Cardiac Overview
Nitrates are indicated to treat what?
Angina (work by relaxing smooth muscles which causes vasodilation)
What are nursing interventions that should be done prior to administering these types of medication?
BP, pulse Cardiac/Resp assessments
Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply.
Grapefruit juice
Which foods will the nurse discuss when teaching a client who has a new prescription for warfarin?
Green leafy vegetables
A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect?
Hypokalemia
A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess for which medication side effect?
Hypotension
A postpartum client receiving a continuous heparin infusion for a deep vein thrombosis has an activated partial thromboplastin time (APTT) of 98 seconds. Which action would the nurse take in response to this situation?
Interrupt the infusion and notify the primary health care provider of the APTT result.
What will the nurse assess before administering this spironolactone?
K+ (avoid if patient has hyperkalemia) Weight I/O
how will the nurse assess for the adverse effects of atorvastatin?
Monitor for S/S of rhabdomyolysis Muscle pain and/or weakness Tea colored urine Irregular HR Monitor labs: BG, LFTs, LDL
Which of the following manifestations are associated with digoxin toxicity? Select all that apply
Nausea Headache Vision changes
What labs should be monitored when a patient is on warfarin?
PT INR
Avoid nitrates with which type of drugs?
Vasodilators *such as sildenafil
A client is taking warfarin. If an antidote is needed, which agent will be used?
Vitamin K
A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." Which response would the nurse provide?
"The medication may need to be discontinued. Come to the clinic this afternoon."
The nurse knows that a therapeutic serum digoxin level to treat heart failure is what?
0.8 ng/mL to 2 ng/mL > 2 ng/mL can indicate digoxin toxicity (though some patients may experience this at levels around 1.8 ng/mL)
What is the ideal therapeutic range for Digoxin?
0.8 to 2 ng/mL. Anything above 2ng/mL is TOXIC Some patients may experience manifestations of toxicity and ranges closer to 1.8ng/mL
Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The nurse advises the client to anticipate pain relief will begin within which period of time?
1 to 3 minutes
The nurse has an order to administer spironolactone to a patient. The nurse knows this medication is indicated for what?
HTN Edema (associated with HF or liver dysfunction)
A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective?
Heart rate of 98 beats/minute
Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin forta partial occlusion of the left common carotid artery. The client expresses concern about why both medications are needed at the same time. Which rationale would the nurse include to address the client's concern?
Heparin provides anticoagulant effects until warfarin reaches therapeutic levels.
The nurse is administering 40 mg of furosemide intravenously. Which sensation reported by the client would the nurse consider when determining that it is being administered too quickly?
Buzzing ears
Which information about a client who has heart failure would the nurse communicate to the health care provider before administration of the prescribed digoxin?
Potassium level of 2.3 mEq/L (2.3 mmol/L)
Clopidogrel (Plavix) is to treat what?
Prevent thrombosis in unstable angina, MI, TIA, stroke Works be inhibiting platelet aggregation
Reversal agents for Heparin
Protamine sulfate
The nurse has administered sublingual nitroglycerin. Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin?
Relief of anginal pain
A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. Which instruction will the nurse teach the client related to the medication?
Report any occurrence of multiple bruises
What should patient education include for a patient taking an ACE inhibitor?
Report dry cough Monitor BP Report weight gain, edema and decreased urine output Report S/S of angioedema to HCP Avoid salt substitutes or foods high in K+
Atorvastatin can have serious adverse effects. What are they and how will the nurse assess for these?
Rhabdomyolysis Muscle spasms Abnormal liver enzymes Hyperglycemia
Important teaching for a patient taking a beta blocker would include...
Taking apical pulse for at least 1 minute prior to giving medication Never stop meds abruptly Never skip or double up on meds Monitor own HR and BP at home
You have patient on a variety of cardiac medications including... a beta blocker, calcium channel blocker and diuretic. Is it appropriate for the patient to be on these medications together? Provide rationale.
Yes, they have different mechanisms of action
Which collaborative and nursing actions would help prevent venous thrombosis in a client during the perioperative period?
Administer subcutaneous heparin injections. Assist the client to don antiembolism stockings. Apply pneumatic compression devices to the legs..
Which nursing action has the highest priority when caring for a client receiving nitroglycerin for the treatment of angina?
Asking the client to sit or stand slowly
To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ?
Avoid massaging the injection site after the injection.
What is the mechanism of action for ARBs such as losartan?
Block Angiotensin II in the renin-angiotensin-aldosterone system 🡪 produces vasodilation
How does diltiazem work on the body?
Block influx of calcium, slows conduction, decreases myocardial contractility (negative inotrope
Metoprolol is prescribed for a client with hypertension. The nurse monitors the client for which adverse effect?
Bradycardia
What will you include in patient teaching regarding acetylsalicylate acid (Aspirin)?
Can cause GI upset, headache and dizziness Take with food Alert MD before any procedures (dental/medical) Report S/S of tinnitus
Which advice would the nurse include in a teaching plan to reduce the side effects of diltiazem?
Change slowly from sitting to standing.
Which of the following manifestations are associated with left sided heart failure?
Cough Coarse lung sounds Dyspnea
Captopril is prescribed for a client. Which effect would the nurse anticipate?
Decreased blood pressure
A beta blocker is prescribed for the client with persistent ventricular tachycardia. Which response indicates that the beta blocker is working effectively?
Decreased heart rate
What is the therapeutic effect for losartan?
Decreased peripheral resistance Decreased BP
A client who takes multiple medications complains of severe nausea, and the client's heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of which medication?
Digoxin
What would patient teaching include for the medication enoxaparin?
Does not require frequent lab monitoring Once a day dosing Comes in a prefilled syringe, leave air bubble in place Monitor for signs of bleeding Avoid aspirin and NSAIDs
Side/Adverse effects of nitroglycerin?
Headache Flushing of extremities Tingling under tongue (SL route) Hypotension
How does ezetimibe work on the body?
Inhibits cholesterol absorption from the small intestine
How does atorvastatin work on the body?
Inhibits cholesterol synthesis by the liver *Taken in the evening because most cholesterol synthesis occurs over night
A health care provider prescribes losartan for a client. Which is an important nursing action?
Monitor the client's blood pressure.
When the international normalized ratio (INR) for a client receiving warfarin for venous thrombosis is 4.6, which action will the nurse take?
Notify the health care provider of the laboratory results.
A client receives a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator. The client's apical pulse rate is 44 beats/minute. The nurse concludes that the decreased heart rate is caused by which medication?
O Cardiac glycoside
Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse's priority?
Signs of bleeding
Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina?
Sinus bradycardia, rate 54 on monitor
Patient teaching regarding hydrochlorothiazide (Hydro-diuril) should include?
Take in the morning Monitor weight K+ levels will be monitored Encourage K+ rich diet Will decrease BP Change positions slowly Often combined with an ACE inhibitor to help with hypertension
Patient teaching regarding furosemide (Lasix) should include which of the following?
Take this medication in the morning Change positions slowly Report difficulties with breathing
Reversal agents for Warfarin
Vitamin K
What medication(s) breaks up existing clots?
alteplace (tPA)
A patient has been prescribed an antihypertensive medication and has called the clinic to complain that they have developed a dry hacking cough. The nurse anticipates that the patient is currently taking what medication?
captopril ACE inhibitors can have a side effect of a dry (non-productive) hacking cough.
A patient is taking an ACE inhibitor and reports a dry hacking cough. The nurse may anticipate that the provider would discontinue the ACE inhibitor and order which medication instead?
losartan this is an ARB, which is very similar to an ACE inhibitor, therefore it is a good alternative
The nurse knows to avoid which antiarrhythmic medication in patients who have COPD?
propranolol (Inderal)
Which client statements indicate that the teaching about furosemide is understood?
"I need to change my position slowly." "I should eat more food that is high in potassium."
What antiarrhythmic drug prototype is indicated to treat life threatening arrhythmias such as ventricular tachycardia and ventricular fibrillation?
amiodorone (Cordarone)
The nurse notes that a serum digoxin level comes back at 2.6 ng/mL. The nurse would anticipate the provider would order which medication?
digoxin immune fab
What is the therapeutic INR level when a patient is on warfarin?
2.0 to 3.5, depending on the indication (usually 2.5-3.5 with mechanical valves)
The nurse is preparing to administer furosemide to a patient. The nurse knows that 2 to 3 priority assessments are what?
K+ level (assess for hypokalemia) BP Renal function (labs, I/O)
What should be included in patient teaching when taking digoxin?
Monitor BP and HR Hold if HR less than 60, call provider Signs of digoxin toxicity Monitor weight Avoid high fiber/bran diet as this will decrease drug absorption
Clopidogrel (Plavix) teaching should include what?
Monitor for bleeding Don't take with any aspirin containing products Avoid alcohol
What labs should be monitored when a patient is on heparin?
PTT aPTT
A health care provider prescribes a diuretic for a client with hypertension. Which mechanism of action explains how diuretics reduce blood pressure?
They reduce the circulating blood volume.
A patient has just taken SL nitroglycerin and experiences a headache. What should the nurse tell the patient regarding their headache?
This is an expected effect of the medication
All antiarrhythmic drugs can cause dysrhythmias?
True True, which is why ECG monitoring is essential before, during and after medication interventions are provided
a patient has a heart rate of less than 54 bpm and is scheduled for digoxin (Lanoxin). Should the nurse hold the dose? Provide rationale
Yes, hold the medication Because it has a negative chronotropic effect (decreases heart rate)