Pharmacology Made Easy 4.0 The Cardiovascular System

A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions?

-Hypotension (Large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the drug in the body can intensify otherwise therapeutic effects like hypotension, causing serious risk for syncope and dizziness.)

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

"Monitor your pulse rate and report changes." (Sodium channel blockers, like quinidine, can worsen dysrhythmias, or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.)

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug?

-Grapefruit juice (Grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers, such as amiodarone.)

A nurse is teaching a client who has a new prescription for nitroglycerin. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug?

-Headache (Adverse effects of nitrates, such as nitroglycerin, include headaches, which can be severe at the beginning of nitrate therapy but decrease in severity with continued exposure to nitrates.)

A nurse is providing teaching to a client who is taking simvastatin. The nurse should instruct the client to report which of the following manifestations as an indication of a serious adverse reaction that could require discontinuing drug therapy?

-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 combination 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.)

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. (Because gemfibrozil, a fibrate, can cause myopathy, clients should monitor and report any unexplained muscle or joint pain.) -Expect periodic liver function testing. (Because gemfibrozil, a fibrate, increases the risk for liver toxicity, clients will require liver function testing while taking this drug.)

A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions?

-Second-degree AV block (Verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second- or third-degree AV block. Verapamil is indicated for hypertension, angina pectoris, and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches.)

A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia?

-Simvastatin (Simvastatin 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 rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug?

-The drug does not promote diuresis for clients who have renal insufficiency. (Adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic, to promote urine production and effective excretion.)

A nurse is caring for a client who 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 the patch to a hairless area and rotate sites" (Hair can interfere with the adhesion of the patch. Rotating patch application sites helps prevent skin irritation.) -"Apply a new patch when you start your day" (The therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last for up to 14 hr. Because angina pain is more likely to occur with activity, most clients require this protection during waking hours.) -"Remove patches for 10 to 12 hr each day" (Removing the patches for 10 to 12 hr each day helps prevent the development of tolerance to the drug. For most clients, sleeping hours are the best time to remove the patch and go "patch-free," because angina pain is more likely during activity.)

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

-Acute myocardial infarction. (Milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who have had an allergic reaction to phosphodiesterase inhibitors and for clients who have an acute myocardial infarction and aortic or pulmonary valve disorders.)

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

-Antigen-binding fragments. (Antigen-binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.)

A nurse is providing teaching to a client who has a new prescription for losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported?

-Facial edema (Losartan, an angiotensin II receptor blocker, can cause angioedema, which often manifests as swelling around the eyes and lips. Clients who develop this adverse effect should stop taking the drug and seek medical attention.)

A nurse is caring for a client who 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 taken in combination with an ACE inhibitor, potassium supplements, or potassium-sparing diuretics. The nurse should obtain a potassium level at baseline and periodically monitor the client's potassium level thereafter.) -Throat swelling (Aliskiren can cause angioedema, which is swelling of the mouth and throat. Clients who develop this adverse effect should stop taking the drug and seek medical attention.) -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 hydrochlorothiazide.)

A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their new diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions?

-Hypoglycemia (There are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic drugs. Also, carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.)

A nurse is assessing a client who is taking a loop diuretic and is experiencing a thready, irregular pulse, orthostatic hypotension, and confusion. The nurse should identify that these manifestations indicate which of the following adverse effects?

-Hypokalemia (Manifestations of hypokalemia include a thready, irregular pulse, orthostatic hypotension, anxiety, confusion, skeletal muscle weakness, hypoactive bowel sounds, polyuria, nausea, and vomiting.)

A nurse is 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 types of drugs? (Select all that apply.)

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

A nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of over-the-counter drugs while taking propranolol?

-NSAIDs (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 who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory 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 at risk for cardiac dysrhythmias. This potassium level is outside the expected reference range of 3.5 to 5.0 mEq/L and requires immediate intervention.)

A nurse should identify that which of the following drugs is used only for the short-term treatment of a cardiac dysrhythmia because of the 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 cardiotoxicity and arterial embolism.)

A nurse is caring for a client who is 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 foods in their diet, such as raisins and other dried fruits.)

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.) -Distorted taste (Captopril can cause distortions in taste sensations and loss of taste, which can lead to anorexia and weight loss. This often indicates the need to discontinue 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 (Captopril can cause a dry cough because of an accumulation of bradykinin. This often indicates the need to discontinue drug therapy.)

A nurse is caring for a client who has a 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, such as reserpine. These adverse effects develop because of the depletion of serotonin and norepinephrine and can persist after clients discontinue taking the drug.)