pharm final

Blurred vision or halos are signs of: -Blurred vision or halos are signs of: -Digoxin toxicity -Nothing related to digoxin -Corneal side effects of digoxin

Digoxin toxicity. Halos is a hallmark sign of digoxin toxicity.

blocks the enzyme Phosphodiesterase in cardiac and smooth muscle. This will increase the amount of calcium available. Calcium will increase the force of myocardial contractions. This action also increases cardiac output.

Milrinone

Which is the MOST appropriate action for the nurse to take before administering digoxin? -Monitor potassium level -Assess blood pressure -Evaluate urinary output -Avoid giving with thiazide diuretic

Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity.

Adverse effects include Head ache ( most serious ), Lightheadedness, N/V, Dizziness

Nitroglycerin

Contraindicated in patients -with nitroglycerin allergy, Hypotensive, Children under 12, Increased intracranial pressure, Has severe anemia

Nitroglycerin

Mechanism of action is to relax both arterial and venous smooth muscle, thus decreasing the workload of the heart and lowering myocardial oxygen demand.

Nitroglycerin

Therapeutic effect is to relieve angina pain, and decrease the workload of the heart

Nitroglycerin

The only contraindication for is a previous hypersensitivity. Caution should be used when combining with digoxin, dobutamine, or other positive inotropic drugs because the positive inotropic effects on the heart may be additive.

Milrinone

Therapeutic effect: helps with management of heart failure by increasing the force of myocardial contraction.

Milrinone

Which of the following clients is at greatest risk for digital toxicity? -A 25-year-old client with congenital heart disease -A 50-year-old client with CHF -A 60-year-old client after myocardial infarction -An 80-year-old client with CHF

An 80 yr old with CHF

A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? A. "Apply the patch to a non-hairy area of the upper torso or arm." B. "Apple the patch to the same site each day." C. If you have a headache, remove the patch for 4 hours then reapply." D. If you have chest pain, apply a second patch next to the first patch."

Apply the patch to a non hairy area of the upper torso or arm

A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure 120/80 mm Hg b. Heart rate 70 beats per minute c. ECG without evidence of ST changes d. Client stating that pain is 0 out of 10

Client stating that pain is 0 out of 10

Therapeutic effect increases the force of myocardial contraction, slows heart rate and conduction of the heart. It is a positive inotropic and a negative chronotropic which is used for heat failure.

Digoxin

inhibits the critical enzyme (sodium potassium ATPase) responsible for pumping sodium ions out of the myocardial cell in exchange for potassium ions. As sodium accumulates calcium ions are released from their storage areas in the cell producing a more forceful contraction.

Digoxin

Adverse effects include: "First-dose phenomenon"; Orthostatic hypotension; Headache; Dizziness; Angioedema; Neutropenia; Agranulocytosis; Hyperkalemia; Dry cough

Enalapril

May increase the following labs: AST/ALT; Glucose; Amylase; Bilirubin; Potassium; Lipase; Contraindications: Pregnancy, Hypersensitivity, History of angioedema

Enalapril

Therapeutic effects of this drug include: Significant reduction in blood pressure. Reduction of death or development of CHF after an MI. Prevents the progression to heart failure in asymptomatic patients with left ventricular dysfunction.

Enalapril

_____________ works to decrease blood pressure by reducing angiotensin II and aldosterone levels to produce a significant reduction in blood pressure. It can be used as monotherapy or in combination with other antihypertensives. ACE inhibitor

Enalapril

The client has a nighttime cough related to taking enalapril (Vasotec). What is the best nursing intervention to promote rest in this client? A. Contact the physician for an order for a sedative-hypnotic medication. B. Have the client sleep on two or three pillows a night. C. Contact the physician for an order for a cough-suppressant medication. D. Have the client sit up at an 80-degree angle in a comfortable chair at night.

Have the client sleep on two or three pillows a night

Which of the following is a contraindication for digoxin administration? -Blood pressure of 140/90 -Heart rate above 80 -Heart rate below 60 -Respiratory rate above 20

Heart rate below 60

Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? A) "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." B) "I should keep my nitroglycerin in a cool, dry place." C) "I should change positions slowly to avoid getting dizzy." D) "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

I can take up to five tablet at 3 minute intervals for chest pain if necessary

The nurse is providing discharge instructions for a patient with hypertension who has a new prescription for enalapril (Vasotec). The nurse determines the patient needs more education when he makes which statement? A. "I need to increase my dietary intake of high-potassium foods." B. "I need to make an appointment with the dietician for teaching." C. "I need to check my blood pressure at home at least once a day." D. "I should move slowly when rising from sitting to standing."

I need to increase my dietary intake of high potassium foods

The health care provider prescribes levothyroxine (Synthroid) for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says: a. "I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to normal function with the use of this drug." d. "I will report any chest pain or difficulty breathing to the doctor right away."

I only need to take this drug until my symptoms are improved

Actions are those of endogenous thyroid hormone which include: Increase metabolic rate, improved tolerance to environmental temperature, increased activity, increased pulse rate

Levothyroxine

Administer the medication at the same time every day preferably in the morning to decrease the potential for insomnia. Start low, go slow, Replacement therapy for most patients is continued lifelong. Pregnancy category A.

Levothyroxine

Adverse effects are rare. The adverse effect are those of Hyperthyroidism, Palpitations, Dysrhythmias, Anxiety, Insomnia, Weight loss, Heat intolerance, Menstrual irregularities may occur in females

Levothyroxine

Labs/contraindications: Serum TSH levels are regularly monitored to determine whether the patient is receiving sufficient levothyroxine, high TSH levels usually indicate that the dosage of T4 needs to be increased. Contraindications: Hypersensitivity, Experiencing thyrotoxicosis (excess of thyroid hormone in your body), Has severe cardiovascular conditions or acute MI

Levothyroxine

Therapeutic effects: Increase metabolic , Improved tolerance to environmental temperature, Increased activity, Increased pulse rate

Levothyroxine

Adverse effects: Dysrhythmias, headache, Nausea & vomiting. The most common adverse effect is hypotension. If the BP goes too low support it with vasopressors or fluid replacement.

Milrinone

Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the following nursing actions is necessary? -Record sodium level -Administer loading dose over 15 minutes. -Assess CV status. -Review medication regimen to identify if client is on IV furosemide (Lasix).

Review medication regimen to identify if client is on IV furosemide, they are incompatible. Most patients with CHF are taking lasix

What is a priority nursing assessment for a client that has just been prescribed the antihypertensive medication enalapril (Vasotec)? A. Review the client's lab results for hypokalemia. B. Order a sodium-restricted diet for the client. C. Take the client's blood pressure. D. Monitor the client for headaches.

Take the client's blood pressure

In the administration of the drug Levothyroxine, the nurse must teach the client: (select all that apply) A. Therapy could take 3 weeks or longer B. Periodic lab tests for T4 levels are required C. Report weight loss, anxiety, insomnia, palpitations D. Jaundice

Therapy could take 3 weeks or longer, periodic lab tests for T4 levels are required, report weight loss, anxiety, insomnia, palpitaions

A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: A. Should be taken in the morning B. May decrease the client's energy level C. Must be stored in a dark container D. Will decrease the client's heart rate

should be taken in the morning

A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is: -bradypnea -failure to thrive -tachycardia -vomiting

vomiting