pharm cardiovascular

The nurse is providing education to a client being discharged home with a new prescription for digoxin. Which client statement is most important for the nurse to address?

"I drink a glass of red wine every evening to help me relax" This answer is correct because it is most important for the nurse to follow up on the client's statement about drinking a nightly glass of red wine. Clients should avoid drinking alcohol while taking digoxin. Alcohol can decrease the available concentration of digoxin in the bloodstream and cause cardiac abnormalities.

The nurse is caring for a client who is taking enalapril for hypertension. Which client statement should the nurse report to the health care provider?

"i have developed a dry hacking cough i cannot get to go away" --This answer is correct because enalapril is an ACE inhibitor. ACE inhibitors can cause a persistent, dry cough. The nurse should report this statement to the health care provider because a change in the type of antihypertensive may be indicated.

Procianamide hydrochloride (Pronestyl)

-antiarrhythmic -treats a-fib and ventricular arrhythmias

Cardiotonics (cardiac glycosides)

-meds that stimulate or strengthen the heart's pumping action -digitalizing dose, maintenance dose digoxin

Lidocaine (Xylocaine)

Antiarrhythmic -treats life threatening ventricular arrhythmias after MI

The nurse administers a scheduled dose of propranolol to a client. Which findings would indicate that the medication has been effective when the nurse reassesses the client an hour later?

initial BP 162/94, repeat BP 128/70 --This answer is correct because beta blockers block the action of the sympathetic nervous system and prevent the hormone epinephrine from affecting the body. Propranolol is a nonspecific beta blocker that acts on the beta receptors in the heart and the lungs. A decrease in blood pressure indicates that this medication has been effective.

The nurse is caring for a client who has an order for spironolactone. Which information is most important for the nurse to include in the teaching plan about this medication?

limit intake of salts and sports drinks --This answer is correct because clients taking spironolactone, a potassium-sparing diuretic, should avoid intake of high-potassium salt substitutes or sport drinks or other electrolyte-enhanced beverages that are high in potassium. Clients should also follow a low-sodium diet. While taking this diuretic, labs are drawn at regular intervals to monitor potassium levels and monitor renal function.

The nurse is caring for a client who takes lisinopril for hypertension. Which dietary consideration is most important for this client?

limit intake of avocados, oranges and liver --This answer is correct because lisinopril is an ACE inhibitor. This type of antihypertensive medication can predispose clients to hyperkalemia by increasing the circulation of potassium in the body. Clients should limit potassium-rich foods like avocados, oranges, and liver that could further exacerbate the risk of hyperkalemia.

antiarrhythmic drugs

medications that regulate heart rhythm -Quinidine -Pronestyl -Calan, Isoptin -Inderal -Xylocaine

a nurse is teaching a client who has a new prescription doe quinidine. Which of the following statements should the nurse include?

-"monitor your pulse rate and report changes" --sodium channel blockers 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.

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 type of drugs? (select all that apply)

-MAOIs: can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias. -General anesthetic: can cause dysrhythmias when clients take them while also taking dobutamine -Tricyclic antidepressants: can cause toxicity when clients take them while also taking dobutamine. This significantly increases the client's risk for tachydysrhythmias. -Beta blocker: such as propranolol can decrease the effects of dobutamine.

antianginal agents

-actions: lower cardiac oxygen demand and improve exercise tolerance and decrease pain ex: ranolazine (Ranexa) -uses: chronic stable angina along with other medications monitor: BP, palpitations, chest pain or dyspnea

a nurse should recognize that milrinone is contradicted for a client who has which of the following conditions?

-acute myocardical infarction --milrinone, a phosphodiesterase inhibitor,is contraindicated for clients who have had an allergic reaction to phosphodiesterase inhibitors and for clients who have an AMI and aortic or pulmonary valve disorders.

vasodilators

-dilate blood vessels to treat peripheral blood vessel disease, CAD, and HTN -increase lumen size of vessels and increases blood flow

cardiac meds that affect blood vessels

-vasoconstrictors -vasodilation: nitrates and others

The nurse is caring for a client who is scheduled to receive a morning dose of diltiazem. Prior to administration, the nurse notes that the client's blood pressure is 98/60 mmHg and the client's heart rate is 110 beats/minute. Which action is most important for the nurse to take?

-withhold the medication and notify provider --This answer is correct because although the client's heart rate is well above the 60 beats per minute that can support receiving diltiazem, the client's blood pressure is mildly hypotensive. Since the client's systolic blood pressure is less than 100 mmHg, the nurse should withhold the scheduled dose of diltiazem because this medication will further decrease the client's blood pressure. The nurse should notify the health care provider.

*******Propanolol hydrochloride (Inderal)

BETA 1-BETA2 NONSELECTIVE BLOCKER Action: nonselective- beta 1 and 2 blocker, beta blocking action that prevents arterial dilation and inhibits renin secretion, decrease BP and HR, improve myocardial contractility, decreases myocardial oxygen demand Uses: HTN, chronic angina, supraventricular arrhythmias, and ventricular tachycardia control tremor, prevent vascular migraine headaches, prevent MI Interactions: ACE inhibitors, anesthetics, beta blocks, calcium channel blockers, fentanyl, insulin, Mao inhibitors, tricyclic antidepressants NSAIDS, phenytoin, etc. S.E.: anxiety, depression, dizziness, AV conduction disorders, bradycardia, heart failure, hypotension, dry eyes, agranulocytosis, thrombocytopenic purpura, bronchospasm

The nurse is caring for a client who is scheduled to receive a dose of metoprolol for hypertension. Which abnormal finding is most important for the nurse to report immediately to the health care provider?

HR of 58bpm --This answer is correct because a rate of 58 beats/minute is considered bradycardia. Administering metoprolol as scheduled can decrease the heart rate further. The nurse should withhold the medication and contact the health care provider.

The nurse is preparing to administer the next scheduled dose of digoxin to a client. Which result causes the nurse to withhold the medication and contact the health care provider?

a digoxin level of 2.6ng/mL --This answer is correct because therapeutic digoxin levels should be no greater than 2.0 ng/mL. A serum digoxin level of 2.6 ng/mL is consistent with digoxin toxicity. The nurse should withhold the client's scheduled dose of digoxin and immediately notify the health care provider.

Organic Nitrates

action: dilates veins and decreases venous return (preload), which decreases cardiac oxygen demand ex: nitro, isosorbide dinitrate (sublingual), isosorbide mononitrate (oral) -uses: acute angina, phrophylaxis of chronic stable angina or cariant angina -monitor: BP, HR, HA, tolerance -comes in many form, most often see sublingual one tab (or one spray if translingual) every 5min x3

angina agents

anginal pain can be sudden pain beneath the sternum that can radiate down the left shoulder, arm and jaw. results from inadequate oxygen supply to meet myocardial demands -organic nitrates

The nurse is caring for a client with a prescription for a vasodilator. Which consideration is most important for the nurse to include in the teaching plan?

changed positions carefully and slowly --Clients taking vasodilators may experience orthostatic or positional hypotension. To minimize dizziness and prevent falls, clients should understand the importance of changing positions slowly and carefully. Examples of vasodilators include nitroglycerin and hydralazine.

The nurse is caring for a client who has an order for furosemide to be administered via intravenous push. Which action is most important for the nurse to take first?

determine the clients potassium and creatinine levels -This answer is correct because prior to administration, the nurse should carefully evaluate the client's blood pressure, potassium, and creatinine levels. The nurse should determine the client's potassium level to ensure that the value is at least 3.5 mEq/L, and also check the client's creatinine to verify that the client does not have compromised kidney function. If the potassium level is low or the creatinine level is elevated, the nurse should withhold the medication and contact the health care provider.

The nurse is caring for a client with a new prescription for amlodipine. Which information is most important for the nurse to include in the medication teaching plan?

move slowly when changing positions --Client education helps ensure understanding of possible side effects and pertinent safety considerations. The nurse should instruct the client with a new prescription for amlodipine about the importance of changing positions slowly, especially when moving to a more upright position.

The nurse is caring for a client in hypertensive crisis who has an order for nitroprusside. Which action should the nurse take first?

obtain an accurate weight --This answer is correct because nitroprusside is delivered as an intravenous infusion that is dosed according to the client's weight (mcg/kg/min). Ensuring a recent and accurate rate is a critically important nursing consideration with this medication. Client vital signs should be monitored continuously, and the nitroprusside drip is titrated until the goal blood pressure is obtained.

The nurse is caring for a client with a critically high digoxin level that is experiencing significant changes in cardiac rhythm. The health care provider orders digoxin immune Fab. Which changes best indicate that this medication is working effectively?

the client reports clearer vision and fewer palpitations --This answer is correct because manifestations of digoxin toxicity include vision changes (difficulty reading, changes in color perception or yellowed vision, blurred vision), nausea and vomiting, confusion, and dizziness. The client's report of clearer vision and fewer palpitations indicate that the reversal is effective. Evidence of the effectiveness of the reversal of digoxin toxicity usually occurs within 15-60 minutes after the antidote is administered.

The intensive care unit nurse is caring for a client receiving a continuous infusion of verapamil. The nurse notes that the client's blood pressure changed from 172/90 mm/Hg to 140/60 mm/Hg on the two most recent sets of vital sign readings. Which action is most important for the nurse to take next?

titrate the drip to a lower dose --This answer is correct because the client's two most recent blood pressure readings reveal a 30 mmHg difference in both systolic and diastolic values. This drop is significant, so the nurse should first titrate the drip to a lower dosage to ensure that the client's blood pressures do not continue to decrease. The nurse should then notify the health care provider and document the findings.

vasopressors

used to control suoerficial hemorrhage, increase heart's pumping action, raise BP and relieve nasal congestion

verapamil (Calan, Isoptin)

- Calcium channel blocker - Used to Tx angina, hypertension & arrhythmias

Norepinephrine bitartrate (Levophed)

-vasopressor, vasoconstrictor -raises and sustains BP

The nurse is caring for a client with atrial fibrillation who was prescribed digoxin to help with controlling the client's heart rate. The client presents to the clinic for a check up. Which client statement is most concerning to the nurse?

"i have been managing my depression by taking St. John's wort" --This answer is correct because the nurse should immediately follow up on the statement in which the client indicates taking both digoxin and St. John's wort. When taken concurrently with digoxin, St. John's wort (an over-the-counter supplement) can decrease digoxin efficacy. Furthermore, once this supplement is discontinued, the client is at increased risk for digoxin toxicity.

The nurse is preparing to administer a scheduled dose of extended release isosorbide mononitrate to a client. Which client statement prompts the nurse to provide additional client teaching?

"i take this med crushed up with applesauce" --This answer is correct because this statement indicates that the client takes the medication improperly at home. Crushing extended release medication negates its gradual release and instead releases the medication all at once. The nurse should teach the client about the importance of swallowing the pill whole.

hydralazine (Apresoline)

-vasodilator -relaxes arterial smooth muscle causing vasodilation so decreases BP

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 history of which of the following conditions?

-2nd degree AV block --verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or 2nd/3rd 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 caring for a client who has a new prescription for verapamil to treat AFIB. 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

-Hypotention -- 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 caring for a client who has a new presciption for popranolol to treat tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following OTC drugs while taking propranolol?

-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 is caring for a client taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?

-Raisins -- diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium-rich food in their diet, such as raisins and other dried fruits.

quinidine sulfate (Quinidine)

-antiarrhythmic -Used to treat atrial arrhythmias -Regulates the number of times the atria contract in a given period Side effects: -Dizziness, headache, ventricular tachycardia, angina, bradycardia, nausea

a nurse is caring for a client who is taking digoxin and develops changes in their ECG tracing and other manifestations that indicate the client has a severe digoxin toxicity. which of the following drugs should the nurse expect to administer to treat this complication?

-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.

The nurse is caring for a client who has been prescribed a diuretic to manage hypertension. The nurse should caution the client about use of which type of over-the-counter medication? Select all that apply.

-cold meds -nasal decongestants -ibuprofen -antacids -acetaminophen --This answer is correct because many over-the-counter cold and flu medications are high in sodium and may increase blood pressure. Other over-the-counter medications that may also have this effect include pain medications, nasal decongestants, and certain antacids. Clients should consult with their health care provider before taking any of these over-the counter medications.

digoxin (Lanoxin)

-derived from digitatis leaf -strengthen the force of ventricular contractions which increase cardiac output (CO) -due to increase CO the HR decreases so less workload on the heart -needs a loading dose and then a maintenance dose -apical pulse needs to be 60 or greater BEFORE giving -toxic levels of digoxin can happen; can occur more rapidly if pt is hypokalemic, be cautious when using diuretics with this med. signs and symptoms of toxicity: N/V/D, HA, PVCs, blurred vision or visual disturbances, confusion, drowsiness

nitrates

-vasodilators -treat angina pectoris -dilate the vessels, in particular coronary arteries, which increases blood flow to myocardial tissues, this decreases pain caused by the constriction of vessels

The nurse is caring for a client who is receiving losartan. Which statement indicates that the client correctly understands the nurse's teaching about this medication?

'i will change positions slowly and carefully" --This answer is correct because this statement indicates that the client understands that this medication may cause orthostatic hypotension. Orthostatic hypotension can increase risk of falls and injury. Clients should change positions slowly and carefully.

The nurse is caring for a client receiving nitroglycerin. Which statement indicates that the client understands an important safety consideration related to this medication?

"i will not take sildenafil while taking nitro" --This answer is correct because sildenafil is a phosphodiesterase inhibitor that is used to treat erectile dysfunction. This medication increases blood flow by relaxing smooth muscle. Combining sildenafil with nitroglycerin can cause an unsafe drop in blood pressure that could lead to cardiovascular collapse.

The nurse is educating a client with a new prescription for hydrochlorothiazide. Which client statement indicates that the nurse's teaching about this medication has been effective?

"i will wear a hat and apply sunscreen before spending time outside" --This answer is correct because HCTZ can cause photosensitivity and increase risk of skin cancer. Clients should wear protective clothing and apply sunscreen with a sun protection factor (SPF) of at least 30 before going outdoors. Health care providers may also recommend that clients undergo annual check-ups with a dermatologist while taking HCTZ.

The nurse is educating a client about a newly-prescribed calcium channel blocker. Which statement indicates that the client understands the nurse's teaching?

"this medication may cause headaches or gum changes and irritation" --This answer is correct because calcium channel blockers may cause headaches, minor gum irritation or bleeding, flushing, or mild nausea. These side effects are common, and clients should continue taking the medication even if these side effects occur. The client should report these side effects to the health care provider, and if they persist or become severe, the provider may choose to change the medication.

The nurse is caring for a client who has been prescribed a beta blocker for hypertension that failed to respond to first-line therapy. Which statement indicates that the client understands the nurse's teaching about this medication?

"this medication may make me tired, but i will not stop taking it suddenly" --This answer is correct because fatigue is a common side effect associated with beta blockers due to the reduction in sympathetic nervous system activity on the heart, which can lower energy. Despite the potential for this side effect and others (like depression or sexual dysfunction), clients must understand that abrupt discontinuation of this medication can lead to beta blocker withdrawal that can precipitate myocardial infarction or tachyarrhythmias. This client correctly verbalizes understanding that this medication should not be stopped suddenly.

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 patch to a hairless area and rotate sites": hair and interfere with the adhesion of the patch, rotating sites can help prevent skin irritation. -"apply a new patch when you start your day": the therapeutic preventative effects of transdermal nitroglycerin patches begin 30-60min after application and last for up to 14hrs. because angina pain is more likely to occur with activity, most clients require this protection during waking hours. -"remove patches for 10-12 hours each day": helps prevent the development of tolerance to the drug. For most clients, sleeping hours are the time to remove the patch, because angina is more likely during activity.

The nurse is caring for a client who receives a beta blocker for antihypertensive therapy. Which information is most important for the nurse to include in the teaching plan?

-educate the client on the importance of slow position changing --Beta blockers may cause orthostatic hypotension, which can significantly increase a client's risk for falls. The nurse should educate the clients on the importance of slow position changes to help ensure client safety.

The nurse is caring for multiple clients who are scheduled to receive a dose of atenolol for hypertension. For which client should the nurse withhold the medication and contact the health care provider to question the medication order?

the client with an ejection fraction of 23% --This answer is correct because the client with an ejection fraction of 23% has a heart that is functioning at approximately one third of its normal capacity. This value is consistent with significant heart failure, and administration of a beta blocker could further compromise the client's heart function by compounding reduction of cardiac output. The nurse should withhold the beta blocker and contact the health care provider.

a nurse is caring for a client who is taking amiodarone to AFIB. which of the following should the nurse instruct the client to avoid while taking this drug?

-grapefruit juice -- grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers

The nurse is caring for a client who has a new prescription for hydralazine. The nurse recognizes that this medication has been effective when observing which change?

the client's blood pressure decreases from 164/90 to 128/70 --This answer is correct because this answer option displays a decrease in blood pressure. Hydralazine is a potent vasodilator that works by relaxing vascular muscle to dilate blood vessels and decrease vascular resistance. This medication is used to lower blood pressure, and may be used for management of hypertension or even hypertensive crisis, preeclampsia, or eclampsia.

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 --losartan, an angiotensin 2 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 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 effects of this drug?

-headache --adverse effects of nitrates, such as nitroglycerin, includes 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 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: aliskiren, a direct renin inhibitor, can cause elevated potassium levels, especially when take in combo with an ACE inhibitor, potassium supplements or potassium-sparing diuretics. the nurse should obtain a potassium level at baseline and periodically monitor the client's potassium level thereafter. -throat swelling: aliskiren can cause angioedema, which is swelling of the mouth and throat. clients develop this adverse effect should stop taking the drug and seek medical attention. -cough: aliskiren, a direct renin inhibitor, can cause a cough.

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 indicates an adverse effect of this drug?

-hyperuricemia --hyperuricemia, or increased uric acid levels, along with gouty arthritis, can occur in clients who have a history of these conditions and are taking hydrochlorthiazide.

a nurse is caring for a client who is taking carvedilol and has a prescription for a 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?

-hypoglycemia -- these are 2 factors that increase the clients risk. 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 has 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 --manifestations of hypokalemia include a thready, irregluar 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 intruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy?

-muscle pain --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 is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. the nurse should recognize that this drug combo places the client at an increased risk for which of the following adverse effects?

-myopathy --when taking a statin drug, it is important to know that concurrent use of fibric acid derivatives, such as gemfibrozil, or other drugs to lower cholesterol, can increase the risk for myopathy.

The nurse is caring for a client receiving daily furosemide. The client's potassium levels are low, and the health care provider orders repletion with an oral potassium supplement. Which action is most important for the nurse to take?

-place the client on a cardiac monitor --This answer is correct because abnormal potassium levels place the client at risk for changes in waveform conduction and abnormal heart rhythms. Mildly decreased potassium levels may cause flattened, inverted T-waves, while moderately to severely low potassium levels may lead to prolonged Q-T intervals, visible U waves, and slight ST-segment depression. Continuous cardiac monitoring is an important safety consideration.

a nurse is caring for a client who is taking spironolactone to treat hypertension. the nurse should recognize that which of the following lab values requires immediate intervention?

-potassium 5.2 mEq/L -- spironolactone is a diuretic and an aldosterone antagonist that can cause hyperkalemia and places the client as risk for cardiac dysrhythmias. this potassium level is outside the expected reference range of 3.5 - 5.0 mEq/L and required immediate intervention

a nurse should identify that which of the following drugs is used for the short-term treatment of a cardiac dysrhythmia because of serious adverse effects associated with long-term use?

-procainamide --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 risk for serious adverse effects, including cardiotocicity and arterial embolism.

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 a need to discontinue drug therapy? select all that apply

-rash: captopril, an ACE inhibitor can cause a persistent rash. this often indicates the need to discontinue drug therapy. -swelling of the tongue: 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. dry cough: can cause dry cough because of the accumulation of bradykinin. this often indicates the need to discontinue therapy.

The nurse is caring for a client scheduled to receive a calcium channel blocker. The nurse is aware that this type of medication may be used to manage which condition?

-raynaud's syndrome --This answer is correct because Raynaud's syndrome is a condition that causes decreased blood flow to certain areas of the body, particularly the fingers (and also the toes, nose, ears, or knees). This condition results from constriction and vasospasms of blood vessels that supply these areas of the body. Calcium channel blockers inhibit the inflow of calcium into cardiac cells and dilate blood vessels, which helps manage this condition.

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

-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: can cause myopathy, clients should monitor and report any unexplained muscle or joint pain -expect periodic liver functioning testing: increased risk for liver toxicity, clients will require liver function testing while taking meds

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 --severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers. these adverse effects develop because of the depletion of serotonin and nor-epi and can persist after clients discontinue taking the drug.

a nurse is reviewing new prescription 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 -- simvastin is an HMG-CoA reductase inhibitor. It blocks the synthesis of cholesterol by the body to help lower cholesterol levels.

a nurse is caring for a client who has a glomerular filtration of 10mL/min and a reduced urine output. The should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug?

-the drug does not promote diuresis for clients who has renal insufficiency. --adequate kidney function is essential for clients who take hydroclorothiazide, a thiazide diuretic, to promote urine production and effective excretion.

pazosin (Minipress)

-vasodilator -decreases peripheral vascular resistance, allowing arteries and veins to dilate so decreases BP -can cause orthostatic hypotension, SOB, fluid retention (so usually prescribed with a diuretic), dizziness, HA, and drowsiness

nitroglycerin (NTG)

-vasodilator -treats angina -given under the tongue, on tongue or buccal -quick absorption so quick relief, within 1-2 min and lasts ~ 30 minutes -protect from light, only good for 6 months -patches, ointments, long-acting capsules, IV, sprays -DO NOT GIVE FOR: recent MI, severe, asthma, angle closure glaucoma, severe anemia, increased ICP or hypotension

Metaraminol Bitartrate (Aramine)

-vasopressor, vasoconstrictor -indirectly affects the release of norepinephrine -used to prevent hypotension -to raise or maintain blood pressure

The nurse is caring for multiple clients who each have an order for digoxin. The nurse recognizes which client has the greatest risk for developing digoxin toxicity?

a middle aged client with a history of PKD and hypokalemia --This answer is correct because this client displays two significant factors that increase the risk for developing digoxin toxicity: a history of polycystic kidney disease and a history of hypokalemia. Clients with a history of kidney disease or damage are at increased risk for digoxin toxicity because digoxin excreted almost completely unchanged by the kidneys (making it extremely harsh on the kidneys). Additionally, hypokalemia also increases this client's risk for developing digoxin toxicity.

The nurse is caring for multiple clients who each receive an angiotensin-converting enzyme (ACE) inhibitor to manage hypertension. For which client should the nurse suggest discussing a medication change with the health care provider?

a newly-married female client who uses natural family planning --This answer is correct because ACE inhibitors have teratogenic properties, which means that this medication may cause severe birth defects. The client who is newly married and using natural family planning may become pregnant, so a different medication would be a better choice for managing this client's hypertension. Methyldopa, labetalol, and nifedipine are all examples of antihypertensives that may be safe to use during pregnancy.

The nurse is caring for a client who recently began treatment for hypertension with lisinopril. The nurse should carefully monitor the client for which complication?

angioedema --This answer is correct because lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, and can lead to a life-threatening complication known as ACE inhibitor-induced angioedema. This complication can cause swelling of the lips, tongue, and throat, and manifestations may include hoarseness, stridor, or dysphagia. ACE inhibitor-induced angioedema most often develops within the first few days to weeks of medication therapy.