(2042) Exam #4 Questions *new material*

A patient who has been taking warfarin is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? 1( )Vitamin E 2( )Vitamin K 3( )Protamine sulfate 4( )Calcium gluconate

2( )Vitamin K

A nurse is caring for a patient who is prescribed procainamide. Which nursing action is the priority when providing care to the patient? 1( )Monitoring for tachycardia 2( )Measuring blood pressure regularly 3( )Assessing for signs of thrombophlebitis 4( )Asking the patient about any changes in vision

2( )Measuring blood pressure regularly

A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the nurse? 1( )Headache 2( )Muscle pain 3( )Constipation 4( )Slight nausea

2( )Muscle pain

When teaching a patient about the drug atenolol, what information should the nurse include in the teaching plan? 1. "Stop the medication if you feel tired." 2. "Do not stop the medication abruptly." 3. "If you have gastric upset, take the medication with an antacid." 4. "Use a hot tub daily to help vasodilate so that the medication will work more effectively."

2. "Do not stop the medication abruptly."

7. The medication order for a 5-year-old patient reads: "Give digoxin elixir, 15 mcg/kg, PO now." The child weighs 20 kg. How many milligrams will this patient receive?

0.3 mg

A serum digoxin therapeutic level:

0.5 to 2 ng/mL

A patient who is receiving digoxin reports headache, dizziness, nausea, and blurred vision. After assessing the patient, the nurse finds that the patient's pulse rate is 48 beats/min. Which medication should the nurse expect the primary health care provider to prescribe? 1. Milrinone 2. Nesiritide 3. Dobutamine 4. Digoxin immune Fab

4. Digoxin immune Fab

The nurse is providing care to a patient who is experiencing adverse reactions related to the administration of 5000 units of heparin. What is the appropriate dose of protamine sulfate, the antidote? Record your answer using a whole number. _______ mg

1 mg of protamine sulfate can reverse the effects of 100 units of heparin; therefore, 5000 units of heparin effects can be reversed by 50 mg of protamine sulfate.

Which beverage is contraindicated when the patient is taking nifedipine? 1. Tea 2. Milk 3. Mango juice 4. Grapefruit juice

4. Grapefruit juice

When teaching the nursing student about coronary heart disease, which statement will the nurse include in the session? 1( )"Coronary heart disease occurs due to the formation of atherosclerotic plaques." 2( )"Coronary heart disease cannot be prevented by changing lifestyle modifications." 3( )"Coronary heart disease is due to decreases in the cholesterol levels to below 200 mg/dL." 4( )"Coronary heart disease is nonlethal and cannot be prevented by antilipemic medications."

1( )"Coronary heart disease occurs due to the formation of atherosclerotic plaques."

A patient receiving atorvastatin therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? 1( )"Stop taking the drug and visit the clinic immediately." 2( )"Continue taking the drug; leg pain is a common side effect." 3( )"Stop taking the drug if the symptoms persist for another week." 4( )"Continue taking the drug along with antilipemic drugs and a painkiller."

1( )"Stop taking the drug and visit the clinic immediately."

Which assessment is most important before administering digoxin? 1( )Apical pulse 2( )Homans sign 3( )Breath sounds 4( )Weight in kilograms

1( )Apical pulse

A patient is prescribed digoxin for supraventricular dysrhythmia. The nurse instructs the patient to avoid consuming bran. What is the reason behind this instruction? 1( )Bran decreases digoxin absorption. 2( )Bran and digoxin cause constipation. 3( )Bran and digoxin cause urinary retention. 4( )Bran increases the digoxin concentration in the body.

1( )Bran decreases digoxin absorption.

A patient who has heart failure is prescribed digoxin. The patient also has hypothyroidism. What is the best nursing intervention to prevent digoxin toxicity? 1( )Calculate the digoxin dose with correct decimal placement. 2( )Administer a higher-than-usual dose of digoxin to the patient. 3( )Administer digoxin immune Fab before administering digoxin. 4( )Prevent the consumption of large amounts of bran with digoxin.

1( )Calculate the digoxin dose with correct decimal placement.

Which drugs are referred to as positive chronotropic drugs? 1( )Drugs that affect heart rate 2( )Drugs that affect blood pressure 3( )Drugs that affect conduction velocity 4( )Drugs that affect myocardial contractility

1( )Drugs that affect heart rate

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? 1( )High levels of low-density lipoproteins (LDL) 2( )High levels of high-density lipoproteins (HDL) 3( )Low levels of very-low-density lipoproteins (VLDL) 4( )Low levels of intermediate-density lipoproteins (IDL)

1( )High levels of low-density lipoproteins (LDL)

The charge nurse does not need to intervene when observing a new staff nurse preparing to administer diltiazem by which method? 1( )IV tubing in a delivery pump 2( )Drawing up the medication in a heparin flush 3( )Stating medication should be pushed intravenously over 30 seconds. 4( )Hanging the medication secondary to a free hanging dextrose solution

1( )IV tubing in a delivery pump

When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? 1( )In the evening 2( )With breakfast 3( )With an antacid 4( )On an empty stomach

1( )In the evening

A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? 1( )Monitor blood pressure continuously. 2( )Administer digoxin via intravenous infusion with the milrinone. 3( )Administer furosemide via intravenous infusion after the milrinone. 4( )Maintain an infusion of lactated Ringer solution with the milrinone infusion.

1( )Monitor blood pressure continuously.

A patient with hyperlipidemia has been prescribed simvastatin. While caring for the patient, the nurse unknowingly administers niacin along with simvastatin. Which complication may the patient have due to the drug interaction? 1( )Myopathy 2( )Blurred vision 3( )Bowel obstruction 4( )Hepatic dysfunction

1( )Myopathy

A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess? 1( )Platelet level 2( )Urine culture 3( )Ingestion of acetaminophen 4( )Over-the-counter medications

1( )Platelet level

A child admitted to the hospital with significant growth retardation and severe heart failure is found to have a ventricular septal defect. Which is the best treatment approach for this patient? 1( )Septal repair surgery 2( )Diuretics such as furosemide 3( )Cardiac glycoside such as digoxin 4( )Exercise and other physical activity

1( )Septal repair surgery

The nurse is caring for a patient who has hyperlipidemia and who has been prescribed gemfibrozil. On reviewing the medical history of the patient, the nurse learns that the patient is taking warfarin. What does the nurse anticipate after reviewing the patient's medical history? 1( )The patient has an increased risk of bleeding. 2( )The patient has an increased risk of infection. 3( )The patient has an increased risk of bowel obstruction. 4( )The patient has an increased risk of vitamin K toxicity.

1( )The patient has an increased risk of bleeding.

The health care provider discontinues a patient's quinidine and prescribes procainamide. The patient asks the nurse about the possible side effects of this medication. What is the nurse's best response? 1. "Take this medication with food to relieve an upset stomach." 2. "Use over-the-counter steroid cream if a red, swollen rash occurs." 3. "Taking an antacid with this medication will relieve digestive problems." 4. "Diphenhydramine can be taken with the medication if you develop a rash or breathing problems."

1. "Take this medication with food to relieve an upset stomach."

Which assessment finding is a contraindication to a patient being prescribed a beta blocker? 1. Asthma 2. Weight loss 3. Elevated cholesterol 4. History of alcohol abuse

1. Asthma

A patient with deep vein thrombosis is receiving fondaparinux therapy. After reviewing the patient's laboratory reports, the nurse believes that discontinuing the therapy will be beneficial for the patient. Which finding supports the nurse's suspicion? 1( )The patient's hemoglobin level is 16.5 g/dL. 2( )The patient's platelet count is 75,000 cell/μL. 3( )The patient's fasting blood glucose level is 95 mg/dL. 4( )The patient's creatinine clearance value is 40 mL/min.

2( )The patient's platelet count is 75,000 cell/μL.

Which class of drugs is prescribed for a patient who experiences exertional angina? 1. Beta blockers 2. Nitrate antianginal drugs 3. Calcium channel blockers 4. Nitroglycerin transdermal patch

1. Beta blockers

Before the nurse administers isosorbide mononitrate, what is a priority nursing assessment? 1. Blood pressure 2. Serum electrolytes 3. Level of consciousness 4. Blood urea nitrogen and creatinine

1. Blood pressure

What is the most appropriate outcome criterion for a patient who has been prescribed an antidysrhythmic medication? 1. Cardiac output increased 2. Weight gain of 5 lb in one week 3. Systolic blood pressure 90 mm Hg 4. Palpated radial pulses > pedal pulses

1. Cardiac output increased

A calcium channel blocker has been prescribed for a patient. Which condition in the patient's history is a contraindication to this medication? 1. Hypotension 2. Hypokalemia 3. Dysrhythmias 4. Increased intracranial pressure

1. Hypotension

A 100-mg IV bolus of lidocaine is prescribed for a patient experiencing ventricular dysrhythmias. Which available lidocaine medication should the nurse use to prepare this bolus? 1. Lidocaine vial of clear solution 2. Lidocaine 1% vial of light yellow solution 3. Lidocaine with epinephrine vial of clear solution 4. Lidocaine premixed in 50 mL of normal saline prepared within the past 48 hours

1. Lidocaine vial of clear solution

Which form of nitroglycerin is likely to have a large first-pass effect? 1. Oral 2. Sublingual 3. Intravenous 4. Transdermal

1. Oral

What is the most important assessment to complete before the nurse administers an antidysrhythmic medication? 1. Pulse rate 2. Temperature 3. Respiratory rate 4. Lung auscultation

1. Pulse rate

Which medication increases the duration of the action potential by prolonging repolarization in phase 3? 1. Sotalol 2. Verapamil 3. Flecainide 4. Adenosine

1. Sotalol

Which statement is true about positive dromotropic medications? 1. They accelerate conduction in the heart. 2. They inhibit angiotensin-converting enzyme. 3. They increase the rate at which the heart beats. 4. They increase the force of myocardial contraction

1. They accelerate conduction in the heart.

Which medication blocks angiotensin II receptors? 1. Valsartan 2. Lisinopril 3. Metoprolol 4. Eplerenone

1. Valsartan

A patient with heart failure is prescribed lisinopril. Arrange the order in which lisinopril acts. 1.Prevents sodium and water resorption 2.Decreases the volume of blood 3.Decreases the work of the heart 4.Decreases the end diastolic volume

1.Prevents sodium and water resorption 2.Decreases the volume of blood

7. The order for enoxaparin (Lovenox) reads: Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8 mL. How many milligrams will this patient receive? How many milliliters will the nurse draw up for the injection? (Round to hundredths.)

110 mg 0.73 mL

A patient is prescribed milrinone. Which is a contraindication to safe administration of milrinone? 1. Diabetes 2. Skin disease 3. Ear infection 4. Hypokalemia

4. Hypokalemia

What are the common side effects of fenofibrate, a fibric acid derivative? Select all that apply. 1[X]Impotence 2[X]Constipation 3[X]Cutaneous flushing 4[X]Nausea and abdominal pain 5[X]Increase in gallstone formation

1[X]Impotence 4[X]Nausea and abdominal pain 5[X]Increase in gallstone formation

Which classes of drugs are used in the treatment of angina pectoris? Select all that apply. 1. Diuretics 2 . Beta blockers 3. Antihistamines 4. Nitrates and nitrites 5. Calcium channel blockers

2 . Beta blockers 4. Nitrates and nitrites 5. Calcium channel blockers

7. The medication order reads: niacin, 500 mg PO, every evening. The medication is available in 250-mg tablets. How many tablets will the patient receive per dose?

2 tablets

The nurse is assessing a patient with diabetes who has hyperlipidemia. The patient asks the nurse to suggest either an herbal medication or a dietary modification to reduce cholesterol levels. Which suggestion, given by the nurse would be most beneficial to the patient? 1( )"Include flaxseeds in your food." 2( )"Eat foods rich in omega-3 fatty acids." 3( )"Consume excessive amounts of garlic." 4( )"Take 20 mg of St. John's wort regularly."

2( )"Eat foods rich in omega-3 fatty acids."

A patient who is on enoxaparin therapy has hematuria, melena, petechiae, and bleeding from the gums. Which treatment strategy will be most beneficial for the patient? 1( )Administering vitamin K1 2( )Administering protamine sulfate 3( )Increasing the dose of enoxaparin 4( )Infusing 50 mL of warfarin sodium

2( )Administering protamine sulfate

A patient is admitted to the emergency department experiencing symptoms of a thrombolytic stroke. Which medication should the nurse expect to be prescribed for the patient? 1( )Heparin 2( )Alteplase 3( )Clopidogrel 4( )Fondaparinux

2( )Alteplase

A patient is receiving clofibrate. A careful adjustment of the dosage of warfarin is required for patients taking this medication because of the risk of which condition? 1( )Clotting 2( )Bleeding 3( )Vitamin K toxicity 4( )Deep vein thrombosis

2( )Bleeding Clofibrate can bind with vitamin K in the intestinal tract, reducing vitamin K absorption. Because vitamin K is the antidote for warfarin, a lack of vitamin K increases the anticoagulant effect of warfarin and thus the risk for bleeding. Warfarin is an anticoagulant, so it will not increase the risk of clotting.

The nurse is caring for a patient who is being treated with dabigatran and who is scheduled to be placed on phenytoin. The nurse anticipates which effect will occur when the phenytoin is administered? 1( )Increased effect of the dabigatran 2( )Decreased effect of the dabigatran 3( )Therapeutic effect of the dabigatran 4( )Anaphylactic reaction to the dabigatran

2( )Decreased effect of the dabigatran

A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient? 1( )Lung sounds 2( )Electrocardiogram (ECG) 3( )Blood pressure measurement 4( )Blood urea nitrogen and creatinine

2( )Electrocardiogram (ECG)

Which complication may be experienced by a patient who is prescribed lisinopril? 1( )Insomnia 2( )Hyperkalemia 3( )Abdominal pain 4( )Cardiac dysrhythmia

2( )Hyperkalemia

A patient who receives digoxin therapy states, "I missed one dose of the drug." The nurse learns that the patient hasn't taken the drug for the past 12 hours. What should the nurse do next? 1( )Instruct the patient to stop taking digoxin. 2( )Immediately inform the primary health care provider. 3( )Instruct the patient to double up on the next digoxin dose. 4( )Instruct the patient to take two doses of digoxin with a 6-hour gap.

2( )Immediately inform the primary health care provider.

The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug? 1( )Intradermal 2( )Intravenous 3( )Subcutaneous 4( )Intramuscular

2( )Intravenous

A patient is receiving transdermal clonidine. What information does the nurse need to include in the teaching plan? 1. "Take the medication on an empty stomach." 2. "Remove the old patch before applying the new patch." 3. "Stay in bed for at least an hour after receiving a new patch." 4. "Keep the new patch on for 30 minutes before removing the old patch."

2. "Remove the old patch before applying the new patch."

A patient telephones the clinic and asks the nurse if he should still take today's "heart pills" since he noticed a waxy shell that looked like a pill capsule in his bowel movement yesterday. What is the nurse's best response? 1. "Wait 24 hours to make sure all of yesterday's dose is out of your system." 2. "The wax is part of the capsule shell, but the drug is still getting absorbed." 3. "I need to discuss this situation with the prescriber, and I will call you back." 4. "After today's bowel movement, take the medication if there is no waxy shell."

2. "The wax is part of the capsule shell, but the drug is still getting absorbed."

What assessment finding indicates that a patient is having a therapeutic response to a beta blocker administered for angina? 1. Decreased heart rate 2. Absence of chest pain 3. Decreased blood glucose 4. Blood pressure less than 130/90 mm Hg

2. Absence of chest pain

What is the primary cause of ischemic heart disease? 1. Clotting 2. Atherosclerosis 3. Angina pectoris 4. Myocardial infarction (MI)

2. Atherosclerosis

Which medications should be used cautiously in a patient who has been prescribed nitrate therapy? Select all that apply. 1. Diuretics 2. Beta blockers 3. Phenothiazines 4. Calcium channel blockers 5. Phosphodiesterase 5 (PDE5) inhibitors

2. Beta blockers 3. Phenothiazines 4. Calcium channel blockers 5. Phosphodiesterase 5 (PDE5) inhibitors

A patient with angina is prescribed ranolazine. Which assessment finding will the nurse report to the primary health care provider? 1. Migraine 2. Elevated liver enzymes 3. History of ischemic heart disease 4. Blood pressure of 130/90 mm Hg

2. Elevated liver enzymes

The nurse is providing care to a patient who is prescribed both digoxin and verapamil. Which side effect should the nurse expect the patient to experience? 1. Increased risk for bradycardia 2. Increased serum levels of digoxin 3. Decreased risk for digoxin toxicity 4. Reduced therapeutic effect of digoxin

2. Increased serum levels of digoxin

Which medication is appropriate for a patient who is diagnosed with heart failure who is experiencing dyspnea at rest? 1. Captopril 2. Nesiritide 3. Carvedilol 4. Metoprolol

2. Nesiritide

Which assessment finding in a patient receiving nitrate therapy requires immediate nursing intervention? 1. Headache 2. Severe anemia 3. Anginal episode 4. Ischemic heart disease

2. Severe anemia

7. A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardizem) at 5 mg/hr, but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 5 mg/mL. How many milligrams will the patient receive, and how many milliliters will the nurse draw up for this dose?

25 mg 5 mL

Which are positive risk factors for coronary heart disease (CHD)? Select all that apply. 1[X]Blood pressure of 130/85 mm Hg 2[X]Family history of premature CHD 3[X]Blood pressure higher than 140/90 mm Hg 4[X]Serum triglyceride level of 150 mg/dL or more 5[X]High-density lipoprotein level of 60 mg/dL or higher

2[X]Family history of premature CHD 3[X]Blood pressure higher than 140/90 mm Hg

The patient has received a dose of esmolol. The nurse should carefully monitor for which adverse effects? Select all that apply. 1[X]Tachycardia 2[X]Hypotension 3[X]Bronchospasm 4[X]Decreased cardiac output 5[X]Capillary blood glucose 145 mg/dL

2[X]Hypotension 3[X]Bronchospasm 4[X]Decreased cardiac output 5[X]Capillary blood glucose 145 mg/dL

A patient has been receiving hydralazine. What findings indicate the patient is experiencing adverse effects of this medication therapy? Select all that apply. 1] The patient is constipated. 2] The patient complains of being dizzy. 3] The patient has a "pounding headache." 4] The patient has been vomiting and has diarrhea. 5] The patient is disoriented to person, place, and time. 6] The patient is having difficulty walking to the bathroom.

2] The patient complains of being dizzy. 3] The patient has a "pounding headache." 4] The patient has been vomiting and has diarrhea.

7. The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?

3 tablets per dose (150 mg per dose)

The nurse is caring for a patient who has hypercholesterolemia and who has been prescribed atorvastatin. Which instruction will the nurse receive from the primary health care provider for the safe administration of the medication? 1( )"Administer 2 mg of atorvastatin orally." 2( )"Administer 20 mg of atorvastatin orally." 3( )"Administer 10 mg of atorvastatin orally." 4( )"Administer 40 mg of atorvastatin orally."

3( )"Administer 10 mg of atorvastatin orally."

After talking with a patient who is receiving warfarin sodium therapy, the nurse believes that the patient is at increased risk for bleeding. Which statement made by the patient supports the nurse's conclusion? 1( )"I do not take aspirin for pain relief." 2( )"I eat one cup of green leafy vegetables daily." 3( )"I take ginkgo supplements for memory enhancement." 4( )"I refrain from drinking coffee and citrus fruit juices daily."

3( )"I take ginkgo supplements for memory enhancement."

Which statement made by the patient indicates an understanding of discharge instructions on antihyperlipidemic medications? 1( )"I will stop taking the medication if it causes nausea and vomiting." 2( )"It is important to double my dose if I miss one in order to maintain therapeutic blood levels." 3( )"I will continue my exercise program to help increase my high-density lipoprotein serum levels." 4( )"Antihyperlipidemic medications will replace the other interventions I have tried to decrease my cholesterol."

3( )"I will continue my exercise program to help increase my high-density lipoprotein serum levels."

A patient is started on warfarin therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? 1( )"Your concern is valid. I will call the doctor to discontinue the heparin." 2( )"Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications." 3( )"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." 4( )"Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than either one alone."

3( )"It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."

A patient with a history of gastroesophageal reflux asks the nurse if it is okay to take over-the-counter medication for heartburn with the newly prescribed antidysrhythmic drug. What is the nurse's best response? 1( )"An over-the-counter antacid is fine to take with your antidysrhythmic." 2( )"It's best to take the antidysrhythmic on an empty stomach if heartburn occurs." 3( )"Take an antacid, if needed, 2 hours before or 2 hours after the antidysrhythmic." 4( )"You can take an antacid along with the antidysrhythmic 30 minutes before eating."

3( )"Take an antacid, if needed, 2 hours before or 2 hours after the antidysrhythmic."

The nurse plans which intervention to decrease flushing associated with niacin? 1( )Administer niacin with an antacid. 2( )Apply cold compresses to the head and neck. 3( )Administer aspirin 30 minutes before nicotinic acid. 4( )Administer diphenhydramine hydrochloride with the niacin.

3( )Administer aspirin 30 minutes before nicotinic acid.

The nurse is teaching a patient about therapy with anticoagulants. What is essential information to include in the teaching plan? 1( )Anticoagulants dissolve clots. 2( )Anticoagulants alter platelet function. 3( )Anticoagulants prevent clots from forming. 4( )Anticoagulants interfere with drug metabolism

3( )Anticoagulants prevent clots from forming.

The patient who is receiving antidysrhythmic drugs exhibits increased cardiac output, increased activity tolerance, blood pressure 130/75, pulse 86, and has voided 400 mL of urine during the past 8-hour shift. What is the nurse's best action? 1( )Notify the health care provider. 2( )Increase the continuous intravenous fluid rate. 3( )Document the findings in the patient's medical record. 4( )Place the patient in the Trendelenburg's position to improve venous return.

3( )Document the findings in the patient's medical record.

A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? 1( )Anxiety 2( )Medication reaction 3( )Embolus to the lungs 4( )Fatigue from the extra work of walking with pain

3( )Embolus to the lungs

A patient will be discharged to continue treatment with simvastatin. The nurse will teach the patient to report which symptom? 1( )Fatigue 2( )Headache 3( )Muscle pain 4( )Nausea and vomiting

3( )Muscle pain

The patient is being treated with abciximab. The nurse assesses the patent's laboratory test results and finds that the platelet count has dropped to 75,000/mm3. What action will the nurse perform next? 1( )Prepare to administer protamine sulfate. 2( )No action is needed; this is a normal finding. 3( )Notify the primary care provider of this finding. 4( )Document the finding and continue to monitor the patient.

3( )Notify the primary care provider of this finding.

A patient with hypercholesterolemia is prescribed lovastatin. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the health care provider. What did the nurse find in the patient's medical history? 1( )The patient has leukemia. 2( )The patient has renal disease. 3( )The patient has hepatic disease. 4( )The patient has chronic pulmonary disease.

3( )The patient has hepatic disease.

A patient with nonvalvular atrial fibrillation is receiving dabigatran therapy. After assessing the patient, the nurse concludes that the patient is receiving effective treatment. Which finding supports the nurse's conclusion? 1( )The patient has increased bowel sounds. 2( )The patient's heart rate is 50 beats/min. 3( )The patient's extremities are pink and warm. 4( )The patient's rate of respiration is 11 breaths/min.

3( )The patient's extremities are pink and warm.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient? 1) "Change the patch daily at the same time." 2) "Remove the patch before taking a shower or bath." 3) "Get up slowly from a sitting to a standing position." 4) "Do not take other antihypertensive medications while using this patch."

3) "Get up slowly from a sitting to a standing position."

A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dinitrate. What instruction should the nurse give the patient to minimize side effects? 1. "Measure your pulse rate before taking the medication." 2. "Eat a potassium-rich diet while taking the medication." 3. "Change position carefully while taking the medication." 4. "Eat a magnesium-rich diet while taking the medication."

3. "Change position carefully while taking the medication."

What information about interactions should be included in the discharge teaching plan of a patient who is receiving nifedipine for angina? 1 . "Avoid milk products while taking nifedipine." 2. "Nifedipine cannot be taken with any other cardiac medications." 3. "Grapefruit and grapefruit juice can cause toxicity and should be avoided." 4. "Spinach can interact with the medication and needs to be eliminated from the diet."

3. "Grapefruit and grapefruit juice can cause toxicity and should be avoided."

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? 1. "I will change my position slowly to prevent feeling dizzy." 2. "I will not mow my lawn until I see how this medication makes me feel." 3. "I will check my blood pressure daily and take my medication when it is over 140/90 mm Hg." 4. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."

3. "I will check my blood pressure daily and take my medication when it is over 140/90 mm Hg."

What information is essential to include in a discharge plan for a patient prescribed nitroglycerin as needed for angina pain? 1. "You can put a few tablets in a sealed bag and carry it in your pocket." 2. "You can protect the medication from heat by placing the bottle in a cooler with ice." 3. "It is best to keep the medication it in its original container away from heat and light." 4. "Keep the medication in the glove compartment of your car to protect it from heat and light."

3. "It is best to keep the medication it in its original container away from heat and light."

The nurse administers clonidine. What finding indicates the medication is therapeutic? 1. Absence of chest pain 2. Increased urinary output 3. Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg 4. Heart rate decrease from 100 beats/min to 40 beats/min

3. Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg

The nurse reviews a patient's laboratory values, including a digoxin level of 10 ng/mL and serum potassium value of 6.2. Which drug does the nurse ask the primary health care provider to prescribe? 1. Atropine 2. Epinephrine 3. Digoxin immune Fab 4. Potassium supplements

3. Digoxin immune Fab

Which medication acts by blocking calcium channels? 1. Digoxin 2. Ibutilide 3. Diltiazem 4. Lidocaine

3. Diltiazem

A patient takes a sublingual nitroglycerin for chest pain and begins to feel dizzy. The patient continues to have pain after 10 minutes. What is the best nursing intervention? 1. Apply a nitro patch. 2. Give the patient another dose of the medication. 3. Have the patient sit down and assess blood pressure. 4. Hold any more doses of the medication and call the health care provider.

3. Have the patient sit down and assess blood pressure.

A community health nurse is providing education on clonidine to an elderly patient during a home visit. Which adverse effect should be emphasized as most concerning to this patient? 1. Dry mouth 2. Restlessness 3. Hypotension 4. Constipation

3. Hypotension

The patient's blood pressure is 200/120 mm Hg, and the health care provider prescribes sodium nitroprusside. What is the nurse's priority action? 1. Measure hourly output. 2. Administer with a full glass of water. 3. Monitor blood pressure continuously. 4. Make certain the patient does not crush the pill

3. Monitor blood pressure continuously.

The nurse is caring for a patient with a history of angina who complains of chest pain. What nitroglycerin preparation does the nurse administer? 1. Isosorbide dinitrate 2. Isosorbide mononitrate 3. Sublingual nitroglycerin 4. Nitroglycerin transdermal patch

3. Sublingual nitroglycerin

What is the primary indication for the use of calcium channel blockers (CCBs)? 1. To prolong the QT interval 2. To reduce elevations in heart rate 3. To decrease the workload of the heart 4. To treat acute myocardial infarction (MI)

3. To decrease the workload of the heart

The nurse is teaching a group of nursing students about statin drugs and asks about the mechanism of action of lovastatin. Which response from the students indicates effective learning? 1( )"It inhibits the absorption of dietary cholesterol in the small intestine." 2( )"It stimulates the biliary system to increase the excretion of dietary cholesterol." 3( )"It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces." 4( )"It inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase to reduce the biosynthesis of cholesterol in the liver."

4( )"It inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase to reduce the biosynthesis of cholesterol in the liver."

What is the intravenous loading dose of milrinone for an adult patient? 1( )0.75 mcg/kg 2( )35 mcg/kg 3( )40 mcg/kg 4( )50 mcg/kg

4( )50 mcg/kg

A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action? 1( )Administer potassium. 2( )Hold future digoxin doses. 3( )Call the health care provider. 4( )Administer the prescribed dose of digoxin.

4( )Administer the prescribed dose of digoxin.

The nurse recognizes which drug as a Class III antidysrhythmic? 1( )Atenolol 2( )Lidocaine 3( )Verapamil 4( )Amiodarone

4( )Amiodarone

A patient is taking 0.25 mg of digoxin and 40 mg of furosemide daily. When the nurse enters the room, the patient reports seeing yellow halos around the lights. What is the nurse's first action? 1( )Withhold the next dose of furosemide. 2( )Administer the medication as prescribed. 3( )Document the findings and reassess in 1 hour. 4( )Assess the patient for symptoms of digoxin toxicity.

4( )Assess the patient for symptoms of digoxin toxicity.

The nurse knows that simvastatin exerts its action by doing what? 1( )By inhibiting lipolysis in the adipose tissue 2( )By activating the lipoprotein lipase enzyme 3( )By preventing the reabsorption of bile acids 4( )By inhibiting the enzyme HMG-CoA reductase

4( )By inhibiting the enzyme HMG-CoA reductase

Which drug has antifibrinolytic properties? 1( )Heparin 2( )Alteplase 3( )Fondaparinux 4( )Desmopressin

4( )Desmopressin

Which medication prolongs the effective refractory period? 1( )Atenolol 2( )Lidocaine 3( )Propafenone 4( )Procainamide

4( )Procainamide

The nurse is teaching a medication regimen to a patient who has type II hyperlipoproteinemia and who has been prescribed cholestyramine. Of what will the nurse inform the patient during the teaching? 1( )Include milk in the diet while taking this medication. 2( )Avoid doing deep breathing exercises after taking the medication. 3( )Avoid taking vitamin A supplements while taking the medication. 4( )Take other medications 1 hour before the administration of cholestyramine.

4( )Take other medications 1 hour before the administration of cholestyramine.

A patient has overdosed on warfarin. Which substance will the nurse administer to reverse the effect of warfarin? 1( )Aspirin 2( )Calcium 3( )Potassium 4( )Vitamin K

4( )Vitamin K

What should the nurse teach the patient to ensure patient understanding of pharmacologic therapy for hypertension? 1. "Urinary output determines blood pressure." 2. "Blood pressure is determined by heart contraction." 3. "Sympathetic stimulation causes blood pressure to decrease." 4. "Blood pressure is a product of cardiac output and vascular resistance."

4. "Blood pressure is a product of cardiac output and vascular resistance."

A patient taking adrenergic drugs for hypertension is being given discharge teaching about the therapy. What information should be included in this teaching plan? 1. "This therapy will cause bruising." 2. "Take this medication after dinner." 3. "Take this medication before dinner 4. "Do not drink alcohol when using this therapy."

4. "Do not drink alcohol when using this therapy."

A patient is prescribed a Alpha2-Adrenergic Receptor Stimulator during pregnancy. What teaching is essential for this patient? 1. "Do not take the medication with food." 2. "Only take this medication in the morning." 3. "Take the medication with potassium supplements." 4. "Sit on the side of the bed before getting up, and get up slowly."

4. "Sit on the side of the bed before getting up, and get up slowly."

The nurse is teaching a patient about the reason for the administration of calcium channel blockers. What statement should be included in the teaching plan? 1. This medication will help your body to get rid of sodium." 2. "This medication will work to cause your body to get rid of fluid." 3. "This medication will help you to lose weight to lower your blood pressure." 4. "This medication will vasodilate your blood vessels to lower your blood pressure."

4. "This medication will vasodilate your blood vessels to lower your blood pressure."

What is the duration of action of a nitroglycerin transdermal patch? 1. 3 to 5 minutes 2. 0.5 to 1 hour 3. 4 to 6 hours 4. 8 to 12 hours

4. 8 to 12 hours

The nurse administers an Angiotensin II Receptor Blocker to a patient. Which patient assessment finding should the nurse use as a clinical indicator of therapeutic effectiveness of the medication? 1. Cool, dry, pale extremities 2. Serum sodium of 140 mEq/L 3. Serum potassium of 3.8 mEq/L 4. Blood pressure of 120/72 mm Hg

4. Blood pressure of 120/72 mm Hg

The nurse is administering amlodipine. What assessment finding requires immediate action? 1. Calcium level of 8 mEq/dL 2. Potassium level of 5 mEq/dL 3. Apical pulse of 100 beats/min 4. Blood pressure of 80/60 mm Hg

4. Blood pressure of 80/60 mm Hg

Which drug would reduce the therapeutic effect of digoxin if it is taken concurrently? 1. Quinidine 2. Verapamil 3. Cyclosporine 4. Cholestyramine

4. Cholestyramine

A patient is admitted to the hospital for an intestinal obstruction and has been placed on strict nothing by mouth (NPO) status. The nurse is reconciling the patient's home medications and notes that the patient's daily dose of the antihypertensive lisinopril has not been prescribed by the health care provider. Which action should the nurse take? 1. Address hypertensive episodes only when they arise. 2. Obtain a prescription to administer the lisinopril intravenously. 3. Obtain a prescription for the daily lisinopril and give with a sip of water. 4. Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed.

4. Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed

A patient has a serum digoxin level of 0.4 ng/mL. What can the nurse interpret from the scenario? 1. It is on the therapeutic level. 2. It has reached the toxic level. 3. It is above the therapeutic level. 4. It is below the therapeutic level.

4. It is below the therapeutic level.

Which are expected clinical manifestations of hypomagnesemia? Select all that apply. 1. Edema 2. Anorexia 3. Insomnia 4. Twitching 5. Hyperactive reflexes

4. Twitching 5. Hyperactive reflexes

6. The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/day. The child weighs 16 pounds. How much hydralazine will be given? (Record your answer using two decimal places.)

5.45 mg/kg/day

A patient who was admitted to the hospital for treatment of atrial fibrillation is about to go home with a new prescription for diltiazem (Cardizem). As the nurse goes over the patient's medication list, the patient complains, "I'm feeling very tired. And when I stand up, I can hardly walk because I'm so dizzy." What is the nurse's priority action at this time?

Calcium channel blockers may cause bradycardia, heart block, hypotension, and dizziness. The nurse's priority action is to assess the patient's vital signs, including apical pulse and postural blood pressure. It is possible that the patient is experiencing orthostatic changes when he stands up. The nurse will need to teach the patient to sit upright before standing up from a reclining position and to stand up slowly.

A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse? 1( )"I will avoid contact sports." 2( )"I will take my medication at the same time each day." 3( )"I will increase dark-green leafy vegetables in my diet." 4( )"I will contact my health care provider if I develop excessive bruising."

Dark-green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin.

Mrs. A. has been shoveling snow all morning. As you work on the snow in your yard, you see her suddenly sit down in her driveway. When you go over to check on her, she says that she has nitroglycerin tablets in her jacket pocket but she forgot how to take them. What is your priority action at this time?

Mrs. A. did the right thing by stopping her activity, but she needs to take the nitroglycerin immediately. The priority is relieving her chest pain, if possible, and accessing emergency assistance if needed. After verifying that the tablets are indeed sublingual nitroglycerin, she needs to place one tablet under her tongue and allow it to dissolve without swallowing it. You will stay with her and keep her calm and warm. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after 1 dose, the patient (or family member) needs to call 911 immediately. Mrs. A. can take one more tablet while awaiting emergency care, and a third tablet 5 minutes later, but no more than three tablets total. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose will be placed under the tongue, and the patient needs to avoid swallowing until the tablet is dissolved; the patient should not eat or drink until the drug has completely dissolved. If the chest pain resolves, assist her carefully into her home; keep in mind that she may experience orthostatic blood pressure changes and may feel dizzy. It is important to get her into a warm environment as soon as possible. Make sure she is not left alone.

What node is the pacemaker of the heart?

SA node

2. A patient is receiving an angiotensin-converting enzyme (ACE) inhibitor, a diuretic, and a beta blocker as treatment for heart failure. He has a history of hypothyroidism, which is controlled by thyroid replacement hormones, and chronic bronchitis. He states that he stopped smoking 1 year ago after smoking two packs a day for 30 years. This morning he complains of a dry cough but says he does not feel short of breath, even when getting up to go to the bathroom. He is unable to produce any sputum. When the nurse listens to his lungs, his breath sounds are clear except for very few scattered rhonchi bilaterally. His weight is the same as yesterday's weight, and his ankles show only trace edema (2 days ago he had 2+ edema on the edema scale). His temperature is 98.4° F (36.9° C), his pulse is 88 beats/min, and his blood pressure is 124/86 mm Hg. He says to the nurse, "This cough is awful! I am so afraid that my heart failure is getting worse or that I'm getting pneumonia!" What is the nurse's priority action at this time?

The assessment does not indicate that he has signs of worsening heart failure. He has no increase in weight or edema, no crackles, and no dyspnea. He also does not show signs of developing pneumonia (no sputum, no fever, no consolidation in the lungs). However, did you recall that an annoying adverse effect of ACE inhibitors is a dry cough? This cough is harmless, but with his history of chronic bronchitis, he may already have a chronic cough that is made worse by the ACE inhibitor. The priority would be to explain this to the patient and notify the prescriber of the patient's complaint. The prescriber may decide to change the ACE inhibitor to another drug, such as an angiotensin II receptor blocker, which does not cause the dry cough.

A 79-year-old woman has been admitted to the emergency department after experiencing severe headaches and "feeling faint." Upon admission, her blood pressure is measured as 286/190 mm Hg. A sodium nitroprusside infusion is started, and the nurse is monitoring the patient closely. After 8 minutes of infusion, the nurse notes that the patient's blood pressure suddenly drops to 100/60. What is the nurse's priority action at this time?

The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension. If it occurs while the patient is receiving this drug, the priority action is to discontinue the infusion. Doing this has an immediate effect because the drug is metabolized very rapidly (half-life of 2 minutes, duration 1 to 10 minutes). Treatment for the hypotension is supportive and symptomatic; if necessary, pressor drugs can be infused to raise blood pressure quickly.

After a patient undergoes total hip replacement, the nurse reviews the new postoperative orders and notes an order for dalteparin (Fragmin) 2500 international units subcutaneously 6 hours after surgery, then 5000 international units daily for 7 days. When assessing the patient before administering the drug, the nurse sees that the patient has an epidural catheter for administration of pain medication. What is the nurse's priority action regarding the administration of the dalteparin?

The nurse must not give the anticoagulant. Dalteparin (Fragmin) and enoxaparin (Lovenox), both low-molecular-weight heparins (LMWHs), have black box warnings that specify that they are not to be given to a patient who has an indwelling epidural catheter because of the risk for an epidural hematoma. The LMWHs can be given 2 hours after the removal of an epidural catheter. Careful assessment is vital when administering anticoagulants.

2. A patient has been admitted to the emergency department and is experiencing PSVT that has not responded to treatment with calcium channel blockers. Immediately after the patient receives a dose of adenosine (Adenocard) by intravenous push, the monitor shows asystole. What is the nurse's priority action in response to the asystole?

The nurse should remember that adenosine (Adenocard) may cause a transitory episode of asystole immediately after administration. The nurse should monitor the patient to make sure this asystole is indeed transitory and that either normal sinus rhythm or the PSVT returns. In addition, the nurse should make sure that the patient has a pulse when the heart rhythm reverts from asystole.

2. During a follow-up appointment, a 58-year-old man is pleased to hear that his blood pressure is 118/64 mm Hg. He says, "I've been hoping to hear this good news! Now I can stop taking these pills, right?" What is the nurse's best answer?

The nurse should tell the patient that one reading of a good blood pressure result will not be grounds for discontinuing the blood pressure medication. The patient must manage hypertension by both pharmacologic and nonpharmacologic means. In addition to medications, the patient should modify his diet by reducing sodium and increasing fiber intake, exercising regularly, and trying to reduce the amount of stress in life. The nurse should remind the patient that hypertension increases the risk for cardiovascular injury, and he will have to be monitored for evidence of controlled blood pressure as well as for potential complications of treatment for the rest of his life. In addition, he must also be monitored constantly for the development of end-organ damage (i.e., checking renal function, examination of the fundus of the eye).

2. While reviewing instructions for a newly prescribed antilipemic drug, a patient informs the nurse that he "hates to mix powdered medicines" and plans to take his cholestyramine (Questran) powder dry. What is the nurse's best response to this patient's comment?

The nurse will review with the patient the instructions for properly taking this medication. If he does not like mixing it with fluid, he can mix it thoroughly with fruit, such as crushed pineapple or applesauce. Taking the powder in dry form may increase the risk of choking. The patient needs to be encouraged to take this medication with plenty of fluids and even with a fiber supplement to prevent constipation and bloating. If he is not willing to follow these instructions, the prescriber needs to be contacted to change the medication to a nonpowder form. The anticholesterol medication will not work if the patient does not take it.

A patient has started taking niacin (nicotinic acid) as part of treatment for high cholesterol levels. After the first dose, he tells the nurse that he feels "hot" and that his face and neck are flushed. He says that he thinks he is having an allergic reaction. What is the nurse's priority action at this time?

The priority action is to assess the patient for signs of an allergic reaction. Asse ss for difficulty in breathing and for hives and a rash, and also check vital signs. If the assessment reveals no other problems, the most likely reason for the patient's complaints is the nicotinic acid (niacin) itself. The flushing may be minimized by taking a small dose of aspirin or an NSAID half an hour before the nicotinic acid, as long as these medications do not interfere with other medications ordered for the patient. Extended-release dosage forms, which dissolve more slowly than the immediate-release forms, but faster than the sustained-release forms, appear to cause less flushing of the skin.

2. A patient is going home and will be taking warfarin (Coumadin). While discussing his medications just before his discharge to home, the patient says, "I want to get back to taking my vitamins with gingko. They really help my memory." What is the priority as the nurse answers the patient's question?

The priority is to ensure that the patient understands the interactions that may occur with warfarin. Certain herbal preparations, such as garlic, ginseng, and ginkgo, among others, may also cause a degree of anticoagulation. If the patient is already taking warfarin, the drug levels are carefully balanced to a particular degree of anticoagulation, which is monitored on a regular basis by prothrombin time/international normalized ratio (PT/INR) results. Adding another agent that also alters coagulation may increase the patient's risk for bleeding. The patient must avoid taking additional products, even over-the-counter products, that increase anticoagulation while taking warfarin.

A nurse administered 125 mg of digoxin instead of 0.125 mg of digoxin intravenously. The patient has developed a severe heart block dysrhythmia, and the slow heart rate has not responded to administration of atropine and other measures. The nurse stays with the patient while the charge nurse notifies the cardiologist. What will be the priority in this situation? What will the nurse expect to give next? How could this situation have been prevented?

The priority would be to monitor the patient closely and continuously for clinical signs and symptoms of digoxin toxicity. Serum digoxin levels are not an accurate measure of results because the bound digoxin that is still circulating causes serum drug elevations. Digoxin immune Fab is an antibody that recognizes digoxin as an antigen and forms an antigen-antibody complex with the drug, thus inactivating the free digoxin. It is not used in every case of digoxin toxicity but is used in certain situations such as this one, in which the patient is experiencing life-threatening dysrhythmias and has received a life-threatening overdose. The recommended dosage is determined by consulting the manufacturer's dosage table; each milligram can neutralize up to 0.5 mg of digoxin. Careful checking of the right dosage would have prevented this situation.

2. When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline)

a. Alpha blockers such as doxazosin (Cardura)

3. Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina."

A patient asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). Which response by the nurse is accurate? a. "We do not know how Ranexa works." b. "This drug is the first medication your health care provider will use to treat your angina." c. "This drug must be given intravenously." d. "Ranexa is safe to use in patients with liver failure."

a. "We do not know how Ranexa works."

6. The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. tadalafil (Cialis), an erectile dysfunction drug d. metformin (Glucophage), an antidiabetic drug e. carvedilol (Coreg), a beta blocker

a. A glass of wine c. tadalafil (Cialis), an erectile dysfunction drug e. carvedilol (Coreg), a beta blocker

Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? a. Avoid drinking large amounts of green tea. b. Cranberry juice will provide you with needed nutrients while taking Coumadin. c. You must never eat spinach. d. You can only eat lettuce once a month.

a. Avoid drinking large amounts of green tea.

2. When administering niacin, the nurse needs to monitor for which adverse effect? a. Cutaneous flushing b. Muscle pain c. Headache d. Constipation

a. Cutaneous flushing

3. When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a. Dysrhythmia b. Proteinuria c. Hyperglycemia d. Hypertension

a. Dysrhythmia

8. The nurse is assessing a patient who has a new prescription for vorapaxar (Zontivity). Which of these conditions are considered contraindications to the use of vorapaxar? (Select all that apply.) a. Impaired renal function b. Impaired liver function c. History of myocardial infarction d. Peripheral artery disease e. History of stroke

a. Impaired renal function b. Impaired liver function e. History of stroke

6. The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects

a. Positive inotropic effects b. Vasodilation e. Positive chronotropic effects

When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of a. hypotension. b. hyperkalemia. c. oliguria. d. respiratory distress.

a. hypotension.

Hypomagnesemia manifestations:

agitation twitching hyperactive reflexes N/V ECG changes

6. When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs."

b. "Do not chew sustained-release capsules." e. "You may take the medication with food if stomach upset occurs."

5. A 68-year-old male patient has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."

b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists."

3. A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse? a. "Not to worry. Eventually, tolerance will develop." b. "The physician can work with you on changing the dose and/or drugs." c. "Sexual dysfunction happens with this therapy, and you will learn to accept it." d. "This is an unusual occurrence, but it is important to stay on your medications."

b. "The physician can work with you on changing the dose and/or drugs."

3. The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. "We will need to teach a family member how to give this drug in your arm." b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel." c. "This drug needs to be taken at the same time every day with a full glass of water." d. "Be sure to massage the injection site thoroughly after giving the drug."

b. "This drug is given in the folds of your abdomen, but at least 2 inches away from your navel."

5. A patient is currently taking a statin. The nurse considers that the patient may have a higher risk for developing rhabdomyolysis when also taking which product? a. NSAIDs b. A fibric acid derivative c. Orange juice d. Fat-soluble vitamins

b. A fibric acid derivative

5. A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches

b. A potassium supplement taken daily e. An NSAID taken as needed for headaches

A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice. b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach. d. Have the patient increase dietary fiber intake.

b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose.

6. A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value.

b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.

6. The nurse is administering cholestyramine (Questran), a bile acid sequestrant. Which nursing intervention(s) is appropriate? (Select all that apply.) a. Administering the drug on an empty stomach b. Administering the drug with meals c. Instructing the patient to follow a low-fiber diet while taking this drug d. Instructing the patient to take a fiber supplement while taking this drug e. Increasing fluid intake f. Not administering this drug at the same time as other drugs

b. Administering the drug with meals d. Instructing the patient to take a fiber supplement while taking this drug e. Increasing fluid intake f. Not administering this drug at the same time as other drugs

A patient is receiving an IV infusion of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work was drawn. What will the nurse do first? a. Monitor the site for further bleeding. b. Apply pressure to the site with a gauze pad. c. Slow the rate of infusion of the thrombolytic drug. d. Stop the infusion of the thrombolytic drug.

b. Apply pressure to the site with a gauze pad.

A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? a. Assess the patient for diaphoresis. b. Check the IV lock to see if it is functioning properly. c. Repeat the dose of diltiazem (Cardizem). d. Restart the IV in another location.

b. Check the IV lock to see if it is functioning properly.

5. A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a. Give IV vitamin K as an antidote. b. Give IV protamine sulfate as an antidote. c. Call the blood bank for an immediate platelet transfusion. d. Obtain an order for packed red blood cells.

b. Give IV protamine sulfate as an antidote.

3. The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. muscle pain. b. tinnitus. c. chest pain. d. excessive thirst.

b. tinnitus.

1. The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation

b. Hypotension

A patient is receiving oral quinidine. Which assessment finding is of most concern? a. Nausea b. Prolonged QT interval c. Diarrhea d. Occasional palpitations

b. Prolonged QT interval

A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? a. Take his nitroglycerin tablet b. Stop mowing and sit or lie down c. Go inside the house to cool off and get a drink of water d. Call 911

b. Stop mowing and sit or lie down

8. A patient has been taking simvastatin (Zocor) for 6 months. Today he received a call that he needs to come to the office for a "laboratory check." The nurse expects which laboratory studies to be ordered at this time? (Select all that apply.) a. PT/INR b. Total cholesterol c. Triglyceride d. Liver function studies e. Complete blood count f. HDL and LDL levels

b. Total cholesterol c. Triglyceride d. Liver function studies f. HDL and LDL levels

A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension

b. Transitory asystole

When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for a. visual changes such as photophobia. b. flickering lights or halos around lights. c. dizziness when standing up. d. increased urine output.

b. flickering lights or halos around lights.

Before administering niacin, it is most important for the nurse to assess the patient for a. allergy to erythromycin. b. gout. c. coronary artery disease. d. hypothyroidism.

b. gout.

The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include: a. immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. b. overlapping therapy of IV heparin and warfarin are for at least 5 days. c. monitoring the INR and stopping the IV heparin when the INR is 1.0

b. overlapping therapy of IV heparin and warfarin are for at least 5 days.

4. A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a. increase urine output. b. prevent stimulation of the heart by catecholamines. c. increase the contractility of the heart muscle. d. cause peripheral vasodilation.

b. prevent stimulation of the heart by catecholamines.

A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is a. the medication is better absorbed at this time. b. this timeframe correlates better with the natural diurnal rhythm of cholesterol production. c. there will be fewer adverse effects if taken at night instead of with the morning meal. d. this timing reduces the incidence of myopathy.

b. this timeframe correlates better with the natural diurnal rhythm of cholesterol production. (we produce a lot of cholesterol at night)

A patient asks how to apply transdermal nitroglycerin. What is the nurse's best response? a. "Always apply the transdermal patch over the area of your chest where your heart is." b. "Keep the previous patch on for 1 full day so you always have two patches on at a time." c. "Apply the patch to hairless areas of the body." d."First apply Vaseline to your body; then apply the transdermal patch."

c. "Apply the patch to hairless areas of the body."

What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina? a. "Call your health care provider if you heart rate is 64 beats/min." b. "These drugs are safe to use in patients who have asthma." c. "Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week." d. "Avoid taking these medications with grapefruit juice."

c. "Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week."

8. A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How much sun exposure have you had recently?"

c. "This can happen with amiodarone. I will let your doctor know about it right away."

4. A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."

c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed."

Which statement about ARBs does the nurse identify as being true? a. Hyperkalemia is more likely to occur than when using ACE inhibitors. b. Cough is more likely to occur than when using ACE inhibitors. c. Chest pain is a common adverse effect. d. Overdose is usually manifested by hypertension and bradycardia.

c. Chest pain is a common adverse effect.

8. A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity

4. When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? a. Diarrhea b. Nausea c. Dry, nonproductive cough d. Sedation

c. Dry, nonproductive cough

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? a. Pressure should be applied to the lump for 3 to 5 minutes. b. He will need to take two doses of warfarin tonight to prevent blood clotting. c. He needs to be examined for possible internal bleeding from the fall. d. As long as there is no bleeding, there is no concern.

c. He needs to be examined for possible internal bleeding from the fall.

A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911? a. Immediately b. If the pain becomes more severe c. If one sublingual tablet does not relieve the pain after 5 minutes d. If the pain is not relieved after three sublingual tablets, taken 5 minutes apart

c. If one sublingual tablet does not relieve the pain after 5 minutes

2. A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions.

c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing.

3. Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the "statin" class? a. The drug needs to be taken on an empty stomach before meals. b. A low-fat diet is not necessary while taking these medications. c. It is important to report muscle pain immediately. d. Improved cholesterol levels will be evident within 2 weeks.

c. It is important to report muscle pain immediately.

4. A patient is being assessed before a newly ordered antilipemic medication is given. Which condition would be a potential contraindication? a. Diabetes insipidus b. Pulmonary fibrosis c. Liver cirrhosis d. Myocardial infarction

c. Liver cirrhosis

2. A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin.

c. NSAIDs

2. When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria

c. Photophobia

A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication? a. Positive chronotrope b. Negative chronotrope c. Positive inotrope d. Negative inotrope

c. Positive inotrope

4. A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a. Asthma b. Elevated liver enzymes c. Renal impairment d. History of myocardial infarction

c. Renal impairment

A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? a. Apical heart rate of 58 beats/min b. Ankle edema +1 bilaterally c. Serum potassium level of 2.9 mEq/L d. Serum digoxin level of 0.8 ng/mL

c. Serum potassium level of 2.9 mEq/L (precipitate dig. toxicity) therapeutic potassium: 3.5-5.0 mEq/L

A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient? a. Vasodilation of the coronary arteries b. Increased force of cardiac contraction c. Slowing of the heart rate d. Maintaining adequate BP

c. Slowing of the heart rate

A patient has been ordered the powdered form of the bile acid sequestrant colestipol. Which of the following does the nurse identify as true? a. The nurse should have the patient swallow the dose of the colestipol powder one teaspoonful at a time. b. The powder should be dissolved and immediately administered. c. The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. d. The colestipol should be administered with meals.

c. The colestipol should be administered 1 hour before or 4 to 6 hours after any other oral medication. DOES NEED DISSOLVED, BUT NEEDS TO DISSOLVE FOR AT LEAST 1 MINUTE - NOT IMMEDIATELY

A patient is receiving an IV infusion of heparin and was started on warfarin therapy the night before. Which statement is most correct? a. The patient is receiving a double dose of anticoagulants. b. The heparin therapy was ineffective, so the warfarin was started. c. The heparin provides anticoagulation until therapeutic levels of warfarin are reached. d. The heparin and warfarin work together synergistically to provide anticoagulation.

c. The heparin provides anticoagulation until therapeutic levels of warfarin are reached.

A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina

c. To prevent the occurrence of angina

A 72-year-old woman is taking an over-the-counter multivitamin that contains ginkgo. Her physician has recommended that she start taking low-dose aspirin therapy as part of her treatment for transient ischemic attacks. The concern with taking these two drugs together is a. increased risk of gastric ulcer. b. decreased action of the aspirin because of the interaction with the ginkgo. c. increased risk of bleeding because of the ginkgo. d. antagonism of the action of the aspirin because of the multivitamins.

c. increased risk of bleeding because of the ginkgo.

2. During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as: a. apical pulse rate of 62 beats/min. b. digoxin level of 1.5 ng/mL. c. serum potassium level of 2.0 mEq/L. d. serum calcium level of 9.9 mEq/L.

c. serum potassium level of 2.0 mEq/L.

The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which the ACE inhibitors exert their therapeutic effect in a patient in HF is a. to inhibit catecholamine release. b. to inhibit acetylcholine release. c. to inhibit aldosterone secretion. d. to prevent vagal stimulation.

c. to inhibit aldosterone secretion.

Which patient would benefit from administration of simvastatin (Zocor) 80 mg? a. A patient newly diagnosed with hyperlipidemia b. A patient with muscle aches who was taking another antilipidemic drug c. A patient who is taking verapamil d. A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy

d. A patient who has already been taking simvastatin (Zocor) for 12 months with no evidence of myopathy TYPICAL AMOUNT IS 5-40 MG. SHOULD NOT TAKE THIS HIGH 80 MG DOSE UNLESS THEY STARTED OUT SMALL WITH NO EVIDENCE OF MYOPATHY

Which patient is the best candidate to receive nesiritide therapy? a. A patient with atrial fibrillation who has not responded to other drugs b. A patient needing initial treatment for HF c. A patient with reduced cardiac output d. A patient with acutely decompensated HF who has dyspnea at rest

d. A patient with acutely decompensated HF who has dyspnea at rest

4. While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a. Hypertension b. Essential tremors c. Exertional angina d. Asthma

d. Asthma

A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? a. Clonidine b. Prazosin c. Diltiazem d. Captopril

d. Captopril

A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? a. Check the patient's pulse. b. Prepare to administer cardiopulmonary resuscitation. c. Set up for defibrillation. d. Continue to monitor the patient.

d. Continue to monitor the patient.

A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? a. Digoxin 0.25 mg PO daily b. Digoxin 1 mg PO now; then 0.25 mg PO daily c. Digoxin 0.5 mg IV push daily d. Digoxin 1 mg IV push now; then 0.25 mg IV daily

d. Digoxin 1 mg IV push now; then 0.25 mg IV daily

A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate? a. Sublingual spray b. Transdermal patch c. Oral capsule d. IV infusion

d. IV infusion

The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm

d. Irregular heart rhythm

When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? a. Platelet levels b. aPTT c. Red blood cell count d. PT/INR

d. PT/INR Heparin is aPTT Warfarin is PT/INR

5. The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction

d. Renal dysfunction

7. The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? a. Asthma b. Rheumatoid arthritis c. Hyperthyroidism d. Renal insufficiency

d. Renal insufficiency

A patient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? a. Hypertension b. Bowel obstruction c. Sinus infection d. Scheduled surgery

d. Scheduled surgery GARLIC IS ANTIPLATELET - WILL INCREASE RISK OF BLEEDING

A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her physician has never told her that she has hypertension. What is the best explanation for this order? a. The doctor knows best. b. The patient is confused. c. This medication has cardioprotective properties. d. This medication has a protective effect on the kidneys for patients with diabetes.

d. This medication has a protective effect on the kidneys for patients with diabetes.

8. A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic

d. Vasospastic

5. The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia

d. Ventricular dysrhythmia

The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication? a. atropine b. carvedilol (Coreg) c. lisinopril (Prinivil) d. nesiritide (Natrecor)

d. nesiritide (Natrecor)

A patient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to a. take the medication at bedtime. b. take the medication with a small dose of a steroid. c. take the medication with a full glass of water on an empty stomach. d. start with a low initial dose and then increase it gradually.

d. start with a low initial dose and then increase it gradually.

A patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. The nurse anticipates administration of a. protamine sulfate. b. alteplase (Activase, Cathflo Activase). c. reteplase (Retavase). d. vitamin K.

d. vitamin K. protamine sulfate: reverse heparin

The nurse is preparing to educate a group of patients on the management of angina. Which drug groups are most often used to treat patients with angina?

nitrates beta blockers calcium channel blockers

Your patient has been switched from oral nitroglycerin capsules to a transdermal form. What are the priorities for patient teaching regarding transdermal nitroglycerin therapy?

• Sites of application must be rotated, and the skin must be washed when the patch is removed so as to remove medication residue. • The patch needs to be applied to clean, dry, and hairless skin. • Never apply a patch on irritated or open skin or into skin folds. • The old patch must not be left on when applying the new patch. • If the transdermal patch becomes loose, the patient needs to remove it and gently remove the residue with lukewarm soap and water, pat the area dry, and place another patch in another area. • Rotation of sites is helpful for preventing irritation. • The prescriber may order the removal of the patch for an 8-hour period on specific days or at specific times to help decrease or prevent drug tolerance. • The patch should not be cut because doing so may affect the dose. • The used patches need to be disposed of carefully. Follow the manufacturer's guidelines. Used patches may be toxic to children and pets. • Emphasize the same instructions as those for nitrate drugs with regard to avoiding alcohol, hot temperatures, emotional stress, smoking, and excessive physical activity. •the patient needs to be aware that the transdermal patch is intended to prevent angina episodes; it is not intended to stop angina once it has begun.