Quiz

Which adverse effect of lisinopril (Prinivil) should be reported to the healthcare provider? Cough Fever Increased urine output Facial flushing

1 Explanation: A cough is an adverse effect of lisinopril and should be reported to the healthcare provider. A fever is not an adverse effect of lisinopril. Increased urine output is not associated with lisinopril. Facial flushing is not an adverse effect of lisinopril.

A client asks which conditions will cause the heart to need more oxygen. Which information should the nurse be prepared to discuss? Sleep apnea Hyperthyroidism Asthma Hepatitis B

1 Explanation: Sleep apnea is associated with angina. Hyperthyroidism is not associated with angina. Asthma is not associated with angina. Hepatitis B is not associated with angina.

Which intervention is the highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? Smoking-cessation program Diuretic therapy Weight-loss program Stress management

1 Explanation: Smoking cessation is the priority. The client is in the prehypertensive class and is not a candidate for prescriptive therapy. Although weight management is very important, the client has a normal body mass index of 20. There is no indication the client is experiencing stress.

Which statement by the client receiving nitroglycerine (Nitrostat) should the nurse be concerned about? "I'm getting married tomorrow; I hope my erectile dysfunction isn't a problem." "I'm going water skiing tomorrow; I hope my angina isn't a problem." "I really don't like taking those little pills, I would like to use a patch." "My angina has been a little more frequent I would like something to take for the pain."

1 Explanation: A patient with erectile dysfunction is likely to use sildenafil (Viagra). Concurrent use of sildenafil (Viagra) and nitroglycerine (Nitrostat) may cause life-threatening hypotension and cardiovascular collapse. An activity like waterskiing could precipitate angina; however, this can be prevented by taking nitroglycerine (Nitrostat) prior to the activity (prophylactic use). Patches can be substituted for pills in many cases; this is a reasonable question but not the primary concern at this time. Occurrences of stable angina can change somewhat in frequency; however, an analgesic is not indicated.

The nurse has provided education for a client prescribed nifedipine (Adalat CC). Which statement made by the client indicates an understanding of the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "If I drink alcohol while taking this medication, I will get very sick to my stomach." "I should stop taking my melatonin sleep medication." "I should no longer drink grapefruit juice." "I should no longer drink sports drinks with caffeine in them." "I should stop taking my vitamin C supplement."

1 Explanation: Alcohol may potentiate the effects of nifedipine, but this combination does not cause gastric irritation. Concurrent use with melatonin may increase blood pressure and heart rate. Grapefruit juice may enhance absorption of nifedipine. Caffeine is not contraindicated when taking nifedipine. Vitamin C supplements are not contraindicated when taking nifedipine.

Which classification of prescription should the nurse anticipate to be prescribed to a client newly diagnosed with chronic heart failure? Angiotensin-converting enzyme (ACE) inhibitor Beta-adrenergic blockers Cardiac glycosides Diuretics

1 Explanation: An angiotensin-converting enzyme (ACE) inhibitor is the first-line prescription for the treatment of chronic heart failure. Beta-adrenergic blockers are standard therapy for stage III heart failure. Cardiac glycosides such as digoxin is not as safe and effective as ACE inhibitors or angiotensin-receptor blockers (ARBs) and is reserved for more advanced stages of heart failure. Diuretics are used to treat symptoms of heart failure such as fluid volume overload, edema, and pulmonary congestion.

Which vital sign is of the greatest concern to the nurse prior to administering digoxin (Lanoxin)? Apical pulse Temperature Blood pressure Respiratory rate

1 Explanation: An apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is low (generally 60 bpm), the medication should be held and the ordering practitioner informed. Digoxin can suppress electrical activity within the heart and lower heart rate. Temperature is not the greatest concern. Blood pressure is not the greatest concern. Respiratory rate is not the greatest concern.

Which prescription should the nurse anticipate to increase the myocardial contractility for a client with heart failure? Digoxin (Lanoxin) Lisinopril (Prinivil) Carvedilol (Coreg) Furosemide (Lasix)

1 Explanation: Cardiac glycosides increase cardiac output by increasing the force of contraction. ACE inhibitors lower peripheral vascular resistance and blood volume. Beta-blockers lower heart rate. Diuretics lower blood volume.

Which client should the nurse anticipate a prescription for reteplase (Retavase) therapy post myocardial infarction? A 54-year-old female with type 2 diabetes A 45-year-old female with a 2-week-old cranial artery repair A 62-year-old with a recent hemorrhagic stroke A 70-year-old male with active GI bleed

1 Explanation: Contraindications for reteplase therapy include a history of CVA (stroke), recent surgical procedure, and active bleeding. Recent surgical procedures preclude use of reteplase. Recent stroke precludes use of reteplase. Active bleeding precludes use of reteplase.

Which prescription should the nurse be concerned about a pregnant client receiving? Enalapril (Vasotec) Potassium supplement Doxazosin (Cardura) Hydrochlorothiazide (HCTZ)

1 Explanation: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed. Potassium supplements are Pregnancy Category A drugs. Doxazosin is a Pregnancy Category B drug. HCTZ is a Pregnancy Category B drug.

Which symptom is most likely to be related to angina as opposed to a myocardial infarction? Chest pain relieved by one sublingual nitroglycerin Chest pain that radiates to the patient's back Chest pain that occurred while the patient was eating breakfast Chest pain accompanied by shortness of breath

1 Explanation: It is essential to recognize the difference between angina and myocardial infarction because the treatments are very different. Chest pain that is relieved by one sublingual nitroglycerin is most likely angina. Chest pain that is not relieved by nitroglycerin would most likely be from a myocardial infarction. Chest pain that is radiating can be from angina or a myocardial infarction. Chest pain related to angina is often experienced when the person is doing a strenuous activity. Eating is not strenuous. Chest pain that is accompanied by shortness of breath can be from angina or a myocardial infarction.

Which is the most serious adverse effect associated with milrinone (Primacor)? Ventricular dysrhythmia Nausea Headache Atrial dysrhythmia

1 Explanation: Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhythmias. Nausea can occur but is not as serious as another adverse effect. Headache can occur but is not as serious as another adverse effect. Atrial dysrhythmias can occur but are not as serious as another adverse effect.

A client receiving diltiazem (Cardizem) asks the nurse why they get a headache after taking the prescription. Which response should the nurse provide the client? "Diltiazem (Cardizem) causes the blood vessels in your brain to widen, giving you the headache." "Diltiazem (Cardizem) increases prostaglandin synthesis, giving you the headache." "Diltiazem (Cardizem) releases Substance P, activating pain receptors in your brain and giving you the headache." "Diltiazem (Cardizem) causes the blood vessels in your brain to narrow, giving you the headache."

1 Explanation: Side effects of diltiazem (Cardizem) are generally not serious and are related to vasodilation: headache, dizziness, and edema of the ankles and feet. Diltiazem (Cardizem) does not alter prostaglandin synthesis. Diltiazem (Cardizem) does not lead to a release of Substance P. Side effects of diltiazem (Cardizem) are related to vasodilation, not vasoconstriction.

Pharmacology for Nurses, 6e (Adams) Chapter 27 Drugs for Heart Failure A client asks the nurse how hypertension can lead to heart failure. Which response should the nurse provide the client? "Hypertension increases the resistance in the blood vessels causing the heart to work harder to pump the blood out against the resistance of the arteries." "Hypertension limits the ability of the heart to stretch before emptying resulting in the heart working harder to pump the blood out into the arterial system." "Hypertension causes resistance in the venous system requiring the heart to work harder to pump the blood forward." "Hypertension limits the amount of blood entering the left ventricle increasing the workload of the heart to pump an adequate amount of blood into the circulatory system."

1 Explanation: The peripheral resistance that occurs in hypertension causes the heart to work harder to pump the blood out into the arterial system. This places the client at risk for heart failure. Hypertension does not affect the heart's ability to stretch. The resistance the heart pumps against is in the arterial system, not the venous system. Heart failure does not result from hypertension limiting the amount of blood in the left ventricle that the heart has to pump out into the circulatory system.

Which information about the primary therapeutic action of an antianginal prescription should the nurse include in client teaching? "The prescription decreases how much oxygen your heart needs." "This prescription will thin your blood so your heart receives more oxygen." "This prescription increases the amount of oxygen your heart receives." "This prescription increases the oxygen to your heart by increasing nitric oxide production."

1 Explanation: The primary means by which antianginal drugs terminate an acute angina episode, or decrease the frequency of angina episodes, is by reducing the myocardial demand for oxygen. Antianginal medications do not have an anticoagulant effect. Antianginal medications cannot increase the oxygen supply to the myocardium. Antianginal medications do not increase nitric acid production.

The nurse has completed the education for a client with angina prescribed nitroglycerine (Nitrostat). Which statement made by the client indicates further teaching is required? "I can take up to 5 tablets to resolve the chest pain." "If my pain is not reduced 5 minutes after taking one tablet I should call EMS." "I should take a tablet as soon as chest pain occurs." "I can take three tablets, one every 5 minutes."

1 Explanation: When directed to do so, patients should follow the time frame of taking a nitroglycerine (Nitrostat) tablet every 5 minutes and not exceed three tablets. Additional teaching is indicated. If pain is not gone 5 minutes after taking one tablet, EMS should be notified. The patient should not take additional NTG until directed to do so. No additional teaching is indicated. The patient should not delay when chest pain occurs and should take a tablet immediately. No additional teaching is necessary. When directed to do so, nitroglycerine (Nitrostat) tablets should be taken every 5 minutes. No additional teaching is necessary.

The nurse is preparing to discuss the use of primary hypertensive agents with a client. Which prescriptions should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Thiazide diuretics Angiotensin-II receptor blockers (ARBs) Beta-adrenergic antagonists Direct-acting vasodilators Peripheral adrenergic antagonists

1, 2 Explanation: Diuretics are considered a primary antihypertensive agent. ARBs are considered a primary antihypertensive agent. Beta-adrenergic antagonists are considered second line drugs for treatment of hypertension. Direct-acting vasodilators are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response. Peripheral adrenergic antagonists are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response.

Which electrolytes should the nurse anticipate monitoring for a client prescribed losartan (Cozaar)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Potassium Sodium Calcium Chloride Magnesium

1, 2 Explanation: The electrolytes that will be monitored for a client prescribed losartan include potassium. The electrolytes that will be monitored for a client prescribed losartan include sodium. The electrolytes that will be monitored for a client prescribed losartan do not include calcium. The electrolytes that will be monitored for a client prescribed losartan do not include chloride. The electrolytes that will be monitored for a client prescribed losartan do not include magnesium.

Which findings should the nurse anticipate when assessing a client developing right-sided heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Ankle edema Enlarged liver Displaced apical heart rate Shortness of breath Coughing

1, 2, 3 Explanation: In right heart failure, the blood backs up into the venous system resulting in peripheral edema. In right heart failure, the blood backs up into the venous system resulting in engorgement of organs such as the liver. A displaced apical heart rate indicates cardiac hypertrophy has developed. Cardiac hypertrophy is associated with right heart failure. Shortness of breath is a manifestation of left heart failure. Coughing is a manifestation of left heart failure.

Which statements made by the client indicate an understanding of the compensatory mechanisms associated with heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "My heart enlarged in order to compensate for the effects of heart failure." "My nervous system kicks in to compensate for the effects of heart failure." "My body will decrease blood flow to other organs in order to compensate for heart failure." "My body will increase urine output in order to compensate for the effects of heart failure." "My body will produce anti-inflammatory agents to compensate for heart failure."

1, 2, 3 Explanation: Ventricular hypertrophy occurs as a compensatory mechanism to heart failure. One of the fastest homeostatic responses to diminished cardiac output is the activation of the sympathetic nervous system (SNS). The increased heart rate resulting from sympathetic activation is a normal compensatory mechanism that serves to increase cardiac output. When cardiac output in a patient with HF is diminished, blood flow to the kidneys is reduced. Vasopressin (antidiuretic hormone), which is elevated in HF patients, causes fluid retention and worsens this condition. Two pro-inflammatory substances, tumor necrosis factor (TNF) and interleukin, are found in high levels in patients with HF and are associated with a poor prognosis.

Which conditions contribute to heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Uncontrolled hypertension Coronary artery disease (CAD) Diabetes (DM) HIV Mitral stenosis

1, 2, 3, 5 Explanation: Uncontrolled hypertension is associated with the development of heart failure. Coronary artery disease is associated with the development of heart failure. Diabetes is associated with the development of heart failure. HIV is not associated with the development of heart failure. Mitral stenosis is associated with the development of heart failure.

Which prescriptions does the nurse anticipate to be included in the goal to reduce the post-MI mortality of a client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Aspirin Beta blockers Narcotic analgesics ACE inhibitors Antidysrhythmics

1, 2, 4 Explanation: Aspirin is often prescribed to reduce the risk of post-MI mortality. Beta blockers are often prescribed to reduce the risk of post-MI mortality. Narcotic analgesics are not prescribed to reduce the risk of post-MI mortality. They are administered to manage severe pain and anxiety associated with MIs. ACE inhibitors are prescribed to reduce the risk of post-MI mortality. Antidysrhythmics are prescribed to treat post-MI dysrhythmias, not to reduce the risk of post-MI mortality.

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I have incorporated yoga into my exercise program." "I will monitor my daily sodium intake." "I will drink a glass of red wine daily to help lower my blood pressure." "I am receiving acupuncture to help me stop smoking."

1, 2, 4 Explanation: Incorporating yoga into an exercise program will help decrease stress and improve body strength. Restricting sodium intake is a positive lifestyle change. Increasing the intake of alcohol, including wine, is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of alcohol. Eliminating tobacco products is a positive lifestyle change.

Which information should the nurse include when educating a client about coronary artery disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Plaque causes narrowing of the artery. Plaque begins to accrue early in life. Plaque causes narrowing of the veins. Plaque affects the elasticity of the artery. Plaque builds up in the myocardial tissue.

1, 2, 4 Explanation: Plaque builds up resulting in a narrowing of the artery. Plaque accumulates gradually, over a period of 40-50 years in some individuals but actually begins to accrue early in life. Plaque builds up in the arterial system. Plaque affects the elasticity of the artery, impairing the artery's ability to dilate properly when the myocardium requires additional blood flow. Plaque builds up in the arterial system.

The nurse is providing education for nonpharmacological interventions to manage hypertension. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Increase your dietary intake of fruits and vegetables. Decrease the consumption of alcohol. Reduce the dietary intake of potassium. Increase physical activity. Restrict your intake of sodium.

1, 2, 4, 5 Explanation: Increasing the intake of fruits and vegetables is recommended to help manage hypertension. Decrease the consumption of alcohol. Dietary potassium should be increased to help control hypertension Increased physical activity is recommended to help manage hypertension. Reduction of the intake of sodium is recommended to help manage hypertension.

For which conditions is a client with hypertension at risk? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Kidney damage Stroke Liver failure Heart failure Blindness

1, 2, 4, 5 Explanation: The kidneys are affected by hypertension. Stroke is a common effect of hypertension. Liver failure is not commonly associated with hypertension. The heart is affected by hypertension. The retina is affected by hypertension.

For which conditions should the nurse instruct a client to hold the application of nitroglycerin ointment and contact the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Dyspnea Productive cough Headache Fever Confusion

1, 2, 5 Explanation: Nitroglycerin may worsen preexisting respiratory conditions. A productive cough may indicate lung congestion associated with heart failure. Headache is a common adverse reaction and can be treated, therefore, the prescription should not be held. Fever is not an adverse effect of nitroglycerin. Confusion may indicate inadequate cerebral perfusion.

Pharmacology for Nurses, 6e (Adams) Chapter 28 Drugs for Angina Pectoris and Myocardial Infarction Which lifestyle behaviors should the nurse discuss with a client to help reduce their risk of coronary artery disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Abstinence from smoking Decrease stress Limit alcohol consumption Maintain optimal weight Limit sodium intake

1, 3, 5 Explanation: Abstinence from smoking reduces the risk of coronary artery disease. Coronary artery disease results from the formation of arterial plaque. Stress does not contribute the formation of plaque in the arterial arteries. Limiting alcohol consumption reduces the risk of coronary artery disease. Maintenance of optimal weight reduces the risk of coronary artery disease. Limiting sodium intake reduces the risk of coronary artery disease.

Which statements by the client are specifically associated with unstable angina? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "My chest has started hurting even if I am just watching television." "My chest starts hurting if I climb one set of stairs." "My attacks of chest pain are coming more frequently now." "The pain occurs most often after I eat a meal." "The pain is worse than it used to be."

1, 3, 5 Explanation: Paint at rest is considered unstable angina. Chest pain that is predictable is usually stable angina. Increased frequency of pain indicates that the angina is unstable. Pain that occurs after eating a meal is not associated with unstable angina. Pain that is worsening indicates the angina is unstable.

A male client states to the nurse, "I am going to stop taking my metoprolol (Lopressor). I have been experiencing problems having sex." Which responses should the nurse include in the discussion with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I understand sexual dysfunction can be a common problem with this drug." "Perhaps it would be better if you took atenolol (Tenormin)." "I cannot stop you from discontinuing the drug." "Stopping the prescription abruptly may cause your blood pressure to elevate even higher." "Try taking the drug early in the morning."

1, 4 Explanation: One of the major causes of noncompliance is the effect beta blockers have on male sexual function. Acknowledging the client's concern promotes therapeutic communication. Atenolol is also a beta blocker. While this is true, it does not address the issue. Abrupt cessation of beta-blocker therapy can result in rebound HTN. Time of administration is not likely to change overall effects of the drug.

Which physiological systems should the nurse recognize are most at risk for a client in a hypertensive crisis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Cardiac Respiratory Integumentary Gastrointestinal Renal

1, 5 Explanation: The heart responds to hypertension by decreasing heart rate and stroke volume. The respiratory system does not help regulate blood pressure. The integumentary system does not help regulate blood pressure. The gastrointestinal system does not help regulate blood pressure. The kidney responds to hypertension by increasing urine output to decrease blood volume.

The nurse is reviewing the myocardial blood supply for a client with coronary artery disease (CAD). Which statements made by the client indicate an understanding of the information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "The heart has right and left arteries that arise from the aorta." "The coronary arteries carry blood away from the heart to the right atrium." "The heart receives its oxygen through the blood that fills it." "Coronary arteries primarily carry blood to the left ventricle." "The right and left arteries have smaller branches that go around the heart."

1, 5 Explanation: The myocardium receives blood from the right and left coronary arteries that arise from aortic sinuses at the base of the aorta. The coronary veins, not arteries, carry blood to the right atrium. Although the heart is filled with blood, this is not its source of oxygen. The coronary arteries supply blood to all areas of the heart, not primarily the left ventricle. The right and left coronary arteries diverge into smaller branches that encircle the heart.

Which information should the nurse include in the discharge plan for a client prescribed digoxin (Lanoxin)? "Report the development of a metallic taste in the mouth." "Report mental changes such as feelings of depression." "Stop the prescription if your pulse is irregular." "If you miss a dose, take two doses."

2 Explanation: A metallic taste is not associated with digoxin. Digoxin may result in depression. If the pulse is irregular, the client should not stop the prescription but instead should notify the healthcare provider. Client should not take a double dose; this is considered an overdose that could lead to toxicity.

Which action of Lisinopril (Prinivil) results in a decrease in the blood volume? Antagonistic effect on angiotensin-converting enzyme. Decrease aldosterone secretion. Causes hypernatremia and increased renal tubule permeability resulting in a diuretic effect. Causes a diuretic effect by lowering the amount of sodium lost in the urine.

2 Explanation: ACE inhibitors have an antagonistic effect on angiotensin-converting enzyme, but this action lowers blood pressure by reducing peripheral vascular resistance, not by lowering blood volume. ACE inhibitors decrease aldosterone secretion from the adrenal cortex resulting in a lowering of the blood volume. Increasing sodium in the blood does not lower the blood volume. Aldosterone is a hormone that increases the reabsorption of sodium and water.

Which is a priority nursing intervention for a client who is newly prescribed enalapril (Vasotec)? Monitor the client for headaches. Take the client's blood pressure. Order a sodium-restricted diet for the client. Review the client's lab results for hypokalemia.

2 Explanation: Although headache is a side effect, it is not the priority. Enalapril may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Enalapril does not affect sodium levels. Enalapril is more likely to cause hyperkalemia, not hypokalemia.

Which should the nurse anticipate to be included in the treatment plan for a client with stage A heart failure? Angiotensin-converting enzyme (ACE) inhibitor Lifestyle modifications Beta-blocker Cardiac glycoside

2 Explanation: An angiotensin-converting enzyme (ACE) inhibitor is included in the treatment plan for a client in stage B heart failure. Lifestyle modifications are included in the treatment plan for a client with stage A heart failure. A beta-blocker may be added in stage B treatment of heart failure and will be implemented in stage C. Cardiac glycosides are added in stage B treatment of heart failure.

The nurse educator is reviewing the physiological regulation blood pressure. Which should the educator identify as initially involved? Production of angiotensin II Action of renin Antidiuretic hormone Production of angiotensin I

2 Explanation: Angiotensin I forms angiotensin II which results in vasoconstriction. Renin forms angiotensin I. Antidiuretic hormone does not initially regulate the blood pressure. Antidiuretic hormone affects the renin which affects angiotensin I, which affects angiotensin II resulting in vasoconstriction. The production of angiotensin I is acted upon in the lung to form angiotensin II.

Which is the primary desired outcome for a client that has experienced several episodes of angina? The client will experience relief of chest pain with anticoagulant therapy. The client will experience relief of chest pain with nitrate therapy. The client will experience relief of chest pain with aspirin therapy. The client will experience relief of chest pain with therapeutic lifestyle changes.

2 Explanation: Anticoagulant therapy is used to prevent additional thrombi from forming post-myocardial infarction; it will not relieve angina pain. A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Aspirin therapy following an acute myocardial infarction dramatically reduces mortality due to its antiplatelet function; it will not relieve angina pain. Therapeutic lifestyle changes are significant if the patient is to maintain a healthy heart, but they will not relieve chest pain; this is accomplished with medications.

A client is prescribed an intravenous infusion of milrinone (Primacor) for acute heart failure. Which is a priority nursing assessment during the infusion? Monitor for symptoms of atrial fibrillation Continuous ECG monitoring Vital signs every 15 minutes Monitor for hypertension

2 Explanation: Atrial fibrillation is not an adverse effect of milrinone. Due to the risk of ventricular dysrhythmia, the client's ECG is usually monitored continuously during the infusion of milrinone. Vital signs should be assessed continuously, not every 15 minutes, while the client receives milrinone. Hypotension, not hypertension, is an adverse effect of milrinone.

Which changes are sensed by the baroreceptors and relayed to the vasomotor center? Oxygenation Blood pressure Carbon dioxide Blood pH

2 Explanation: Chemoreceptors recognize levels of oxygen. Baroreceptors sense and relay changes in blood pressure. Chemoreceptors recognize levels of carbon dioxide. Chemoreceptors recognize pH levels.

The nurse completes the dietary education for a client prescribed digoxin (Lanoxin). Which dietary choice indicates the client understood the teaching? Cottage cheese, peach salad, and blueberry pie Baked fish, sweet potatoes, and banana pudding Green bean soup, whole-wheat bread, and an apple Hamburger, French fries, and chocolate chip cookies

2 Explanation: Cottage cheese, peach salad, and blueberry pie are not significant sources of potassium needed to help prevent digoxin toxicity. Fish, sweet potatoes, and bananas are high in potassium, which will help prevent digoxin toxicity. Green bean soup, whole-wheat bread, and an apple are not significant sources of potassium needed to help prevent digoxin toxicity. The hamburger is high in potassium, but the French fries are not appropriate for a cardiac client.

A client experiencing bradycardia is suspected of overdosing on diltiazem (Cardizem). Which treatment should the nurse anticipate prescribed? Dopamine Atropine Calcium chloride Narcan

2 Explanation: Dopamine is a vasopressor that may be used to reverse hypotension. Atropine may be used to reverse bradycardia caused by a diltiazem overdose. Calcium chloride is administered to reverse hypotension or heart block induced by a diltiazem overdose. Narcan is used to reverse the effects from an opioid overdose.

Pharmacology for Nurses, 6e (Adams) Chapter 26 Drugs for Hypertension A client receiving hydrochlorothiazide (Microzide) asks the nurse why they are urinating so frequently. Which statement should the nurse provide the client? "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2 Explanation: Hydrochlorothiazide (Microzide) does not enhance kidney function. Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (Microzide) decrease blood pressure by decreasing total blood volume. Hydrochlorothiazide (Microzide) does not dilate blood vessels. Hydrochlorothiazide (Microzide) does not increase heart rate.

Which statement is accurate in regard to secondary hypertension? There is no known cause. It can result from chronic renal impairment. It is also known as idiopathic. It accounts for 90% of all hypertensive cases.

2 Explanation: Primary hypertension has no known cause. Secondary hypertension has an identifiable cause. Primary hypertension is known as idiopathic. Secondary hypertension accounts for 10% of all cases.

Which is a priority assessment for the client receiving reteplase (Retavase) intravenously? Fluid balance Abnormal bleeding Blood glucose Respiratory rate

2 Explanation: Reteplase does not alter fluid balance in the body. Reteplase is used to dissolve blood clots. The most serious adverse effect of reteplase is abnormal bleeding. Reteplase does not cause hypoglycemia. Reteplase does not decrease oxygen to the brain.

A client post-acute myocardial infarction asks the nurse why they are prescribed reteplase (Retavase) intravenously (IV). Which response should the nurse provide the client? "The prescription dilates the arteries in the heart so it can get more oxygen." "The prescription is dissolving the clot that has caused your heart attack." "The prescription thins your blood so more clots will not develop." "The prescription will increase the strength of the muscles in the heart during each beat."

2 Explanation: Reteplase is a thrombolytic used to dissolve clots in the coronary arteries. When treating myocardial infarction (MI), thrombolytic therapy is administered to dissolve clots obstructing the coronary arteries, thus restoring circulation to the myocardium. Reteplase is a thrombolytic used to dissolve clots in the coronary arteries. Reteplase is a thrombolytic used to dissolve clots in the coronary arteries.

Which factors are responsible for blood pressure? Blood volume, heart rate, and stroke volume Cardiac output, blood volume, and peripheral vascular resistance Age, weight, and race Body mass index, diet, and genetics

2 Explanation: The heart rate is not specifically involved in the blood pressure; however, the blood volume or cardiac output influences the blood pressure. Although many factors can contribute to blood pressure, such as diet and weight, the cardiac output, blood volume, and peripheral vascular resistance are the factors responsible for blood pressure. Age, weight, and race do not specifically control blood pressure. Body mass index, diet, and genetics do not specifically control blood pressure.

Which medical condition should the nurse be concerned about for a client prescribed hydralazine? Asthma Angina Diabetes Hyperthyroidism

2 Explanation: The use of hydralazine is not contraindicated with asthma. The use of hydralazine is contraindicated with angina. The use of hydralazine is not contraindicated with diabetes. The use of hydralazine is not contraindicated with hyperthyroidism.

The nurse has prescribed dietary education for a client prescribed nifedipine (Procardia XL). Which dietary choice should the nurse recognize requires further education? Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

2 Explanation: There is no food-drug interaction with calcium channel blockers and whole-wheat pancakes with syrup and bacon, oatmeal, and orange juice. Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. There is no food-drug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. There is no food-drug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

A client asks the nurse if angina is the same thing as having a heart attack. Which response should the nurse provide? "They have some things in common, for example, severe emotional distress and panic can accompany both angina and myocardial infarction." "Angina means the heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died." "Actually, it depends on what type of angina you mean; there are several types." "They are basically the same."

2 Explanation: This is a true statement but is not the best explanation for the patient. A myocardial infarction indicates ischemia and necrosis have occurred to the affected part of the myocardium. Angina results from ischemia without necrosis. There are several types of angina; however, this response does not answer the patient's question. There are differences between angina and myocardial infarction.

Which is the most sensitive and effective biomarker of a myocardial infarction? White blood cells Troponin Myoglobin Creatine kinase

2 Explanation: White blood cells are not used as a biomarker for a myocardial infarction. Troponin is a cardiac-specific and the most sensitive and effective biomarker after a myocardial infarction. Myoglobin is not a specific biomarker of cardiac muscle Creatine kinase is not a specific cardiac biomarker of cardiac muscle.

Which information should the nurse include in the education for a client prescribed antianginal therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The prescriptions increase the heart rate. The prescriptions dilate the veins so that the heart receives less blood. The prescriptions cause the heart to contract with less force. The prescriptions increase blood pressure. The prescriptions increase the ability of the body to produce red blood cells.

2, 3 Explanation: Prescriptions used to treat angina decrease the heart rate. Prescriptions that dilate the veins so that the heart receives less blood treat angina by decreasing preload. Prescriptions that cause the heart to contract with less force reduce contractility and are useful in treating angina. Prescriptions used to treat angina decrease blood pressure. Antianginal prescriptions do not cause the body to produce more red blood cells.

The nurse is preparing to administer clevidipine (Cleviprex) to a client experiencing a hypertensive crisis. Which interventions should the nurse implement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Monitor bowel sounds Administer the drug intravenously Continually monitor blood pressure Crush caplets for administration Infuse prescription in normal saline at 125 mL/h

2, 3 Explanation: There is no particular reason that bowel sounds should be monitored more frequently than normally done. Clevidipine (Cleviprex) is administered intravenously. Clevidipine (Cleviprex) has an ultrashort half-life so blood pressure will be monitored continuously. This drug is not supplied in caplet form. Infusing normal saline at this rate would be contraindicated in hypertensive emergency.

Which laboratory values should the nurse assess for the client receiving lisinopril (Prinivil)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Uric acid Blood urea nitrogen (BUN) Serum bilirubin ALT/AST Serum drug levels

2, 3, 4 Explanation: Lisinopril does not affect the levels of uric acid. Lisinopril may increase the values of blood urea nitrogen. Lisinopril may increase the values of serum bilirubin. Lisinopril may increase the values of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Lisinopril does not require drug serum levels to be monitored.

Which conditions is the use of thrombolytic therapy contraindicated in? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Venous emboli History of intracranial hemorrhage Hemophilia Liver disease Peptic ulcer disease

2, 3, 4, 5 Explanation: Thrombolytic therapy is not contraindicated in a client with a history of venous emboli. Thrombolytic therapy is contraindicated in a client with a history of intracranial hemorrhage. Thrombolytic therapy is contraindicated in a client with hemophilia, a clotting disorder. Thrombolytic therapy is contraindicated in a client with liver disease. Thrombolytic therapy is contraindicated in a client with peptic ulcer disease.

Which classifications of prescriptions are used to increase cardiac output by increasing the force of myocardial contractions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Angiotensin receptor blockers Cardiac glycosides Adrenergic blockers Phosphodiesterase inhibitors Angiotensin-converting enzyme inhibitor

2, 4 Explanation: Angiotensin receptor blockers increase cardiac output by lowering blood pressure and decreasing blood volume. Cardiac glycosides increase cardiac output by increasing the force of myocardial contractions. Adrenergic blockers decrease cardiac workload by slowing the heart rate (β1) and decreasing blood pressure (α1). Phosphodiesterase inhibitors increase cardiac output by increasing the force of myocardial contractions. Angiotensin-converting enzyme inhibitors increase cardiac output by lowering blood pressure and decreasing blood volume.

Which should the nurse assess a client for prior to administering atenolol (Tenormin)? Temperature Pulse Respirations Blood pressure Oxygen saturation

2, 4 Explanation: It is not necessary to assess the client's temperature prior to the administration of atenolol. Atenolol selectively blocks beta1-adrenergic receptors in the heart. Its effectiveness in treating angina is attributed to its ability to slow heart rate and reduce contractility, both of which lower myocardial oxygen demand. The prescription should be held if the pulse is less than 60 beats per minute or if the client is hypotensive. It is not necessary to assess the client's respirations prior to the administration of atenolol. Atenolol selectively blocks beta1-adrenergic receptors in the heart. Its effectiveness in treating angina is attributed to its ability to slow heart rate and reduce contractility, both of which lower myocardial oxygen demand. The prescription should be held if the pulse is less than 60 beats per minute or if the client is hypotensive It is not necessary to assess the client's oxygen saturation prior to the administration of atenolol.

Which information should the nurse include in the education for a client prescribed a transdermal nitroglycerin patch? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Place the patch on the upper arm or leg. Rotate sites of application. Remove the patch for an hour each day. Cleanse the skin under the patch after removal. Triple wrap the patch in plastic wrap for disposal.

2, 4 Explanation: The patch should not be applied to the arm or leg as increased muscle activity may increase drug absorption. Sites of application should be rotated to prevent irritation. The patch should be removed for a period of 6-12 hours as directed, typically at night or when the patient is sleeping. After removing the patch, it is important to cleanse the skin to remove any residual medication. While it is important to dispose of these patches carefully, triple wrapping in plastic wrap is not necessary.

Which clients should the nurse anticipate will require a pharmacological intervention to manage their blood pressure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes A 56-year-old woman whose blood pressure is 135/84 mmHg who also has Cushing's disease A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy

2, 5 Explanation: Hypertension in this age group of healthy adults is considered to be 140/90 mmHg. Since this 61-year-old has both hypertension and diabetes, pharmacotherapy is indicated. This client's blood pressure is not in a hypertensive range. Since there are no other compelling illnesses, this client's hypertension does not require pharmacological intervention. Blood pressure over 150/90 mmHg requires treatment in those over age 60.

Which mechanism of action does beta-adrenergic agonists have on the cardiovascular system? Increase cardiac output Dilate arterial smooth muscle Decrease the contractility of the heart Dilate venous system

3 Explanation: Beta-adrenergic agonists decrease cardiac output. Calcium channel blockers dilate arterial smooth muscle. Beta-adrenergic agonists decrease the contractility of the heart. Organic nitrates dilate venous system.

Which client prescribed metoprolol (Toprol-XL) is most at risk for adverse effects? The client with an apical pulse rate of 100 The client with compensated heart failure The client with chronic bronchitis The client with a history of migraines

3 Explanation: Beta-blockers may be used for client with apical pulse rates of 100. Beta-blockers may be used for a client with compensated heart failure. Metoprolol (Toprol XL) is selective for blocking beta1 receptors in the heart, so adverse effects on the lungs are not as likely as with other nonselective beta-blockers. However, the prescription should be used with caution in clients with asthma and those with a history of bronchospasm because the drug may affect beta2 receptors at high doses. Beta-blockers may be used for clients with migraines.

Which statement is accurate regarding the physiological changes associated with heart failure? Blood backs up into the lungs due to right ventricular hypertrophy. The walls of the heart shrink, leading to lower cardiac output. Cardiac remodeling occurs after prolonged ventricular hypertrophy. Blood pressure increases, resulting in lowered afterload.

3 Explanation: Blood can back up into the lungs, but this would be a result of left ventricular hypertrophy, not right. Heart walls do not shrink. Heart walls thicken and enlarge with heart failure. These changes occur over time and are referred to as cardiac remodeling. Blood pressure can go up but would result in a higher, not lower, afterload.

Which adverse effect is common for clients prescribed topical nitroglycerin paste? Rash Shortness of breath Headache Ventricular tachycardia

3 Explanation: Development of a rash is not common. Shortness of breath is not common. Nitroglycerin can dilate cerebral vessels, leading to headaches. Dysrhythmias are not common.

Which is the nurse's priority assessment for a client treated with intravenous hydralazine (Apresoline)? Hypotension and bradycardia Hypotension and hyperthermia Hypotension and tachycardia Hypotension and tachypnea

3 Explanation: Direct vasodilators do not produce bradycardia. Direct vasodilators do not affect body temperature. Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators do not affect respiratory rate.

A client prescribed doxazosin (Cardura) asks how the medication works. Which information should the nurse provide the client? "Doxazosin causes the kidneys to excrete more urine." "Doxazosin helps the heart work more efficiently." "Doxazosin helps dilate the blood vessels." "Doxazosin decreases the release of the stress hormones."

3 Explanation: Excreting more urine is an effect of diuretic medications. Increasing the efficiency of the heart is not an effect of doxazosin. Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Decreasing the release of stress hormones is not an effect of doxazosin.

The nurse has completed the education for a client prescribed hydrochlorothiazide (Microzide). Which statement made by the client indicates an understanding of the teaching? "I really need to avoid grapefruit juice when I take this medication." "I need to avoid salt substitutes and potassium-rich foods." "I take my medication early in the morning." "If I develop a cough, I should call my physician."

3 Explanation: Grapefruit juice inhibits the metabolism of the calcium channel blockers. Hydrochlorothiazide (Microzide) is a potassium-excreting diuretic, and potassium supplementation is often necessary. Taking hydrochlorothiazide (Microzide) early in the day will help prevent nocturia. Development of a cough occurs with ACE inhibitors.

Which should the nurse recognize are adverse effects associated with digoxin (Lanoxin)? Tachycardia and hypotension Blurred vision and tachycardia Anorexia and nausea Anorexia and constipation

3 Explanation: Hypotension can occur, but bradycardia not tachycardia occurs. Blurred vision can occur, but bradycardia not tachycardia occurs. Anorexia and nausea are common adverse effects of digoxin (Lanoxin). Anorexia can occur, but diarrhea is more likely than constipation.

The nurse has discussed lifestyle modifications to help manage the client's hypertension. Which statement made by the client indicates an understanding of the information? "I need to get started on my medications right away." "My father had hypertension, did nothing, and lived to be 90 years old." "I know I need to give up my cigarettes and alcohol." "I won't be able to run in the marathon race anymore."

3 Explanation: Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. The fact that the patient's father had hypertension and lived to be 90 years old does not mean that the patient will have the same experience; the patient is in denial. Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Increasing physical activity is an important lifestyle modification for controlling hypertension.

Which client is at greatest risk for developing heart failure? A 50-year-old African American female who smokes A 75-year-old Caucasian male who is overweight A 69-year-old African American male with hypertension A 52-year-old Caucasian female with asthma

3 Explanation: Race and smoking are risk factors, but being female and younger decreases the overall risk. Age and obesity are risk factors but not as much as other risk factors. Age, race, and hypertension lead to an increased risk for developing heart failure. Asthma, by itself, is not considered a significant risk factor in the development of heart failure.

The nurse has provided education for a client with diabetes mellitus prescribed metoprolol (Lopressor) for hypertension. Which statement made by the client indicates an understanding of the information? "I might not need to check my blood sugars as often with metoprolol (Lopressor)." "I might be able to change from insulin to a pill with metoprolol (Lopressor)." "I might need less insulin when I take metoprolol (Lopressor)." "I might need more insulin when I take metoprolol (Lopressor)."

3 Explanation: The client will most likely require more frequent blood glucose assessments, as metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin. Metoprolol (Lopressor) will not change a diabetic client's need for insulin; however, the client may require less insulin. Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the client might require less insulin. Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the client might require less, not more, insulin.

Which describes the action of vasodilators in the relief of symptoms of heart failure? Decrease afterload Reduce preload Improve cardiac contractility Reduce fluid overload

3 Explanation: Vasodilators do not decrease afterload. Vasodilators can relieve symptoms of HF by reducing preload and decreasing the cardiac workload. Cardiac glycosides and phosphodiesterase inhibitors improve cardiac contractility. Diuretics reduce fluid overload.

The nurse is preparing to administer nitroglycerine via the intravenous route. Which should the nurse do prior to the administration of the prescription? Use gloves to prevent self-administration. Instruct the client to avoid moving the arm in which the prescription is infusing. Cover the intravenous (IV) bottle to decrease light exposure. Darken the room to decrease light exposure.

3 Explanation: Wearing gloves is indicated when the nurse is administering nitroglycerine paste or ointment to prevent self-administration. There is no reason for the client to avoid arm movement during intravenous administration of nitroglycerine. For intravenous administration, cover the intravenous bottle to reduce degradation of nitrates due to light exposure. Darkening the room is not as effective as covering the intravenous bottle in decreasing light exposure. Also, the patient might not want the room darkened.

For which assessment findings should the nurse hold enalapril (Vasotec)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Cough Lightheadedness on ambulation Periorbital edema Sneezing Difficulty swallowing

3, 5 Explanation: Cough is a common side effect of this drug. The nurse should discuss the finding with the healthcare provider, but there is no need to hold the prescription. Orthostatic hypotension is common at the beginning of therapy. The nurse would manage safety of the patient but would not hold the prescription. Periorbital edema may indicate angioedema, which is a serious adverse effect. Holding the prescription is indicated. Sneezing is not associated with enalapril. Difficulty swallowing may indicate swelling in the throat related to angioedema. Holding the drug is indicated.

A client in heart failure asks the nurse how difficulty breathing is related to a heart problem. Which information should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "The right side of your heart has weakened and blood has entered your lungs." "The right side of your heart has enlarged and cannot effectively pump blood." "What you have is called congestive heart failure." "The left side of your heart is weak and pumps blood too quickly." "The left side of your heart has weakened and blood has entered your lungs."

3, 5 Explanation: Right-sided heart failure results in peripheral edema, not pulmonary congestion. Right-sided heart failure results in peripheral edema, not pulmonary congestion. Left heart failure is sometimes called congestive heart failure. Heart failure results from the inability of the left ventricle to pump blood, not pumping blood too quickly. When the left ventricle cannot compensate for increased preload, blood backs up into the lungs resulting in cough and shortness of breath.

A client experiencing syncope is suspected of taking a losartan (Cozaar) overdose? Which intervention should the nurse anticipate? Administer a calcium infusion Administer a loop diuretic Administer a vasopressor Administer an intravenous solution of normal saline

4 Explanation: A calcium infusion may be indicated for a nifedipine overdose. Vasopressors are not used to a treat overdose of losartan. A loop diuretic will further worsen the situation. An overdose of losartan is treated with intravenous solution of normal saline.

Which factor increases cardiac output? Reduced cardiac contractility Hypovolemia Peripheral vascular resistance Increase in preload

4 Explanation: A reduction in cardiac contractility results in lower preload and subsequent cardiac output. Hypovolemia is a lower blood volume and will result in lower cardiac output. Peripheral vascular resistance increases afterload and increases the workload on the heart. Increased preload results in a more forceful contraction and increases cardiac output.

Which prescriptions reduce the heart's demand for oxygen by lowering heart rate? Anticoagulants and beta-adrenergic blockers Calcium channel blockers and anticoagulants Organic nitrates and calcium channel blockers Beta-adrenergic blockers and calcium channel blockers

4 Explanation: Anticoagulants prevent blood clots from forming. Anticoagulants prevent blood clots from forming. Organic nitrates dilate vessels. Beta blockers and some calcium channel blockers reduce cardiac demand by lowering heart rate.

The nurse has provided education for a client prescribed lisinopril (Prinivil). Which statement made by the client indicates further teaching is required? "I will monitor my blood pressure until my next appointment." "I will avoid using salt substitutes for seasoning." "It takes a while for this medication to take effect." "I will not need to worry about having additional blood tests done."

4 Explanation: Blood pressure should be monitored to assess effectiveness of the medication. Potassium should be limited to avoid hyperkalemia. It takes a while for lisinopril (Prinivil) to become effective. The use of ACE inhibitors can lead to electrolyte disturbances so levels should be monitored.

The nurse notes that a client experiencing heart failure has been receiving nifedipine (Procardia). Which is a priority assessment for the nurse? Review recent lab results for hypokalemia. Assess urinary output. Assess level of orientation. Auscultate breath sounds for crackles.

4 Explanation: Calcium channel blockers do not cause hypokalemia. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time. Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure.

Which prescription is indicated for the prevention of blood clots? Captopril (Capoten) Reteplase (Retavase) Morphine Abciximab (ReoPro)

4 Explanation: Captopril is an ACE inhibitor. Reteplase is used to break up blood clots. Morphine is used for analgesia. Abciximab is a glycoprotein IIb/IIIa inhibitor (antiplatelet agent) used to prevent blood clots.

Which client has the greatest risk for developing heart disease? A 35-year-old with diabetes mellitus and prehypertension A 75-year-old with Parkinson's disease and normal blood pressure A 52-year-old with osteoporosis and stage 1 hypertension A 68-year-old with stage 2 hypertension and recent myocardial infarction

4 Explanation: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. This client is at somewhat less risk due to age. Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. This client has no other risk factors except age. Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. Osteoporosis is not a risk factor. Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. The 68-year-old client has the greatest risk factors for developing heart failure.

The nurse reviewing the records of a client diagnosed with hypertension notes a weight of 200 lbs, height 5' 4", dietary intake includes primarily starches, an alcohol intake of three beers per week, and stressors include 60-hour workweeks. Based on this information, which should the nurse identify as a priority outcome? Patient will eliminate alcohol from the diet. Patient will decrease stress by limiting work to 40 hours/week. Patient will balance diet according to the food pyramid. Patient will achieve and maintain optimum weight.

4 Explanation: Eliminating alcohol is important but not the priority outcome. Decreasing stress is important but not the priority outcome. A balanced diet is important but not the priority outcome. Achieving and maintaining optimum weight is of greatest importance when a client has hypertension. For obese patients, a 10- to 20-pound weight loss can produce a measurable change in blood pressure.

A client prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. Based on this information, which effect should the nurse be concerned about? Hyponatremia Hypermagnesemia Increased effectiveness of furosemide (Lanoxin) Decreased effectiveness of digoxin (Lanoxin)

4 Explanation: Hyponatremia does not result from an interaction with furosemide (Lasix), digoxin (Lanoxin), and antacids. Hypermagnesemia does not result from an interaction with furosemide (Lasix), digoxin (Lanoxin), and antacids. Use of furosemide (Lasix), digoxin (Lanoxin), and antacid does not increase the effectiveness of furosemide. Use of antacids may decrease the effectiveness of digoxin (Lanoxin).

Which is the primary pharmacologic goal in the treatment of a client experiencing stable angina? Increase venous blood flow to the right atrium. Eliminate blockages by using thrombolytics. Establish a regular exercise program and diet plan. Increase cardiac oxygen supply and reduce cardiac oxygen demand.

4 Explanation: Increasing the supply of venous blood to the right atrium might be beneficial but is not a primary goal. Eliminating blockages via thrombolytics would be attributed to myocardial infarctions, not to stable angina. Establishing a regular exercise program and diet plan would be important but is not a pharmacologic goal. The primary pharmacologic goals are to reduce oxygen demand of the heart and increase oxygen supply.

Which statement is accurate regarding the use of beta-adrenergic blockers for use in clients with heart failure? Higher doses are used initially until optimal vital signs are achieved. Dosage changes are done on a daily basis for the first 2 weeks. This drug class does not have an effect on the bronchioles of the lungs. They are generally used in combination with other heart-failure drugs.

4 Explanation: Initial doses are small. Initial doses are doubled every 2 weeks until the optimal dose is achieved. Beta-adrenergic blockers can be selective to beta1 receptors or nonselective. Nonselective blockers block beta1 and beta2 receptors. The blockage of beta2 receptors can affect the bronchioles of the lungs. Beta-adrenergic blockers are rarely used to treat heart failure alone. They are commonly used in combination with ACE inhibitors.

Which electrolyte imbalance should the nurse be concerned about for the client who is prescribed a thiazide diuretic? Magnesium Calcium Chloride Potassium

4 Explanation: Magnesium is not a concern. Calcium is not a concern. Chloride is not a concern. The client prescribed a thiazide diuretic is at risk for a potassium and sodium imbalance. The client should be monitored for hypokalemia. Magnesium, calcium, and chloride are not a concern.

Which statement made by the client indicates an understanding of self-care while taking prescriptions to treat their heart failure? "I will cut back on my smoking." "I will check my pulse every few days." "I will schedule my lab work if I am not feeling well." "I will weigh myself every day in the morning after I wake up."

4 Explanation: The client should be referred to a smoking cessation program. The client should check their pulse and blood pressure daily. The client should schedule their lab work according to the healthcare provider's prescription. The client should weigh themself daily, ideally at the same time of day and report a weight loss or gain of more than 1 kg (2 lb) in a 24-hour period.

Which statement made by a client newly prescribed a beta-adrenergic blocker should the nurse be concerned about? "I don't handle stress well; I have a lot of diarrhea." "When I have a migraine headache, I need to have the room darkened." "My father died of a heart attack when he was 48 years old." "I have always had problems with my asthma."

4 Explanation: There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant but has no correlation to this client and their use of beta-adrenergic blockers. This prescription should be used with caution in clients with asthma. With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction.

Which are the goals of antianginal therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Decreased oxygen consumption of the brain Increased myocardial contractility Increased blood flow to the peripheral blood vessels Increased blood flow to the myocardium Decreased myocardial oxygen demand

4, 5 Explanation: Decreasing brain oxygen consumption does not affect angina. Increasing contractility will increase myocardial oxygen supply, worsening the angina. Increasing blood flow to peripheral blood vessels has no effect on angina. Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to increase oxygen supply by increasing blood flow to the coronary arteries. Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to decrease myocardial oxygen demand.

Which statements made by a client indicates an understanding of the education provided by the nurse regarding digoxin (Lanoxin) toxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I should limit my fluids while taking this medication." "It is okay to keep taking my ginseng." "If I have nausea, it means I must stop the medication." "I can drink orange juice every morning." "I must check my pulse and not take the medication if it is less than 60."

4, 5 Explanation: Dehydration can increase the risk for digoxin (Lanoxin) toxicity; the client must not limit fluids. Ginseng may increase the risk of digoxin (Lanoxin) toxicity. Nausea, by itself, may be a side effect, but it is not necessarily indicative of digoxin (Lanoxin) toxicity. Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity. Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin).