Pharm 2 exam 3 prep u
A nurse is teaching a 54-year-old client how to take sublingual nitroglycerin. What statement by the client indicates an understanding of the nurse's instructions?
- "I can take up to three tablets at 5-minute intervals"
The nurse determines that teaching about warfarin is successful when the client makes what statement?
- "I will check with my health care provider before taking any herbal supplements"
A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response?
- "It dilates peripheral arteries and relaxes vascular smooth muscle".
What order for a digitalizing dose of digoxin for a 62-year-old client would the nurse consider appropriate and safe to administer?
- 0.75 mg orally now
a 50-year-old client has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the client's medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis?
Diagnosis of ulcerative colitis
A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?
Diastolic pressure below 90 mm Hg
A client who has been prescribed digoxin is also taking furosemide 20 mg daily. Which electrolyte imbalances will precipitate the client to develop digoxin toxicity?
Hypokalemia
During a cardiac catheterization and concurrent GP IIb/IIIa receptor antagonist administration, a client begins to bleed from the arterial access site of the catheterization. In what, if any, specific circumstance can the infusion continue?
It can continue when bleeding can be controlled by pressure application
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?
Left- ventricular failure hjbn
After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure? -
Peripheral edema
Clients who are taking nifedipine should be monitored for which of the following adverse effects?
Peripheral edema
Antiplatelet agents decrease the formation of the platelet plug by decreasing responsiveness of the platelets to stimuli that would cause them to stick and aggregate on a vessel wall. The nurse knows that which drug is an antiplatelet agent?
ReoPro, Ticlopidine
A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?
Risk for injury
A client, newly diagnosed with heart failure, questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. What is the rationale for the nurse's response?
To rapidly bring the client's serum digoxin levels up to therapeutic levels
A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed?
atropine
A client has been prescribed transdermal clonidine therapy. What potential adverse effects should the nurse warm the client about?
dry mouth and dizziness
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity?
increased cardiac output
The nurse evaluates an improvement in the client's heart failure status on the basis of what assessment finding? -
using fewer pillows to sleep
Which of the following statements by the client prescribed sublingual nitroglycerin indicates the need for additional education?
"I know the medication is working if I feel as burning sensation in my mouth."
A nurse is preparing to discharge a client who has been prescribed warfarin. While assessing the client's knowledge of the drug, what statement should the nurse address?
"I take aspirin to help with the pain of my arthritis"
The nurse provides client teaching for a client diagnosed with angina about the prescribed nitroglycerin transdermal patch. Which client statement establishes the need for further teaching?
"I will apply the patch for 24 hours and then remove it, and place another transdermal patch.
The nurse is teaching a client diagnosed with angina how to properly store and use nitroglycerin sublingual tablets. Which statement by the client establishes a need for additional teaching by the nurse?
"I will keep the bottle of nitroglycerin in my pants pocket"
An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for additional health education?
"I'll only need to take these drugs on days when my blood pressure is particularly high".
Digoxin has been prescribed for an outclient with symptomatic heart failure. What is the priority teaching point to convey to this client?
"Make sure to take your pulse for a minute before taking your digoxin.
A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response?
"Many clients require two or more drugs for high blood pressure".
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding"
A client taking diltiazem for hypertension has come to the clinic for a follow-up appointment. What adverse effects should the nurse assess the client for?
- Peripheral edema and bradycardia
A nurse is educating a group of nursing students on the adverse effects of antihypertensive durgs. The nurse explains that orthostatic hypotension occurs initially in the therapy. Which of the following pressure changes in an upright position would indicate orthostatic hypotension?
-A fall in the systolic pressure by 10 mm Hg
The nurse identifies the therapeutic range for digoxin as:
0.8 to 2 ng/mL
The nurse identifies the therapeutic range for digoxin as?
0.8 to 2 ng/mL
A nurse obtains the serum digoxin level and immediately reports a level greater than which value?
2.0 ng/mL.
A client is receiving anticoagulant therapy and has an INR done. Which result would the nurse interpret as being therapeutic?
2.4
A client reports seeing halos around lights. The client takes digoxin by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity?
4.0 ng/mL
A client receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?
98 seconds
Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?
A 45-year-old corporate executive with peptic ulcer disease
In heart failure, by what mechanism does the body compensate for decreased circulating blood volume?
Activation of the renin-angiotensin-aldosterone system
A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors. Which medication should the nurse explain as the hormone produced by the adrenal cortex? -
Aldosterone
Which agent would the nurse expect to administer for a client with Prinzmetal's angina?
Amlodipine
The nurse explains to the client that with heart failure, the client may experience which symptom? (Select all that apply.)
Anxiety Weakness Fatigue Shortness of breath
What is the most accurate method for preventing adverse effects associated with the use of digoxin?
Assess the client's heart rate and hold administration if it is less than 60
A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? -
Atropine
The client taking bisoprolol-hydrochlorothiazide (Ziac) states that he is sure the medication is not decreasing his blood pressure. He tells the nurse he is urinating all the time and he does not like this side effect of the medication. What is the nurse's best response? -
Bisoprolol-hydrochlorothiazide (Ziac) works by decreasing the workload of your heart and increasing the excretion of fluid".
Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?
Blood pressure
A client taking a calcium channel blocker (nifedipine) also takes rantidine for dyspepsia. The nurse assesses the client for which medication interactions?
Bradycardia
The client is taking a calcium channel blocker. Which assessment findings would the nurse expect?
Bradycardia
A client who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of the incision sites. During the process of clot formation, plasminogen will become part of a clot by which means?
By binding with fibrin
A pregnant client has been diagnosed with hypertension, and the care team has determined that the benefits of drug therapy outweigh the risks. What category of antihypertensive is most appropriate?
Calcium channel blocker
The nurse is scheduled to administer the following medications at 0900: furosemide, carvedilol, and ivabradine. The morning laboratory values are sodium 135 mEq/L; potassium 3.2 mEq/L; Calcium 9 mg/dl. Which is the nurse's priority in this situation?
Call the primary care provider for further orders
The 96-year-old client is receiving digoxin and furosemide. In the morning, the client reports having a headache and feeling nauseated. What should the nurse do first? -
Check the client's laboratory values and vital signs
Beta-blockers have what advantage over nitrates in the management of angina?
Clients do not develop tolerance to beta-blockers
A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse most likely administer?
Clopidogrel
An older adult client with a history of mild renal failure has experienced two different transient ischemic attacks (TIAs) and has been prescribed clopidogrel therapy. What statement should be the basis of the nurse's response when asked why aspirin (ASA) wasn't prescribed as the drug of choice?
Clopidogrel is believed to be more effect than aspirin in treating TIAs
Nitrates should not be used in client with which of the following?
Closed-angle glaucoma
An adult client experiences angina pectoris upon exertion. The nurse informs the client that the leading cause of angina is what?
Coronary atherosclerosis
When the nurse administers warfarin, it is expected that the drug will have what effect on the body?
Decrease in production of vitamin K-dependent clotting factors
The nurse teaches the client that antacids when taken with digoxin may have which interactions?
Decreased digoxin levels
A client with angina Is prescribed atenolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?
Decreased heart rate
The nurse is providing education to a client who has been prescribed bisoprolol. During teaching, the nurse explains that the drug achieves a therapeutic effect in what way?
Decreasing heart rate
A client admitted with digitalis toxicity has been taking the same dose for more than 10 years. What question should the nurse ask to assess for possible cause of increased serum level of the medication?
Do you take regular doses of antacids?"
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client
Does not have peptic ulcer disease
The nurse should assess for what as a symptom in a client with left-sided heart failure?
Dyspnea
The nurse assesses the client for which symptoms that may indicate heart failure?
Dyspnea, weight gain, edema
A client is admitted to the hospital with deep vein thrombosis. An infusion of heparin is established. What action best protects the client's safety?
Ensure that protamine sulfate is readily available
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways.
While preparing a client for discharge, the nurse is teaching the client about the proper use of warfarin. Which food should the nurse tell the client to avoid?
Green leafy vegetables
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?
I will take a pill every 15 minutes until the pain subsides".
A client is to receive abciximab. The nurse would expect to administer the drug by which route?
Intravenous
A client is to receive abciximab. The nurse would expect to administer the drug by which route? -
Intravenous
A nurse is preparing to administer an antihypertensive drug that lower the BP primarily via suppression of the renin-angiotensin-aldosterone system/ Which drug might this be?
Lisonopril
A nurse explains to a client that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for which?
Nitrate tolerance
A client, diagnosed with erectile dysfunction, is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated?
Nitroglycerin and sildenafil cause a severe decrease in blood pressure"
A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse most commonly assess?
Pitting edema
The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?
Positive inotropic
A client is being treated with heparin therapy for a pulmonary embolism. The nurse caring for this client knows that heparin
Prevents the extension of the clot that has formed in lungs
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A client presents to the emergency department with rales, wheezing, and blood-tinged sputum. The nurse should choose interventions to address what health problem?
Pulmonary edema
The nurse assesses a client before administering digoxin. What finding would cause the nurse to withhold the drug and notify the health care provider?
Pulse 44 beats/min
A client was given a new prescription for a transdermal nitroglycerin patch. What client education should the nurse provide regarding this medication?
Put your patch on a part of your skin that doesn't have too much hair on it
A client is diagnosed with angina pectoris. What would the nurse include when explaining this condition to the client?
The heart muscle isn't getting enough oxygen
client is admitted to the emergency department with severe heart failure. Milrinone is administered IV. For what adverse effect should the nurse assess?
Thrombocytopenia
An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder?
Thrombolytic drugs
A 65-year-old client is prescribed sublingual nitroglycerin for unstable angina. The client contacts the office to report a headache when the nitroglycerin is used for chest pain. Which intervention would help alleviate this effect?
Treat the occurrences of headache with analgesics
A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess?
Yellow or green vision
A client is diagnosed with heart failure and is started on digoxin. On the second day of therapy, lab values, the ECG results, and the client's symptoms indicate that the medication is not producing a therapeutic effect. An appropriate nursing action would be to:
continue to administer the drug as ordered.
A client prescribed ramipril earlier in the week states "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement?
"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider."
A client with a history of trans-ischemic attacks (TIAs) was prescribed aspirin several weeks ago. Which assessment question should the nurse ask to monitor the client for the medication's adverse effects?
"Have you experienced any dizziness?", "Would you say your hearing has been affected?". "Are you experiencing any heart burn or indigestion?", "Have you been testing your stool for occult blood?"
A 37-year-old client presents with a blood pressure of 118/86 mm Hg. What advice should the nurse provide to this client?
- "Be aware of your salt intake and limit hidden salt".
When teaching the client to safely administer nitroglycerin ointment, the nurse should convey which instruction?
- "Make sure you squeeze the ointment on to a paper measure scale before applying it"
A client was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse?
- "Nitroglycerin increases the amount of blood flow through the vessels and could cause increased damage".
A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond? -
- "You may experience headaches as an adverse reaction to nitroglycerin
The nurse is teaching a 63-year-old client about sustained-release oral nitrates which has been prescribed for treatment of angina. Which instructions would the nurse offer to the client when teaching how to properly self-administer the medication?
- Take the medication on an empty stomach
The nurse is measuring the blood pressure of a client during a follow-up office visit. What blood pressure reading, if it repeats a measurement taken during a previous visit, would indicate hypertension?
120/85
A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following?
130/80 mm Hg
A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be
2.7 nanograms/mL
A client prescribed an anticoagulant demonstrates an understanding of their condition by implementing which interventions to manage an episode of bleeding? Select all that apply.
Apply firm, constant pressure to the bleeding site. Notify a health care provider immediately.
A client with angina has been prescribed nifedipine 15 mg po t.i.d. The client has received the first two doses of the medication and reports dizziness. What is the nurse's best action?
Assess the client's blood pressure
The nurse is administering milrinone to a client with heart failure. The nurse should prioritize what assessment when monitoring the client for common adverse effects?
Blood pressure
a 70-year-old resident of a long-term care facility has experienced increasing pain, swelling, and redness to her lower leg over the past 12 hours, prompting the care providers at the facility to have the woman brought to the local emergency department. Diagnostic testing has confirmed deep vein thrombosis (DVT) and an IV infusion of alteplase (Activase) has been initiated. Unlike anticoagulants, a thrombolytic such as alteplase can -
Break down existing clots
The nurse is providing education to a client who has been prescribed bisoprolol. During teaching, the nurse explains that the drug achieves a therapeutic effect in what way? -
Decreasing heart rate
What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL?
Digitalis toxicity is a possibility
What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL?
Digitalis toxicity is a possibility.
A client is experiencing nausea and visual disturbances when taking digoxin. Which medication will be administered?
Digoxin immune fab
The client is started on a transdermal nitroglycerin patch system. The nurse teaches the client that the system relieves pain by which action?
Dilates arteries and veins.
A client is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid what?
Ginkgo
The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
Giving intramuscular injections
The nurse should instruct the client to take what action if nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?
Go to the emergency department
The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decreased blood pressure. Which menu selection indicates the need for further client education?
Ham sandwich with mustard, carrots and cheesy dip
The client is taking a calcium-channel blocker. What adverse effects might the client experience?
Headache and dizziness
The nurse is caring for a client with angina who is taking a calcium-channel blocker. What adverse effects would the nurse caution this client about?
Headache and dizziness
The client has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the client most likely experiencing?
Heart failure
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?
Heparin
The nurse is caring for a postpartum client admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?
Heparin
Which adverse effect might occur in a client receiving milrinone?
Hypotension
The nurse provides a drug teaching to the client prescribed captopril. What statement made by the client does the nurse interpret to mean teaching has been effective?
I will call my doctor if I bruise easily or become extremely tired
A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hyper tensive emergency?
Implement intervention to lower blood pressure
A client takes digoxin and furosemide (Lasix) for peripheral edema resulting from heart failure. Hypokalemia, caused by furosemide, has what effect on digoxin?
Increased action of digoxin
The nursing students are learning about digoxin therapy in their pharmacology class. The students will learn that there is a higher risk of digoxin toxicity in clients with?
Low serum potassium levels
When assessing a 50-year-old client during a routine checkup, the nurse observes that the client has a blood pressure of 140/90 mm Hg in his right arm. Which findings would be most important for the nurse to assess? Select all that apply.
Measure blood pressure in both the arms, assess for pitting edema in the extremities, record the client's body weight
When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition?
Myocardial hypertrophy
A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?
Myocardial infarction
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?
Notify the health care provider
A 59-year-old female client has been prescribed digoxin. the nurse assigned to the client will instruct her to avoid:
OTC cold remedies
A client has been diagnosed with angina and prescribed nitroglycerin. What aspect of the client's health history should prompt the nurse to monitor the client particularly closely after administration of the drug? -
Orthostatic hypotension
What values are used to monitor the effectiveness of warfarin therapy?
PT and INR
A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what effect?
Persistent cough
The nurse is providing drug teaching for a client who is prescribed enalapril. What drug-specific adverse effect will the nurse include in the drug teaching?
Persistent cough
A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?
Positive inotropic effect
The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin toxicity?
Potassium 3.3
A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor?
Potassium levels
Ms. Tacey, a 65-year-old woman, is treated with eplerenone for hypertension. In addition to monitoring her blood pressure, what other important assessment needs to be prioritized in her care?
Potassium levels
A male client is receiving heparin by continuous intravenous infusion. The nurse will instruct the client and family members to report what should it occur?
Presence of blood in urine or stools
A client arrives at the urgent care center complaining of 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?
Prinzmetal angina
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
A client has presented to the emergency department with a new onset of unilateral weakness and visual disturbances. The care team suspects that the client has had a cerebrovascular accident and the administration of alteplase is being considered. What is the care priority prior to administering alteplase?
Ruling out a hemorrhagic stroke
A client with chronic alcoholism has been admitted to the health care center for acute angina management and is started on nitrates. The nurse emphasizes the need for the client to avoid alcohol use to prevent which reaction? -
Severe hypotension
The pediatric nurse examines an 11-year-old client with mildly elevated blood pressure who is 15% above the upper age-based weight limits. What is the nurse's priority teaching point?
Strategize with the client and family about ways to increase the child's activity level
A client is to receive enoxaparin (Lovenox). The nurse would administer this drug by which route?
Subcutaneous injection
A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention?
Take the medication at bedtime.
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?
Tarry stools
The nurse is assessing a client who is being considered for anticoagulant therapy. What aspect of the client's health history should the nurse follow up most closely?
The client has a history of GI ulcers
A combination of drugs needs to be incorporated into the drug regiment for a hypertensive client. What type of diuretic would the nurse expect to administer?
Thiazide
After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when the identify which agent as a calcium channel blocker?
Valsartan
A client who is receiving warfarin has blood in the urinary drainage bag. What medication will likely be prescribed by the health care provider?
Vitamin K
The nurse is caring for a 73 year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?
Vitamin K
The client taking antihypertensive medications is taught to notify the healthcare provider when which findings occur?
Weight gain of five pounds over a 2-day period
Which questions would be the most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?
When was your last menstrual period?"
A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor?
digitalis toxicity
A client is to receive eptifibatide. The nurse would expect to administer this drug by which route? -
intravenous
A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse suspect the health care provider to prescribe?
losartan. What additional medication would the nurse suspect the health care provider to prescribe? - Hydrochlorothiazide
A client, newly diagnosed with heart failure, questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. What is the rationale for the nurse's response?
to rapidly bring the client's serum digoxin levels up to therapeutic levels
Prior to the administration of nitroglycerin, the nurse would assess which of the following?
- Blood pressure
A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regiment to better control the client's hypertension?
A diuretic
What statement should under the nurse's response when asked if ACE inhibitor therapy can be continued during pregnancy?
ACE inhibitors are contraindicated during pregnancy because they are teratogenic
A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which action should the nurse do first when he reports chest pain?
Administer a tablet under the tongue and repeat the action in 5 and 10 minutes if the pain has not subsided
A female client is admitted to the hospital for treatment of a pulmonary embolism. Forty-eight hours after therapy has started, the client reports bleeding from her gums when she brushes her teeth. What orders can the nurse anticipate receiving from the health care provider to reverse the effects of the heparin?
Administer protamine sulfate, at a dosage of 1 mg per 100 units of heparin, for a maximum dose of 100 mg
a 55-year-old client has been diagnosed with coronary artery disease and begun antiplatelet therapy. The client has asked the nurse why a "blood thinner like warfarin" hasn't been prescribed. What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?
Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis
A client is admitted to the emergency department with severe chest pain. The emergency department health care provider orders intravenous nitroglycerin 5mcg/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?
Blood pressure
The chest pain and pressure a client experiences during an anginal attack is caused by which of the following?
Decreased oxygen supply to the heart
A client taking warfarin (Coumadin) tells the nurse she is having bleeding in the gums and teeth. When reviewing the client history, the client states she has decided to try an herbal remedy. Which of the following is most likely the cause of increased bleeding?
Ginger
A client has developed the formation of clots and has bruising. It is determined that there is a depletion of the client's coagulation factors and widespread bleeding. What medication will be administered?
Heparin
A client with a history of clot formation is scheduled for a bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? -
Heparin
A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?
Heparin
The emergency department nurse is asked to prepare a nitroprusside infusion for a client being brought to the hospital in an ambulance. What is this client's most likely diagnosis?
Hypertensive crisis
adverse effect of minoxidil
Increase in breast size is an adverse effect of minoxidil
What are cardiac glycosides used for?
Increase the force of contraction of the heart
The nursing instructor explains to students that positive inotropic action affects the heart in which way?
Increased myocardial contraction
The nurse recognizes that which medication may be used to treat a hypertensive crisis?
Nitroprusside
The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports:
No episodes of angina since ointment was initiated
Mrs. Houston is a 78-year-old woman who resides in 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?
The importance of having required laboratory work performed on time
The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply. - Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider.
The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? - Clonidine
A client is prescribed digoxin for treatment of heart failure. The nurse educates the client regarding safe digoxin administration. The nurse should include which circumstance would lead to considerable reduction in absorption of the drug?
When digoxin is taken with a meal that is very high in bran fiber
A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's
aPTT
What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?
aPTT
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?
omit dose and contact the health care provider.
A client is receiving candesartan. The nurse understands that this drug acts in which manner? -
selectively binds with angiotensin II receptors in the vascular smooth muscle
A client's angina pectoris is being successfully treated on an outclient basis with sublingual nitroglycerin. What teaching point should the nurse convey to the client when reporting concern about the headache that follows the use of the medication? - "
"This is a common adverse effect of nitroglycerin; try taking acetaminophen to treat your headache"
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?
"This medication will keep unnecessary clots from forming in my blood"
The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? -
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease".
A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond?
"You may experience headaches as an adverse reaction to nitroglycerin
What is the total dose range of digoxin for rapid digitalization?
- 0.75 to 1.5 mg
A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?
- 2
A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that
- A persistent, drug cough may occur; however, it is not serious
A client has been diagnosed with hypertension following several elevated blood pressure readings. The nurse should prepare to educate the client regarding which likely drug regimen?
- A thiazide diuretic combined with a beta-blocker
Which assessment findings may indicate the client is experiencing digitalis toxicity?
- Abdominal pain, diarrhea, drowsiness, vomiting
When a client is prescribed nitroglycerin transdermal spray, what instructions should the nurse provide the client concerning how to administer the spray?
- Administer the spray as soon as chest pain develops
To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?
- Administering a one-time loading dose that is higher than the maintenance dose
A health care provider has ordered 40 mg of isosorbide dinitrate for a client who reports chest pain. The nurse administers the medication after confirming the absence of what condition?
- Anemia
A client is prescribed a transdermal nitroglycerin system. The nurse educates the client on which action?
- Apply the new transdermal system at the same time daily
A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of medications and the report of pain, what should the nurse suspect is the cause of the pain?
- Bleeding
How does captopril contribute to a reduction of a client's blood pressure?
- Blocking the conversion of angiotensin I to angiotensin II
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 intravenous heparin infusion. How does this drug achieve therapeutic effect?
- By inactivating clotting factors and thus stopping the coagulation cascade
A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help promote compliance?
- Cough
What drug is a safe and effective calcium channel blocker only if the nurse administers it as a sustained-release or extended-release preparation to treat hypertension?
- Diltiazem
A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. The nurse first reviews the client's most recent blood work and should consider withholding the dose because of what laboratory finding?
- Elevated potassium levels
A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action?
- Hold the dose and call the result to the prescriber
The nurse recognizes that treatment for digitalis toxicity includes which of the following?
- Holding the medication
What assessment finding indicates that a client's left-sided heart failure is worsening?
- Increased crackles in lung fields
The nurse suspects the client may have toxic levels of digoxin in the bloodstream when what is assessed?
- Irregular heart rhythms, nausea, anorexia
The nurse is caring for a client with angina who has been prescribed nitroglycerin. What health teaching about the client's life style should the nurse provide?
- It's best to eliminate or reduce your intake of alcoholic beverages
A client is being discharged home with a prescription for sublingual nitroglycerin. The nurse will instruct the client and family to do which?
- Keep the tablets in the original dark bottle
What is the priority nursing assessment for a client who is about to begin digoxin therapy?
- Kidney function
A client develops primary hypertension and asks the nurse, "how long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long?
- Lifelong
A male client is having angina. As the nurse prepares to administer sublingual nitroglycerin, it is noted that the client's blood pressure is 82/54. What is the best action of the nurse? -
- Notify the health care provider
Prior to administration of digoxin, the nurse evaluates the client's laboratory values. Which lab findings should the nurse alert the health care provider about before administering digoxin?
- Potassium level of 3.0 mEq/L
The client has been taking atenolol for 2 years. The nurse teaches the client to not stop taking his antihypertensives abruptly because what may occur?
- Rebound hypertension
A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan?
- Regular aerobic exercise, diet with more fruits and vegetables, decreased alcohol consumption, smoking cessation
After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided?
- Sildenafil, Tadalafil, Vardenafil
The client has been prescribed amlodipine (Norvasc) for hypertension. His blood pressure upon revisit remains elevated. The nurse inquires about the use of which alternative therapy? -
- St. John's wort
A nurse providing medication education to a client with a new prescription for digoxin should identify which herb as having the tendency to decrease the effects of the medication?
- St. John's wort.vcc
On several occasions, the nurse checks a client's blood pressure. The readings are 130/79, 136/78, and 128/88. What term would the nurse use to document the client's blood pressure?
- Stage 1 hypertension
A client with a BP of 165/95 mm Hg would be classified in which stage of hypertension?
- Stage 2
The goal of therapy for a client taking antihypertensive medication is to maintain
- The blood pressure within normal limits
What is a goal of spironolactone therapy for a client being treated for heart failure? -
- The client will experience a decrease in edema
A recent episode of chest pain while doing yard work prompted a 70-year-old man to seek care and he has been subsequently diagnosed with chronic stable angina. The nurse should recognize what guiding principle in the treatment of this client's angina?
- The client's angina may necessitate the use of a calcium channel blocker
An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect?
- falls
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care this resident should recognize that this change in the resident's medication regiment may create a risk for
- falls
The primary health care provider orders a 300-mg dose of clopidogrel (Plavix) 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?
- loading dose
A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's
- pulse is 52 beats per minute
A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be:
2.7 nanograms/mL
A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?
By inhibiting the transformation of angiotensin I to angiotensin II
A client is being treated for heart failure. What assessment finding would the nurse interpret as most indicative of improved health status?
Decreased pitting edema
A client is being treated for heart failure. What assessment finding would the nurse interpret as most indicative of improved health status? -
Decreased pitting edema
A client with a history of severe renal failure has been placed on digoxin therapy. Based upon the client's history, what changes should be made to the prescribed therapy?
Digoxin dose will need to be reduced
Many commonly used herbs and supplements alter the effects of anticoagulant drugs. Which of the following substances presents an additive bleeding effect when taken concomitantly with warfarin?
Ginger
After administering a nitrate, the nurse would be alert for which reactions? Select all that apply.
Headache, hypotension, flushing
A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?
Heparin is administered parenterally, while warfarin is administered orally
The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?
Hyperkalemia
A client diagnosed with acute-onset pulmonary edema has not experienced a response to digitalization. The nurse should expect what drug to be prescribed for this client?
Hypokalemia
A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin
Hypokalemia
The nurse assesses the client for which of the following adverse reactions related to the use of digoxin?
Hypokalemia
A 49-year-old client is admitted with uncontrolled chest pain. The client is currently taking nitroglycerin. The health care provider adds nifedipine to the client's regimen. The nurse should observe the client for what adverse effects?
Hypotension
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for?
Hypotension
A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client?
Hypotension
A client who uses St. John's wort is receiving warfarin. The nurse would be alert for which deviation from normal findings?
Increase risk of bleeding
The nurse explains to the client that with heart failure, what may occur?
Increased heart rate
Milirinon (Primacor) is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?
Intravenously
A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker?
Isosorbide
A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be?
Lisinopril
A client was admitted with head trauma. The family is concerned the client was not restarted on his transdermal nitroglycerin system. What is the best response of the nurse?
Nitroglycerin increases the amount of blood flow through the vessels and could cause increased damage".
A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets? -
Nitroglycerin will increase intracranial pressure
A male client has sustained a head injury in a motor vehicle accident. He has nitroglycerine tablets for chest pain and asks the nurse for one due to chest pain. What effect will the nitroglycerine have on the client's current status?
Nitroglycerine will increase intracranial pressure
The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?
Nitrostat
A male client is having angina. As the nurse prepares to administer sublingual nitroglycerin, it is noted that the client's blood pressure is 82/54. What is the best action of the nurse?
Notify the health care provider
The nurse cautions a client receiving nitrate therapy about avoiding the use of alcohol to prevent which reaction?
Severe hypotension
The client has been diagnosed with coronary artery disease. The nurse teaches the client to avoid which activity?
Shoveling snow
The clinic nurse assesses a client taking benazepril to control hypertension. What change in the client's health status may require a change in drug therapy?
The client's creatinine clearance is steadily declining
A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications?
Visual disturbances
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?
Vitamin K
A client who has been treated with warfarin 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?
Vitamin K
An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified?
prehypertension
