parenteral

When educating a group of nursing students on the classification of various antiarrhythmic drugs, the nurse cites propafenone (Rythmol) as an example of class IC drugs. Which are the general modes of action of drugs in this class? Select all that apply.

profound slowing of conduction slight effect on repolarization shortening of the action potential duration selective depression of cardiac conduction

anticholinergic and agrenergic dont touch inflmmatory response they

relax smooth muscles to relieve constriction

Peripheral edema and hepatomegaly suggest

right-sided heart failure.

Class IB drugs like lidocaine act by

slight depression of phase 0 and shortening of the action potential duration. Shortening of the action potential duration Depression of cardiac conduction

if atrial fibrillation is longer than a couple days could lead to

stroke bc atria not contracting and blood not being ejected so clot forms and when atria contracts the clot goes with rest of blood into the vascular

Left-sided heart failure would be indicated by

tachypnea, hemoptysis, orthopnea, increased urine output (polyuria), nocturia, dyspnea, and cough.

A platelet count of less than 150,000/microL of blood indicates

thrombocytopenia

In monitoring clients receiving erythropoiesis-stimulating agents, it is most important for the nurse to monitor for

thromboembolus.

Epoetin alfa is contraindicated in clients with

uncontrolled hypertension, clients needing an emergency transfusion, and clients with a hypersensitivity to human albumin.

vitamin k reversal agent for

warfarin

Garlic, gingko biloba, and green tea should not be used during

warfarin therapy because they can increase the risk of bleeding.