Cardiovascular System (Pharmacology SUCCESS NCLEX STYLE )
The client is reporting severe chest pain radiating down the left arm and is nauseated and diaphoretic. The HCP suspects the client is having an MI and has ordered morphine sulfate for the pain. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client not to get out of the bed without notifying the nurse. 2. Administer the morphine sulfate intramuscularly in the ventral gluteal muscle. 3. Dilute the morphine sulfate to a 10-mL bolus with normal saline. 4. Administer the morphine sulfate slowly over 5 minutes. 5. Question the order because morphine sulfate should not be administered to a client with an MI.
1,3,4 Rational: 1) The client should not get out of the bed without assistance due to the drowsiness the client will experience after receiving morphine sulfate, a narcotic analgesic. Also, the client is having chest pain and should not get out of the bed without assistance. 3) Morphine sulfate, a narcotic analgesic, is the drug of choice for chest pain, and it is administered intravenously so that it acts as soon as possible, within 10-15 minutes. IVP medications should be diluted to help decrease the pain when it is administered and to prevent irritation to the vein. 4) An IVP also allows the nurse to inject the medication more accurately over the 5-minute administration time.
The home health nurse is caring for a client diagnosed with congestive heart failure (CHF) who has been prescribed digoxin and furosemide. Which statements by the client indicate the medications are effective? Select all that apply. 1. "I am able to walk next door now without being short of breath." 2. "I keep my feet propped up as much as I can during the day." 3. "I have not gained any weight since my last doctor's visit." 4. "My blood pressure has been within normal limits." 5. "I am staying on my diet, and I don't salt my foods anymore."
1. "I am able to walk next door now without being short of breath." 3. "I have not gained any weight since my last doctor's visit." Rational: 1) Digoxin (Lanoxin), a cardiac glycoside, and furosemide (Lasix), a loop diuretic, are administered for clients diagnosed with CHF to improve the contractility of the cardiac muscle and to decrease the fluid volume overload. A symptom of CHF is shortness of breath. The fact that the client can ambulate without being short of breath is an improvement of symptoms, which shows that the medications are effective. 3) Weight gain would indicate that the client is retaining fluid and the medications are not effective. No weight gain indicates the medication is effective.
The client diagnosed with angina who is prescribed nitroglycerin (NTG) tells the nurse, "I don't understand why I can't take my sildenafi l. I need to take it so that I can make love to my wife." Which statement is the nurse's best response? 1. "If you take the medications together, they may cause you to have very low blood pressure." 2. "You are worried your wife will be concerned if you cannot make love." 3. "If you wait at least 8 hours after taking your nitroglycerin, you can take your sildenafil." 4. "You should get clarification with your HCP about taking sildenafil."
1. "If you take the medications together, they may cause you to have very low blood pressure." Rational: Life-threatening hypotension can result with concurrent use of NTG and sildenafil (Viagra), a peripheral vasodilator erectile agent.
The client with coronary artery disease (CAD) is prescribed cholestyramine. Which intervention should the nurse implement when administering the medication? 1. Administer the medication with fruit juice. 2. Instruct the client to decrease fiber when taking the medication. 3. Monitor the cholesterol level before giving medication. 4. Assess the client for upper abdominal discomfort.
1. Administer the medication with fruit juice. Rational: Cholestyramine (Questran) is a bile acid sequestrant. This medication should be administered with water, fruit juice, soup, or pulpy fruit (apple- sauce, pineapple) to reduce the risk of esophageal irritation.
Which medication should the nurse question administering to a client diagnosed with stage C CHF? 1. Ibuprofen. 2. Amlodipine. 3. Spironolactone. 4. Atenolol.
1. Ibuprofen. Rational: Ibuprofen (Motrin) is an NSAID. NSAIDs promote sodium retention and peripheral vasoconstriction—interventions that can make CHF worse. Additionally, they reduce the efficacy and intensify the toxicity of diuretics and ACE inhibitors. The nurse should question this medication.
The nurse is administering 0900 medications to the following clients. Which client should the nurse question administering the medication? 1. The client received a calcium channel blocker (CCB) who drank a glass of grapefruit juice. 2. The client receiving a beta blocker who has an apical pulse of 62 beats per minute (bpm). 3. The client receiving a nitroglycerin (NTG) patch who has a blood pressure of 148/92. 4. The client receiving an antiplatelet medication who has a platelet count of 150,000.
1. The client received a calcium channel blocker (CCB) who drank a glass of grapefruit juice. Rational: The client receiving a CCB should avoid grapefruit juice because it can cause the CCB to rise to toxic levels.
The HCP prescribed an angiotensin-converting enzyme (ACE) inhibitor for a client diagnosed with CHF. Which instruction should the nurse provide? 1. "Eat a banana or drink orange juice at least twice a day." 2. "Notify the HCP if you develop localized edematous areas that itch." 3. "Expect to have a dry cough early in the morning on arising." 4. "Your symptoms of congestive heart failure should improve rapidly."
2. "Notify the HCP if you develop localized edematous areas that itch." Rational: A condition in which there are localized edematous areas (wheals), accompanied by intense itching of the skin and mucous membranes, is called angioedema. This is an adverse reaction to an ACE inhibitor and should be reported to the HCP.
The client diagnosed with coronary artery disease (CAD) is prescribed atorvastatin. Which statement by the client warrants the nurse notifying the HCP? 1. "I really haven't changed my diet, but I am taking my medication every day." 2. "I am feeling pretty good, except I am having muscle pain all over my body." 3. "I am swimming at the local pool about three times a week for 30 minutes." 4. "I am taking this medication first thing in the morning with a bowl of oatmeal."
2. "I am feeling pretty good, except I am having muscle pain all over my body." Rational: Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor or a statin. Statins can cause muscle injury, which can lead to myositis, fatal rhabdomyolysis, or myopathy. Muscle pain or tenderness should be reported to the HCP immediately; usually the medication is discontinued.
The client with a serum cholesterol level of 320 mg/dL is taking the medication ezetimibe. Which statement by the client indicates the client needs more teaching concerning this medication? 1. "This medication helps decrease the absorption of cholesterol in my intestines." 2. "I cannot take this medication with any other cholesterol-lowering medication." 3. "I need to eat a low-fat, low-cholesterol diet even when taking the medication." 4. "It will take a few months for my cholesterol level to get down to normal levels."
2. "I cannot take this medication with any other cholesterol-lowering medication." Rational: Ezetimibe (Zetia) is an antihyperlipidemic medication. This is not a true statement; therefore, the client needs more teaching. Zetia acts by decreasing cholesterol absorption in the intestine and is used together with statins to help lower cholesterol in clients whose cholesterol levels cannot be controlled by taking statins alone.
The nurse is administering digoxin to a client diagnosed with CHF. Which interventions should the nurse implement? Select all that apply. 1. Assess the client's carotid pulse for 1 full minute. 2. Check the client's current potassium level. 3. Ask the client if he or she is seeing a yellow haze around objects. 4. Have the client squeeze the nurse's fingers. 5. Teach the client to get up slowly from a sitting position.
2. Check the client's current potassium level. 3. Ask the client if he or she is seeing a yellow haze around objects. Rational: 2) Digoxin (Lanoxin) is a cardiac glycoside used to treat heart failure. The client's potassium level, as well as the digoxin level, is monitored because high levels of potassium impair therapeutic response to digoxin and low levels can cause toxicity. The most common cause of dysrhythmias in clients receiving digoxin is hypokalemia from diuretics that are usually given simultaneously. 3) Yellow haze indicates the client may have high serum digoxin levels. The therapeutic range for digoxin is relatively small (0.5 to 1.2), and levels of 2.0 or greater are considered toxic.
The client diagnosed with CHF is prescribed enalapril. Which statement explains the scientific rationale for administering this medication? 1. Enalapril increases the levels of angiotensin II in the blood vessels. 2. Enalapril dilates arteries, which reduces the workload of the heart. 3. Enalapril decreases the effects of bradykinin in the body. 4. Enalapril blocks the intervention of antidiuretic hormones in the kidney.
2. Enalapril dilates arteries, which reduces the workload of the heart. Rational: Enalapril (Vasotec) is an ACE inhibitor. By reducing the levels of angiotensin II, ACE inhibitors dilate blood vessels, reduce blood volume, and prevent or reverse angiotensin II pathological changes in the heart and kidneys.
The client diagnosed with an MI is receiving thrombolytic therapy. Which data warrants immediate intervention by the nurse? 1. The client's telemetry has reperfusion dysrhythmias. 2. The client is oozing blood from the IV site. 3. The client is alert and oriented to date, time, and place. 4. The client has no signs of infiltration at the insertion site.
2. The client is oozing blood from the IV site. Rational: Any bleeding from the IV site, gums, rectum, or vagina should be reported to the HCP. The HCP may not be able to take intervention to prevent the bleeding during therapy, but it warrants notifying the HCP.
Which data indicates to the nurse that simvastatin is effective? 1. The client's blood pressure is 132/80. 2. The client's cholesterol level is 180 mg/dL. 3. The client's LDL cholesterol level is 180 mg/dL. 4. The client's HDL cholesterol level is 35 mg/dL.
2. The client's cholesterol level is 180 mg/dL. Rational: Simvastatin (Zocor) is an HMG-CoA reductase inhibitor, or a statin that lowers cholesterol levels. A cholesterol level less than 200 mg/dL is desirable and indicates the medication is effective.
The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG). Which statement indicates the client needs more medication teaching? 1. "I will always carry my nitroglycerin in a dark-colored bottle." 2. "If I have chest pain, I will put a tablet underneath my tongue." 3. "If my pain is not relieved with one tablet, I will get medical help." 4. "I should expect to get a headache after taking my nitroglycerin."
3. "If my pain is not relieved with one tablet, I will get medical help." Rational: Client should put one tablet under the tongue every 5 minutes and, if the chest pain is not relieved after taking 3 tablets, the client should seek medical attention.
The nurse is preparing to administer clopidogrel bisulfate to the client with coronary artery disease (CAD). The client asks the nurse, "Why am I getting this medication?"Which statement by the nurse is most appropriate? 1. "It will help decrease your chance of developing deep vein thrombosis." 2. "Plavix will help decrease your LDL cholesterol levels in about 1 month." 3. "This medication will help prevent your blood from clotting in the arteries." 4. "The medication will help decrease your blood pressure if you take it daily."
3. "This medication will help prevent your blood from clotting in the arteries." Rational: Clopidogrel (Plavix) is an antiplatelet medication. This medication works in the arteries to prevent platelet aggregation and is prescribed for a client diagnosed with arteriosclerosis.
The nurse is preparing to administer an nitroglycerin (NTG) transdermal patch to the client diagnosed with a myocardial infarction (MI). Which intervention should the nurse implement? 1. Question applying the patch if the client's blood pressure is less than 110/70. 2. Use nonsterile gloves when applying the transdermal patch. 3. Date and time the transdermal patch prior to applying to client's skin. 4. Place the transdermal patch on the site where the old patch was removed.
3. Date and time the transdermal patch prior to applying to client's skin. Rational: The nurse should remove the old patch, wash the client's skin, note the date and time the new patch is applied, and apply it in a new area that is not hairy.
The client being discharged after sustaining an acute MI is prescribed lisinopril. Which instruction should the nurse include when teaching about this medication? 1. Instruct the client to monitor the blood pressure weekly. 2. Encourage the client to take medication on an empty stomach. 3. Discuss the need to rise slowly from lying to a standing position. 4. Teach the client to take the medication at night only.
3. Discuss the need to rise slowly from lying to a standing position. Rational: This medication causes orthostatic hypotension, and the client should be instructed to rise slowly from lying to sitting to standing position to prevent falls and injury.
The client diagnosed with stage D CHF has a brain natriuretic peptide (BNP) level greater than 1,500. Which medication should the nurse anticipate the HCP prescribing? 1. Captopril orally. 2. Digoxin IVP. 3. Dobutamine IV. 4. Metoprolol orally.
3. Dobutamine IV. Rational: Dobutamine (Dobutrex), a synthetic catecholamine, is given for short-term IV therapy for clients in stage D CHF and is preferred to dopamine because it does not increase vascular resistance. Dobutamine increases myocardial contractility and cardiac output.
The nurse is providing discharge instructions for a client who prescribed hydrochlorothiazide. Which instruction(s) should the nurse include? 1. Drink at least 8 to 10 glasses of water a day. 2. Weigh yourself monthly and report the weight to the HCP. 3. Eat bananas or oranges regularly. 4. Try to sleep in an upright position.
3. Eat bananas or oranges regularly. Rational: Hydrochlorothiazide (Diuril) is a thiazide diuretic. Loop and thiazide diuretics cause the body to excrete potassium in the urine. The client should attempt to replace the potassium by eating potassium-rich foods such as bananas and orange juice.
The nurse in the HCP's office is completing an assessment on a client who has been prescribed digoxin for CHF. Which data indicates the medication has been effective? 1. The client's sputum is pink and frothy. 2. The client has 2+ pitting edema of the sacrum. 3. The client has clear breath sounds bilaterally. 4. The client's heart rate is 78 bpm.
3. The client has clear breath sounds bilaterally. Rational: Digoxin (Lanoxin) is a cardiac glycoside. Clear lung sounds bilaterally indicate the treatment is effective. The nurse assesses for the signs and symptoms of the disease for which the medication is being administered. If the symptoms are resolving, then the medication is effective.
The client diagnosed with coronary artery disease (CAD) is instructed to take 81 mg of aspirin. Which statement best describes the scientific rationale for prescribing this medication? 1. This medication will help thin the client's blood. 2. Daily aspirin will decrease the incidence of angina. 3. This medication will prevent platelet aggregation. 4. Baby aspirin will not cause gastric distress.
3. This medication will prevent platelet aggregation. Rational: When 81 mg of aspirin, a baby aspirin, is taken daily, it helps prevent platelet aggregation, which, in turn, helps the blood pass through the narrowed arteries more easily.
The female client diagnosed with CHF tells the nurse that she has been taking hawthorn extract since the HCP told her that she had heart problems. Which statement by the nurse is most appropriate? 1. "You need to take garlic supplements with hawthorn for it to be effective." 2. "You should stop taking this herb immediately because it can cause more problems." 3. "This herb can cause bleeding if you take it with your other medications." 4. "Some clients find this is helpful, but make sure your HCP is aware of the medication."
4. "Some clients find this is helpful, but make sure your HCP is aware of the medication." Rational: Hawthorn dilates the peripheral blood vessels, increases coronary circulation, improves cardiac oxygenation, acts as an antioxidant, has a mild diuretic effect, and is used to treat CHF and HTN. Doses of ACE inhibitors, cardiac glycosides, and beta blockers may need to be modified if taken in combination with hawthorn.
The nurse is completing a.m. care with a client diagnosed with angina when the client reports chest pain. The client has a saline lock in the right forearm. Which intervention should the nurse at the bedside implement first? 1. Assess the client's vital signs. 2. Administer sublingual nitroglycerin (NTG). 3. Administer IV morphine sulfate via saline lock. 4. Administer oxygen via nasal cannula.
4. Administer oxygen via nasal cannula. Rational: The nurse would have oxygen at the bedside, and applying it would be the first intervention the nurse could implement at the bedside.
The client calls the clinic and says, "I am having chest pain. I think I am having another heart attack." Which intervention should the nurse implement first? 1. Call 911 emergency medical services (EMS). 2. Instruct the client to take an aspirin. 3. Determine if the client is at home alone. 4. Ask if the client has any sublingual nitroglycerin (NTG).
4. Ask if the client has any sublingual nitroglycerin (NTG). Rational: Because the client has had one MI, the client may have sublingual NTG, a coronary vasodilator, in a pocket and can take it immediately. If the client does not have any on the body, then the nurse should determine if there is anyone in the home that can help the client.
The client newly diagnosed with coronary artery disease (CAD) is being prescribed a daily aspirin. The client tells the nurse, "I had a bad case of gastritis last year." Which intervention should the nurse implement first? 1. Ask the client if he or she informed the HCP of the gastritis. 2. Explain that regular aspirin could cause gastric upset. 3. Instruct the client to take an enteric-coated aspirin. 4. Determine if the client is taking any anti-ulcer medication.
4. Determine if the client is taking any anti-ulcer medication. Rational: Assessment is the first part of the nursing process, and determining if the client is taking any anti-ulcer medication is the first question the nurse should ask the client.
Which medication should the nurse question administering? 1. Lisinopril to a client with a blood pressure of 118/84. 2. Carvedilol to a client with an apical pulse of 62. 3. Verapamil to a client with angina. 4. Furosemide to a client reporting leg cramps.
4. Furosemide to a client reporting leg cramps. Rational: Furosemide (Lasix) is a loop diuretic. Leg cramps may indicate a low blood potassium level. The nurse should hold the medication until the potassium level can be checked. Loop diuretics cause the kidneys to excrete potassium. Hypokalemia can cause life-threatening dysrhythmias.
The client with coronary artery disease (CAD) is prescribed nicotinic acid. The client reports flushing of the face, neck, and ears. Which priority intervention should the nurse implement? 1. Instruct the client to stop taking the medication immediately. 2. Encourage the client to take the medication with meals only. 3. Discuss that this is a normal side effect and will decrease with time. 4. Tell the client to take 325 mg of aspirin 30 minutes before taking the medication.
4. Tell the client to take 325 mg of aspirin 30 minutes before taking the medication. Rational: Nicotinic acid (Niacin) is a vitamin preparation used to prevent or treat pellagra, a disease of niacin deficiency. Taking an aspirin prior to the medication will help reduce the flushing of the face, neck, and ears.
The elderly client diagnosed with coronary artery disease (CAD) has been taking aspirin daily for more than a year. Which data warrants notifying the HCP? 1. The client has lost 5 pounds in the last month. 2. The client has trouble hearing low tones. 3. The client reports having a funny taste in the mouth. 4. The client has hard, dark, tarry stools.
4. The client has hard, dark, tarry stools. Rational: A complication of long-term aspirin use is gastric bleeding, which could result in dark, tarry stools. This data would warrant further intervention.
The nurse is administering 0.5 inches of nitroglycerin (NTG) paste. How much paste should the nurse apply to the application paper? A) 1/2'' B) 1" C) 1 1/2" D) 2"
A) 1/2'' Rational: The line is in increments of 0.5 inch and the order is 0.5 inch; therefore, the nurse should apply this much paste.
