314 Exam 3

A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect? -Apply pressure to the nares. -Place ice to the bridge of the client's nose. -Instruct the client to blow his nose. -Tilt the client's head backward -Move the client into high-Fowler's position.

Apply pressure to the nares Place ice to the bridge of the client's nose Move the client into high-Fowler's position

A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions? -Asthma -Glaucoma -Depression -Migraines

Asthma -Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.

A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition? -Anorexia -Weight gain -Breathlessness -Distended abdomen

Breathlessness -Manifestations of left-sided heart failure include crackles or wheezes and breathlessness due to pulmonary congestion.

The patient has been receiving clonidine 0.1mg via transdermal patch once every 7 days. Eight hours later, the nurse discovers the patch is no longer present. Which assessment finding should be MOST concerning to the nurse? A: skin tear upper chest B: report of a headache C: BP 182/100 D: HR 120

C: BP 182/100 Application would cause significant hypotension...rapid removal would cause significant rebound HYPERTENSION!

A nurse is assessing a client after administering a dose of losartan. The client has a hoarse voice, and swollen lips and tongue. In which order should the nurse take the following actions? Move the nursing actions into the box on the right, placing them in the selected order of performance. All steps must be used.) Adminster IV epinephrine Initiate IV access Call the emergency response team Adminster IV antihistamines Apply high-flow oxygen Assess the client's airway

Assess the client's airway Call the emergency response team Apply high-flow oxygen Initiate IV access Adminster IV epinephrine Adminster IV antihistamines

The nurse is preparing to administer spironolactone (Aldactone) to treat hypertension. Which of the following laboratory values should alert the nurse to take further action? A: Magnesium 1.9mEq/L B: Potassium 5.2mEq/L C: Chloride 100mEq/L D: Sodium 140mEq/L

B: Potassium 5.2mEq/L Spironolactone is an aldosterone antagonist (and potassium-sparing diuretic); it blocks aldosterone receptors causing secretion of water and sodium.

The nurse is caring for a client who is being prescribed propranolol. What is the client's history would alert the nurse that this drug may be contraindicated? 1. depression 2. glaucoma 3. migraines 4. asthma

4. asthma

A patient who is taking prazosin for hypertension The nurse should be aware that the patient is at risk for which adverse effect? A: Bradycardia B: Hypotension C: Hypoglycemia D: Hyperglycemia

B: Hypotension Dilating the blood vessels can lead to dizziness, hypotension, and tachycardia.

A nurse is teaching a middle-age client about hypertension. Which of the following information should the nurse include in the teaching? -"Reaching your goal blood pressure will occur within 2 months." -"Diuretics are the first type of medication to control hypertension." -"Limit your alcohol consumption to three drinks a day." -"Plan to lower saturated fats to 10 percent of your daily calorie intake."

"Diuretics are the first type of medication to control hypertension." -The nurse should include in the teaching that diuretic medication is the first type of medication to control hypertension, by decreasing blood volume and lowering blood pressure.

A nurse recognizes that the patient taking hydrochlorothiazide may be at risk for a drug interaction if the patient is also taking (Select all that apply)? A: furosemide B: lithium C: ibuprofen D: digoxin

B: lithium C: ibuprofen B+C! Patients can take more than 1 diuretic and digoxin is a drug commonly used in heart failure.

The nurse reviews laboratory values for the patient receiving digoxin (Lanoxin). To which of the following lab values should the nurse be particularly attentive? -sodium level -digoxin level -hemoglobin -platelets

Digoxin level

A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect? -Frothy sputum -Dependent edema -Nocturnal polyuria -Jugular distention

Frothy sputum -Left-sided heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations include hacking cough, frothy sputum, wheezing, fatigue, and weakness.

A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the cause of the client's low potassium level? -Furosemide -Nitroglycerin -Metoprolol -Spironolactone

Furosemide -Loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis, which decreases potassium through excretion in the distal nephrons. Hypokalemia is an adverse effect of furosemide.

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? -Hypernatremia -Hyperuricemia -Hypercalcemia -Hyperchloremia

Hyperuricemia -The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints.

A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide? -Bicarbonate -Carbon dioxide -Potassium -Phosphate

Potassium -Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia.

A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report? -Dry cough -Swelling of the tongue -Nausea -Nasal congestion

Swelling of the tongue -When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued.

The patient has a blood pressure of 124/84. In what category does this place the patient? 1. normal blood pressure 2. pre-hypertension 3. stage 2 hypertension 4. stage 1 hypertension

2. pre-hypertension

A nurse is preparing to administer clonidine 0.3 mg at bedtime to a client. The amount available is clonidine 0.1 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

3

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? -Hypervolemia -Hypertension -Hypokalemia -Hypoglycemia

Hypokalemia -Hypokalemia is an adverse effect of furosemide.

Calcium Channel Blockers

Names - Verapamil - Nifedipine - Diltiazem Method of Action - Blocks calcium access to heart - Decreases contractibility - Lowers BP SE - Reflex tachycardia - Dizziness - Edema - Hypotension - Gingival hyperplasia Nursing Considerations - Use WITH a beta blocker to minimize reflex tachycardia SE - Monitor pulse and BP prior to therapy

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? -Hemoglobin (Hgb) -Prothrombin time (PT) -Bleeding time -Activated partial thromboplastin time (aPTT)

Prothrombin time (PT) -This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.5 tablets - 1 mg = 1000 mcg

A nurse is caring for a patient with multiple drug allergies. Which one would cause the nurse to hold the patient's newly prescribed furosemide? A: Sulfa drugs B: Penicillins C: Cephalosporins D: NSAIDs

A: Sulfa drugs Loop diuretics ending in "-ide", such as furosemide are sulfonamide derivatives. So SULFA allergy is a SULFONAMIDE allergy.

The nurse is caring for the patient who has a GFR of 10mL/min and a reduced urinary output. The nurse should question the use of hydrochlorothiazide because in renal insufficiency: A: The drug can cause hypoglycemia B: The drug will not reduce blood pressure C: The drug will not promote diuresis D: The drug will increase the risk for pulmonary edema

B: The drug will not reduce blood pressure Thiazide diuretics do not induce diuresis with a GFR less than 50 (normal 125 mL/min). Loop diuretics are ok for use with renal insufficiency.

A nurse is assessing a client who is taking chlorothiazide sodium. The nurse recognizes which of the following as a manifestation of hypokalemia? A: hyperreflexia B: hypertensive crisis C: shallow respirations D: diarrhea

C: shallow respirations A client's shallow respirations are a sign of weakness in the accessory muscles of breathing, due to hypokalemia.

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? -Do not use salt substitutes while taking this medication. -Take the medication with food. -Count your pulse rate before taking the medication. -Expect to gain weight while taking this medication.

Do not use salt substitutes while taking this medication. -Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.

Your patient is taking losartan (Cozaar) to treat hypertension. Which of the following adverse effects are you closely monitoring and will report to the physician if present? -Facial edema -Anorexia -Sedation -Constipation

Facial edema

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective? -Increased heart rate -Increased urine output -Decreased blood pressure -Decreased blood glucose level

Increased urine output -Dobutamine is administered to clients who have heart failure to improve their hemodynamic status. The nurse should identify an increase in client's urine output as an indication that the medication is effective.

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take? -Suggest that the client use a salt substitute. -Obtain a 12-lead ECG. -Advise the client to add citrus juices and bananas to her diet. -Obtain a blood sample for a serum sodium level.

Obtain a 12-lead ECG. -This client's potassium level is above the expected reference range of 3.5-5.0 mEq/L and is at risk for dysrhythmias as well as cardiac arrest. Therefore, the nurse should obtain a 12-lead ECG to monitor for cardiac changes.

The nurse reviews various data for the patient taking spironolactone (Aldactone) to treat hypertension. Which of the following results requires attention? -Pulse 98 (normal 68-88) -Potassium 5.2 (normal 3.5-5) -BP 162/88 (normal 120/80) -Sodium 146 (normal 135-145)

Potassium 5.2 (normal 3.5-5)

The patient receives a diuretic for heart failure. What is the intended therapeutic effect in this case? -Dilating blood vessels -Increasing force of myocardial contraction -Increasing cardiac output -Reducing fluid volume

Reducing fluid volume

A nurse is providing teaching about a heart healthy diet to a group of clients with hypertension. Which of the following statements by one of the clients indicates a need for further teaching? -"I may eat 10 ounces of lean protein each day." -"Fresh fruits make a good snack option." -"I will replace table salt with dried herbs." -"I may thicken gravies with cornstarch as I cook."

"I may eat 10 ounces of lean protein each day." -Lean meats should be limited to 5 to 6 oz per day. This statement by a client requires additional teaching.

The nurse is providing teaching for the client newly prescribed hydrochlorothiazide. Which of the following instructions should the nurse include? 1. Take the medication in the morning 2. The medication must be taken on an empty stomach 3. Muscle pain is an expected side effect 4. Report your weight monthly to the clinic

1. Take the medication in the morning

Dobutamine

Name Beta 1 agonist Method of Action -Increases heart contractibility - Treats systolic heart failure SE - tachycardia - palpations - arrhythmias

A nurse is reviewing the serum laboratory findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report to the provider? -Sodium 136 mEq/L -Potassium 2.3 mEq/L -Chloride 99 mEq/L -Calcium 10 mg/dL

Potassium 2.3 mEq/L -A serum potassium below 3 mEq/L is a critical laboratory value. The nurse should report this finding to the provider immediately and monitor the client for dysrhythmias.

A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine? -Respirations are unlabored. -Client reports decreased groin pain of 3 on a 1 to 10 scale. -The client's blood pressure when arising from resting position is at premedication levels. -The client tolerates a second dose of medication with no greater than 1+ peripheral edema.

Respirations are unlabored. -Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator.

A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication? A: Potassium B: Creatinine C: BUN D: Hemoglobin

A: Potassium People with heart failure who take digoxin are commonly given with diuretics. Many diuretics can cause potassium loss. A low level of potassium in the body can increase the risk of digitalis toxicity

A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include? -The client will list foods that are high in calcium, which should be avoided. -The client will walk for 30 min 5 days a week. -The client will increase calorie intake by 200 cal per day. -The client will replace cigarettes with smokeless tobacco products.

The client will walk for 30 min 5 days a week. -CDC recommendations include engaging in a moderate exercise, such as walking, for a total of 150 min each week.

A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur -is a high-pitched sound due to a narrow valve. -is an extra sound due to blood entering an inflexible chamber. -means that there is some inflammation around the heart. -indicates turbulent blood flow through a valve.

indicates turbulent blood flow through a valve. -Turbulent blood flow through a valve generates a murmur, possibly due to a malfunctioning valve, increased blood flow, or some type of defect in the structures of or around the heart.

A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect? -Decreased brain natriuretic peptide (BNP). -Elevated central venous pressure (CVP). -Increased pulmonary artery wedge pressure (PAWP). -Decreased specific gravity

Elevated central venous pressure (CVP). -CVP is a measurement of the pressure in the right atria or ventricle at the end of diastole. An elevated CVP is indicative of heart failure.

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? -"I can walk a mile a day." -"I've had a backache for several days." -"I am urinating more frequently." -"I feel nauseated and have no appetite."

"I feel nauseated and have no appetite." -Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? -"Now I will not have to diet to lose weight." -"With the new medication, I should experience fewer side effects." -"I will not have to do anything different because it is the same medication." -"The extra letters after the name of medication means it is a stronger dose."

"With the new medication, I should experience fewer side effects." -The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages.

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A: Offer the client a light snack. B: Measure the client's blood pressure C: Measure the client's apical pulse. D: Weigh the client.

C: Measure the client's apical pulse. Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected.

What do diuretics do?

Reduce pulmonary and/or systemic congestion and edema

So for we have encountered a few drugs that have tinnitus or hearing loss as potential adverse effects. Which of the following drugs have this potential? -antihistamines -aspirin -corticosteroids -opioids -loop diuretics

Aspirin Loop diuretics

A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication? -Weight gain -Increased blood pressure -Hypoglycemia -Leg cramps

Leg cramps -Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level.

Nifedipine (Procardia) has been ordered for the patient with hypertension. In the care plan, the nursing includes the need to monitor for which adverse effect? -Rebound tachycardia -Increased urine output -Mild weight loss -Fatigue

Rebound tachycardia

The nurse is caring for a patient who is about to begin taking losartan (Cozaar) to treat hypertension. The nurse should tell the patient to report which of the following adverse reactions to this drug? 1: Peripheral edema 2: Angioedema 3: Constipation 4: Sleepiness

2: Angioedema Angiotensin receptor blockers block angiotensin causing vasodilation and urinary excretion of sodium and water (basically same as ACEs); also...prevents degradation of bradykinin and other vasodilating prostaglandins... Watch for facial edema (angioedema)

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity (select all that apply)? A: anorexia B: dizziness C: vision changes D: jaundice

A: anorexia B: dizziness C: vision changes Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. Loss of appetite is an early sign. Digoxin toxicity causes halos around lights and blurry vision.

A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication? -Bradycardia -Tremor -Cough -Constipation

Bradycardia -Atenolol is a beta-blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia.

Captopril (Capoten) is part of the treatment regimen for a patient with hypertension. The nurse monitors the patient for which potential adverse effect? -Anorexia -Nausea -Hypertension -Dry cough

Dry cough

Thiazide diuretics

Method of action - Produce diuresis and natriuresis to reduce blood volume - Decreases BP SE - Increased urination - Weakness - Muscle cramps - Hypokalemia - Hyponatremia - Hypomagnesemia - Hypercholesterolemia - Hyperuricemia - Hyperglycemia - Hypercalcemia Nursing considerations - Contraindicated in kidney failure - Reduced diuretic properties if taken with NSAIDS - Lithium toxicity if taken with Lithium - Need GFR > 60 -

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? -Potassium -Albumin -Cortisol -Bicarbonate

Potassium -Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia.

The nurse prepares to administer lisinopril (Prinovil), an ACE inhibitor, for the patient with heart failure. For which of the following patients is this drug contraindicated? The patient with: -pregnancy -hypertension -asthma -diabetes

Pregnancy

A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide? -Weigh weekly to monitor therapeutic effect. -Take the medication on an empty stomach. -Take the medication early in the day. -Muscle pain is an expected adverse effect.

Take the medication early in the day. -The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia.

The patient is prescribed digoxin (Lanoxin) for the treatment of heart failure. Which of the following statements made by the patient indicates the need for further teaching? -I should report to my doctor if I experience blurry vision or yellow/green halos -My energy level should gradually improve -This drug will cure my heart failure -I may feel tired during treatment

This drug will cure my heart failure

A nurse is providing teaching about the Mediterranean diet to a client newly who has a new diagnosis of hypertension. Which of the following statements by the client indicates a need for further teaching? -"I will limit my intake of red meat to twice weekly." -"I can have dairy in moderate portions daily." -"I can have fish two times a week." -"I can drink wine in moderation."

"I will limit my intake of red meat to twice weekly." -This statement by the client indicates a need for further teaching. Following the Mediterranean diet, red meat should be limited to two times monthly.

A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include? -"Take this medication before bedtime." -"Monitor for leg cramps." -"Avoid grapefruit juice.' -"Reduce intake of potassium-rich foods."

"Monitor for leg cramps." -Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.

A nurse is caring for a client who has hypertension and is afraid to take his blood pressure medication. Which of the following nursing statements is an example of the therapeutic communication response of reflection? -"You seem upset about taking your blood pressure medication." -"Why do you feel afraid to take your medication?" -"You won't get better until you take your medication?" -"Did your symptoms occur before or after you took the medication?"

"You seem upset about taking your blood pressure medication." -This statement is a reflective comment that describes the patient's feelings. A reflective comment repeats what a patient has said or describes the person's feelings.

A nurse is admitting a client who has acute heart failure following myocardial infarction. The nurse recognizes that which of the following prescriptions by the provider requires clarification? -Morphine sulfate 2 mg IV bolus every 2 hr PRN pain -Laboratory testing of serum potassium upon admission -0.9% normal saline IV at 50 ml/hr continuous -Bumetanide 1 mg IV bolus every 12 hr

0.9% normal saline IV at 50 ml/hr continuous - 0.9% sodium chloride is isotonic and will not cause the fluid shift needed in this client to reduce circulatory overload. This prescription requires clarification

The nurse is about to administer furosemide (Lasix) to treat heart failure. The nurse should instruct the patient to report which adverse effect that may occur with this drug? A: hearing loss B: cough C: swelling of the legs D: blurry vision

A: hearing loss hearing loss can occur...reversible if drug is withdrawn

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective? A: increased urinary output B: decreased apical pulse C: decreased blood glucose D: decreased blood pressure

A: increased urinary output Dobutamine is administered to clients who have heart failure to improve their hemodynamic status. The nurse should identify an increase in client's urine output as an indication that the medication is effective.

The nurse is caring for a patient who is about to begin captopril (Capoten) therapy to treat hypertension. When talking with the patient about the drug, the nurse should tell her to report which of the following adverse effects indicating the need to stop drug therapy (select all that apply)? A: Photosensitivity B: Swelling of the tongue C: Dry cough D: Distorted taste

B: Swelling of the tongue C: Dry cough D: Distorted taste ACE inhibitors block angiotensin II causing vasodilation and urinary excretion of sodium and water

The nurse is caring for a client who has heart failure and a history of asthma. The nurse reviews the provider's orders and recognizes that clarification is needed for which of the following medications? -Carvedilol -Fluticasone -Captopril -Isosorbide dinitrate

Carvedilol -Medications that block beta-2 receptors, such as carvedilol, are contraindicated in clients with asthma.

A nurse in a provider's office is reviewing the laboratory results of a client who takes furosemide for hypertension. The nurse notes that the client's potassium level is 3.3 mEq/L. The nurse should monitor the client for which of the following complications? -Cardiac dysrhythmias -Hypoglycemia -Seizures -Neurogenic shock

Cardiac dysrhythmias -This client's potassium level is below the expected reference range. Hypokalemia can cause a number of cardiac effects including flattened T waves, prominent U waves, and S-T depression.

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? -Check the client's vital signs. -Request a dietitian consult. -Suggest that the client rests before eating the meal. -Request an order for an antiemetic.

Check the client's vital signs. -It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.

A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.) -Dyspnea -Gastrointestinal bloating -Jugular vein distention -Confusion -Hypotension

Dyspnea, Jugular vein distention, Confusion -All are clinical manifestations of fluid volume overload

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? -Withholding the medication if the heart rate is above 100/min -Instructing the client to eat foods that are low in potassium -Measuring apical pulse rate for 30 seconds before administration -Evaluating the client for nausea, vomiting, and anorexia

Evaluating the client for nausea, vomiting, and anorexia -Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? -Milk -Orange juice -Coffee -Grapefruit juice

Grapefruit juice -Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

Loop diuretics

Names - Furosemide (Lasix) - "ide" Method of Action - Sulfonamide derivatives used to treat hypertension, heart failure, edema - LOSE fluids - LOSE BP - LOSE electrolytes - LOSE hearing - LOSE ability to block sun (photosensitivity) SE - Hyponatremia - Hypokalemia - Hypomagnesemia - Ototoxicity (hearing loss) - Photosensitivity - Dehydration Nursing considerations - Contraindicated in allergy to sulfa drugs - Limit sun exposure

Angiotensin 2 receptor blockers (ARBS)

Names - Losartan - "sartans" Method of Action - Treat hypertension SE - Angioedema - Headaches - Insomnia - Hypotension Nursing considerations - ABC approach to angioedema

Beta Blockers

Names - Propranolol, Metoprolol, Atenolol, Carvedilol Mechanism of action - Decrease HR SE - Bradycardia - Hypotension - Cough - Hypoglycemia Considerations - Have to TAPER off - Contraindicated in hx of heart failure - Contraindicated in asthma - Fewer side effects if used with hydrochlorothiazide

Cardiac glycosides

Names -Digoxin Method of Action - Increase cardiac contractibility - Chronic heart failure - Atrial arrhythmia SE - GI disturbance - ECG abnormalities - Arrhythmias - Hyperkalemia - Neurological symptoms - Visual disturbances - anorexia - dizziness Nursing considerations - Contraindicated in uncontrolled ventricular fibrillation - Precaution with electrolyte abnormalities - Precaution with diuretic use - Precaution with renal disorder - Treat toxicity with Fab antibody fragments - Measure apical pulse before administration

A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/84 mm Hg places him in which of the following categories? -Within the expected reference range -Prehypertension -Stage 1 hypertension -Stage 2 hypertension

Prehypertension -A blood pressure of 124/84 mm Hg places this client in the prehypertension category. Prehypertension is indicated by a systolic pressure between 120 and 130 mm Hg and a diastolic pressure between 80 and 89 mm Hg.

A nurse is preparing to administer metoprolol 5 mg IV bolus to a client for heart rate control. Available is metoprolol injection 1 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

5 ml

A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

90/min -Bradycardia is an adverse effect of digoxin. Expected apical heart rates vary considerably according to age. The nurse should withhold the digoxin dose for heart rate of 60/min or below in an adult, 70/min or below in a child, and 90/min or below in an infant.

A nurse is assessing a patient following the administration of nifedipine (Procardia). Recognizing the adverse effects of nifedipine, the nurse should be prepared to administer which of the following drugs? A: Propranolol (Inderal) B: Prazosin (Minipress) C: Enalapril (Vasotec) D: Doxazosin (Cardura)

A: Propranolol (Inderal) Calcium channel blockers can cause reflex tachycardia; administering a beta blocker can minimize this adverse effect.

When to hold digoxin levels

Adult: Pulse below 60 Children: Pulse below 70 Infants: pulse below 90

Prior to administration of digoxin (Lanoxin), the nurse completes which assessment? -apical pulse -lung sounds -bowel sounds -nutritional intake

Apical pulse

The nurse is providing teaching to the client receiving a thiazide diuretic. Which points should the nurse plan to include? Select all that apply. A: Take the radial pulse before setting up the medication. B: Include fruits such as melons and bananas in the diet. C: Take the last dose at bedtime. D: Avoid high-fat foods as thiazide diuretics increase cholesterol levels.

B: Include fruits such as melons and bananas in the diet. D: Avoid high-fat foods as thiazide diuretics increase cholesterol levels. Thiazide diuretics can cause hypokalemia and increase serum cholesterol, LDL, and triglyceride levels. They release potassium but not cholesterol!

The nurse is discharging a client from the hospital who has a new prescription for furosemide. Which of the following client statements indicates an understanding of the teaching? A: "I should eat a diet low in potassium while taking this medication." B: "I should limit my fluid intake while taking this medication." C: "My blood pressure will increase while I am taking this medication." D: "I need to limit my sun exposure and wear sunscreen while on this medication."

D: "I need to limit my sun exposure and wear sunscreen while on this medication." Limiting sun exposure and wearing sunscreen are appropriate while taking furosemide due to the adverse effect of photosensitivity.

A nurse is precepting a new nurse on care of the patient with heart failure receiving diuretic therapy. The nurse should explain which of the following medications puts the patient at risk for both hyperkalemia and hyponatremia? A: furosemide B: hydrochlorothiazide C: metolazone D: spironolactone

D: spironolactone Spironolactone is a potassium-sparing diuretic (holds potassium and doesn't let it go out in the urine) because it is an aldosterone antagonist! It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? -Decreased sodium level -Decreased phosphate level -Decreased potassium level -Decreased chloride level

Decreased sodium level -The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? -Fab antibody fragments -Flumazenil -Acetylcysteine -Naloxone

Fab antibody fragments -Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypokalemic? -Pitting edema -Fatigue -Dyspnea -Oliguria

Fatigue -The nurse should expect to find the client with fatigue due to muscle weakness with hypokalemia.

ACE inhibitors

Names - Captopril - Lisinopril Method of Action - Relax veins and arteries to lower BP SE - Taste distortion - Tough swelling - Cough - Angioedema - Hyperkalemia - Ortho hypotension Nursing consideration - Contraindicated with C1 esterase deficiency (angioedema) - Contraindicated with pregnancy - Contraindicated with renal artery stenosis - NO SALT SUBSTITUTES

A nurse is reviewing blood pressure classifications with a group of nurses at an in-service meeting. Which of the following should the nurse include as a risk factor for the development of hypertension? -High-density lipoprotein (HDL) level of 70 mg/dL -A diet high in potassium -Obstructive sleep apnea (OSA) -Taking benazepril

Obstructive sleep apnea (OSA) -The nurse should include OSA as a risk factor in the development of hypertension. OSA is a condition in which the client's airway becomes blocked by the relaxation of the tongue and muscles of the oropharynx, effectively obstructing the airway. The obstructed airway results in surges in the both the systolic and diastolic pressure during sleep and, in some clients, through the waking hours even when breathing is normal.

A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? -Furosemide -Hydrochlorothiazide -Metolazone -Spironolactone

Spironolactone -Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia.

A nurse is auscultating a client's heart sounds and hears an extra heart sound before what should be considered the first heart sound S1. The nurse should document this finding as which of the following heart sounds? -The fourth heart sound (S4) -A friction rub -The third heart sound (S3) -A split second heart sound S2

The fourth heart sound (S4) -S4 is an extra sound that is heard late in diastole just before S1. It occurs due to resistance to blood flow in an enlarged ventricle.

A nurse is caring for a client who has a new diagnosis of essential hypertension. The nurse should monitor the client for which of the following findings that is consistent with this diagnosis? -Vertigo -Uremia -Blurred vision -Dyspnea

Vertigo -The nurse should monitor the client for findings such as vertigo, headache, facial flushing, and fainting. These manifestations are consistent with a new diagnosis of essential hypertension.

A client who has coronary artery disease tells the nurse he is afraid of dying from a heart attack. Which of the following responses should the nurse make? -"Perhaps you should discuss this with your physician." -"Of course you aren't going to die, at least not in the immediate future." -"I recommend you exercise daily and avoid smoking to decrease your risk." -"Tell me more about these fears of dying from a heart attack."

"Tell me more about these fears of dying from a heart attack." -With this response, the nurse uses the therapeutic communication technique of exploring to encourage further communication about the client's feelings.

A patient who is taking carvedilol (Coreg) for hypertension is about to begin taking an oral anti-diabetes drug to manage newly diagnosed type 2 diabetes mellitus. The nurse should be aware that the patient is at risk for which of the following while taking both drugs? A: Bradycardia B: Hypotension C: Hypoglycemia D: Hyperglycemia

C: Hypoglycemia Adrenergic antagonists (nonselective "beta blockers") also can block "adrenaline" which is needed to increase glucose to get more energy to run—so blocks glucose

The nurse is about to administer atenolol (Tenormin) to a patient who has hypertension. Which of the following assessments should the nurse perform prior to giving the drug? A: Serum glucose B: Respiratory rate C: Level of consciousness D: Apical pulse

D: Apical pulse Beta blockers can cause BRADYCARDIA!! Check that pulse! HOLD if less than 50bpm (check hospital policy, some say 60bpm)

A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further? -Diet-controlled Type 2 diabetes mellitus -A history of left-sided heart failure -A concurrent prescription for tadalafil -Recently treated bilateral pneumonia

A history of left-sided heart failure -The nurse should further investigate the client's history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider.

A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tab. The client's current vital signs are: blood pressure 144/96, heart rate 54/min, respirations 18/min, and temperature 98.6° F. Which of the following actions should the nurse take? -Administer digoxin 0.125 mg. -Administer digoxin 0.25 mg. -Withold the digoxin dose for elevated blood pressure. -Withhold the digoxin dose for decreased pulse rate.

Withhold the digoxin dose for decreased pulse rate. -The nurse should withhold the prescribed dose of digoxin as the heart rate is less than 60/min, and notify the provider.