ATI cardiovascular exam
A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug, which of the following instructions should the nurse include? ( select all that apply ) -apply a new patch at the onset of anginal pain -apply the patch to dry skin and cover the area with plastic wrap -apply the patch to a hairless area and rotate sites -apply a new patch when you start your day -remove patches for 10 to 12 hours each day
-apply the patch to a harliess area and rorate sites -apply a new patch when you start your day -remove the patches for 10 to 12 hours each day apply a new patch at the onset of anginal pain is incorrect—nitroglycerin patches provide ongoing prevention of angina episodes apply the patch to dry skin and cover the area with plastic wrap is incorrect— these instructions apply to topical nitrolglycerin ointment, not to nitroglycerin patches apply the patch to a hairless area and rotate sites is correct— hair can interfere with the adhesion of the patch. Rotating patch application sites helps prevent skin irritation. apply a new patch when you start your day is correct— the therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 minutes after application and last for up to 14 hours. because angina pain is more likely to occur with activity, most clients require this protection during waking hours remove patches for 10 to 12 hours each day is correct— removing the patches for 10 to 12 hours each day helps prevent the development of tolerance to the drug. for most clients, sleeping hours are the best time to remove the patch and go patch free, because angina pain is more likely during activity
A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate to discontinue drug therapy? ( select all that apply ) -rash -distorted taste -swelling of the tongue -photosensitivity -dry cough
-rash -distorted taste -swelling of the tongue -dry cough rash is correct— Captopril, an ACE inhibitor can cause a persistent rash. This often indicates the need to discontinue drug therapy. Distorted taste is correct— captopril can cause distortions in taste sensations and loss of taste, which can lead to anorexia and weight loss. This often indicates the need to discontinue a drug therapy. Swelling of the tongue is correct—Captopril can cause angioedema, often manifesting as edema of the tongue, pharynx and glottis. Clients who develop this adverse effect should discontinue the drug and seek medical attention. Photosensitivity is incorrect—Captopril can cause photosensitivity, a relatively benign adverse effect that does not require the client to discontinue drug therapy. Clients who experience this adverse effect should be especially careful about wearing sunscreen and protective clothing when outdoors and should limit the exposure to sunlight. Dry cough is correct— captopril can cause a dry cough because of an accumulation of bradykinin. This often indicates the need to discontinue drug therapy.
A nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of over the counter drugs while taking propranolol? -antihistamines -potassium supplements -NSAIDs -vitamin C
NSAIDs rationale—NSAIDs can interact with propranolol and decrease the anti-hypertensive action because vasoconstriction can occur in some COX-2 inhibitors. The nurse should instruct the client to avoid taking NSAIDs and propranolol at the same time
A nurse should recognize that milirinons is contraindicated for a client who has which of the following conditions? -acute myocardial infarction -peripheral vascular disease -ulcerative colitis -ventricular tachycardia
acute myocardial infarction rationale— milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who have had an allergic reaction to phosphodiesterase inhibitors and for clients who have an acute myocardial infarction and aortic or pulmonary valve disorders.
A nurse is caring for a client who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication? -acetylcysteine -flumazenil -antigen binding fragments -deferoxamine
antigen binding fragments rationale— antigen binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity
a nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. the nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported? -facial edema -sleepiness -peripheral edema -constipation
facial edema rationale—Losartan, an angiotensin II receptor blocker can cause angioedema, which often manifests as swelling around the eyes and lips. Clients who develop this adverse effect should stop taking the drug and seek medical attention.
A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug -grapefruit juice -milk -foods high in vitamin K -NSAIDs
grapefruit juice rationale— grapefruit juice, particularly in large amounts can cause toxicity of potassium channel blockers such as amiodarone
A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicate an adverse effect of this drug -hyperuricemia -hypernatremia -hyperkalemia -hypoglycemia
hyperuricemia rationale— hyperuricemia or increased uric acid levels, along with gouty arthritis can occur in clients who have a history of these conditions and are taking hydrochlorothiazide
A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination places the client at an increased risk for which of the following adverse effects? -myopathy -hypoglycemia -irregular pulse -kidney failure
myopathy rationale—when taking a statin drug, it is important to know that concurrent use of fibric acid derivatives sucha s gemfibrozil, or other drugs to lower cholesterol can increase the risk for myopathy
A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory values requires immediate intervention -Sodium 140 mEq/L -Potassium 5.2 mEq/L -Chloride 100 mEq/L -Magnesium 1.9 mEq/L
potassium 5.2 mEq/L rationale—Spironolactone is a diuretic and an aldosterone antagonist that can cause hyperkalemia and places the client at risk for cardiac dysrhythmias. This potassium level is outside the expected reference range of 3.5 to 5.0 mEq/L and requires immediate intervention
A nurse is caring for a client who has a glomerular filtration rate of 10 ml/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug? -the drug can cause hypoglycemia in clients who have low urine output -the drug does not reduce blood pressure for clients who have low urine output -the drug can increase the risk of pulmonary edema for clients who have renal insufficiency -the drug does not promote diuresis for clients who have renal insufficiency
the drug does not promote diuresis for client who have renal insufficiency rationale—adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic to promote urine production and effective excretion
A nurse is caring for a client who has a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following findings as an adverse effect of the drug? ( select all that apply) -hyperkalemia -throat swelling -constipation -cough -joint pain
hyperkalemia throat swelling cough hyperkalemia is correct— aliskiren, a direct renin inhibitor can cause elevated potassium levels, especially when taken in combination with an ACE inhibitor, potassium supplements, or potassium sparing diuretics. The nurse should obtain a potassium level at baseline and periodically monitor for the client's potassium level thereafter. Throat swelling is correct— Aliskiren can cause angioedema which is swelling of the mouth and throat. Clients who develop this adverse effect should stop taking the drug and seek medical attention constipation is incorrect— constipation is not an adverse effect of aliskiren. this drug can cause diarrhea cough is correct— Aliskiren, a direct renin inhibitor can cause cough joint pain is incorrect— joint pain is not an adverse effect of aliskiren. this drug can cause headaches
A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions? -hyperglycemia -bradycardia -hypotension -hypoglycemia
hypoglycemia rationale— there are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic drugs. Also, carvedilol can mask tachycardia in clients who have hypoglycemia, Carvedilol should be used with caution by clients who have diabetes mellitus.
A nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension and confusion. the nurse should identify that these manifestations indicate which of the following adverse effects? -hypokalemia -hypoglycemia -hyperuricemia -hyponatremia
hypokalemia rationale— manifestations of hypokalemia include a thready, irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, polyuria, nausea and vomiting
A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy? -bronchoconstriction -muscle pain -lip numbness -somnolence
muscle pain rationale—Simvastatin an HMG-CoA reductase inhibitor (statin) can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious adverse effect, muscle protein breaks down and is excreted, resulting in kidney damage.
A nurse should identify that which of the following drugs is used only for the short-term treatment of a cardiac dysrhythmia because of the serious effects associated with long-term use -quinidine -procainamide -nitroglycerin -verapamil
procainamide rationale—procainamide is a sodium channel blocker and a broad spectrum antidysrhythmic. It should not be used for long-term treatment of dysrhythmias because of its risks for serious adverse effects, including cardiotoxicity and arterial embolism.
A nurse is caring for a client who is taking diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake? -raisins -cabbage -cheese -eggs
raisins rationale—diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium rich foods in their diet, such as raisins and other dried fruits
A nurse is caring for a client who has a depressive disorder and requires a prescription drug to treat hypertension. The nurse should recognize that which of the following antihypertensive drugs is contraindicated for this client? -reserpine -captopril -hydralazine -eplerenone
reserpine rationale— severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers such as reserpine. These adverse effects develop because of the depletion of serotonin and norepinephrine and can persist after clients discontinue taking the drug.
A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions? -migraine headaches -pancreatitis -second degree AV block -angina pectoris
second degree AV block rationale—verapamil, a calcium channel blocker can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second or third degree AV block. Verapamil is indicated for hypertension, angina pectoris and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches
A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia? -simvastatin -furosemide -losartan -nitroglycerin
simvastatin rationale— Simvastatin is an HMG-CoA reductase inhibitor. It blocks synthesis of cholesterol by the body to help lower cholesterol levels.
A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following drugs? Select all that apply. -ACE inhibitor -MAOI -general anesthetic -tricyclic antidepressant -beta blocker
-MAOI -General anesthetic -Tricyclic antidepressant -Beta blocker ACE inhibitor is incorrect— Ace inhibitors can cause lithium toxicity in clients who also take lithium, however they do not interact with dobutamine which is a sympathomimetic drug MAOI is correct— MAOIs can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias General anesthetic is correct— General anesthetics can cause dysrhythmias when clients take them while also taking dobutamine Tricyclic antidepressant is correct— Tricyclic antidepressants can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias Beta blocker is correct— Beta blockers, such as propranolol, can decrease the effects of dobutamine
A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include? (select all that apply) -take the drug with food -report any new intolerance to fried foods -report muscle tenderness -expect periodic liver functioning testing -take the drug once each day
-report any new intolerance to fried foods -report muscle tenderness -expect periodic liver function testing take the drug with food is INCORRECT— client should take gemfibrozil, a fibrate 30 minutes before a meal, not with food report any new intolerance to fried foods—because gemfibrozil, a fibrate can cause gallstones, clients should monitor and report any new intolerance to fried foods, as well as any bloating or upper abdominal discomfort report muscle tenderness—Because gemfibrozil, a fibrate, can cause myopathy, clients should monitor and report any unexplained muscle or joint pain expect periodic liver functioning is correct— because gemfibrozil, a fibrate, increases the risk for liver toxicity, clients will require liver function testing while taking this drug take the drug once each day is INCORRECT— clients should take gemfibrozil, a fibrate, 2x a day
A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug? -headache -constipation -hypertension -hyperglycemia
headache rationale— adverse effects of nitrates such as nitroglycerin include headaches, which can be severe at the beginning of nitrate therapy but decrease in severity with continued exposure to nitrates
A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. the nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions? -tachycardia -dehydration -diarrhea -hypotension
hypotension rationale— large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the drug in the body can intensify otherwise therapeutic effects like hypotension causing serious risk for syncope and dizziness.
A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include -monitor your pulse rate and report changes -remain upright for 30 minutes after taking this medication -this medication can decrease digoxin levels -this medication can cause urinary incontinence
monitor your pulse rate and report changes rationale— sodium channel blockers like quinidine, can worsen dysrhythmias or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.
