Chapter 61- Cardiovascular Medications

722. A client who is receiving digoxin (Lanoxin) daily has a serum ptassium level of 3mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1. 0.5-2ng/ml 2. 1.2-2.8ng/ml 3. 3.0-5.0ng/ml 4. 3.5-5.5ng/ml

1. 0.5-2ng/ml Rationale: Therapeutic levels for digoxin range from 0.5 to 2ng/ml. The ranges in the remaining options are incorrect.

729. The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? SELECT ALL THAT APPLY 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2,4,5- Diarrhea, Blurred vision, nausea and vomiting Rationale: Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5-2ng/ml

720. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

2. Activated partial thromboplastin time of 60 seconds Rationale: Common laboratory ranges for activated partial thromboplastin time are 20-36 seconds. Because the activated partial thromboplastin time should be 1.5-2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

730. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium 9.8mg/dl; serum magnesium 1.2mg/d; serum potassium 4.1mg/dl; serum creatinine 0.9mg/dl. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

4. Serum magnesium level Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6-2.6mg/dl and the results in the correct option are reflective of hypomagnesemia.

725. A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium (Coumadin) 7.5mg at 5pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. Rationale: When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2-3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60-80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

732. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid (Amicar)

2. Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

724. The nurse in monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline BP of 150/80mmHg followed by a BP of 138/72mmHg after two doses of the medication 4. A baseline resting HR of 88bpm followed by a resting HR of 72bmp after two doses of the medication

2. The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. B-blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in BP and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

734. The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4F orally 3. BP of 198/100mmHg 4. Respiratory rate of 28 breaths/ minute

3. BP of 198/100mmHg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy.

727. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? 1. Hypouricemia, hyperkalemia 2. Increased risk of osteoporosis 3. Hypokalemia, hyperglycemia, sulfa allergy 4. Hyperkalemia, hypoglycemia, penicillin allergy

3. Hypokalemia, hypoerglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hypoerlipidemia, and hyperuricemia.

726. A client is diagnosed with a ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a PRIORITY nursing intervention? 1. Monitor for kidney failure 2. Monitor psychosocial status 3. Monitor for signs of bleeding 4. Have heparin sodium available

3. Monitor for signs of bleeding Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychological status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

733. A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching; The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the PRIORITY? 1. Administer oxygen and protamine sulfate 2. Cut the infusion rate in half and sit the client up in bed 3. Stop the infusion and call the health care provider (HCP) 4. Administer diphenhydramine (Benadryl) and continue the infusion

3. Stop the infusion and call the health care provider (HCP) Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the HCP. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed.

721. The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption" 2. "I will take my pills every day at the same time" 3. "I have already called my family to pick up a Medic-Alert bracelet"

4. "I have already called my family to pick up a Medic-Alert bracelet" Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

728. The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398mg/dl. The client is taking cholestyramine (Questran). Which statement, by the client, indicates the NEED FOR FURTHER EDUCATION? 1. "Constipation and bloating might be a problem" 2. "I'll continue to watch my diet and reduce my fats" 3. "Walking a mile each day will help the whole process" 4. "I'll continue my nicotinic acid from the health food store"

4. "I'll continue my nicotinic acid from the health food store" Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the two most common side effects/ Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

735. A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol" 2. "The medication should be taken with meals to decrease flushing" 3. "Clay-colored stools are a common side effect and should not be of concern" 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing"

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing" Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the HCP

723. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take FIRST? 1. Measure the heart rate on the rhythm strip 2. Administer prescribed nitroglycerin tablets 3. Obtain a 12-lead EKG immediately 4. Auscultate the client's apical pulse and obtain a BP

4. Auscultate the client's apical pulse and obtain a BP Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting,and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the BP.

731. A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum 2. The serum potassium level changes from 3.8 to 3.1mEq/L 3. B-natriuretic peptide (BNP) factor increases from 200 tp 262pg/ml 4. Urine output increases from 10ml/hr to greater than 50ml/hr

4. Urine output increases from 10ml/hr to greater than 50ml/hr Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 2, and 3 are incorrect.