Exam 1 PrepU
What aspect of a client's current health status would potentially contraindicate the administration of nesiritide?
Blood pressure of 88/50 mmHg Nesiritide should not be administered if the systolic blood pressure is less than 90 mm Hg. The presence of jaundice, edema, or an irregular heart rate does not necessarily contraindicate the use of this drug.
A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do?
Discontinue the drug The FDA has issued a black box warning for ACE inhibitors and ARBs during pregnancy because their use can cause injury and even death to a developing fetus.Key behavioral determinants of blood pressure are related to what factor?
The nurse recognizes that which finding is associated with right-sided heart failure?
Nocturia Nocturia is a symptom of right-sided heart failure. Crackles in the lungs, dyspnea, and orthopnea are symptoms related to left-sided heart failure because they are pulmonary symptoms.
A male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?
Take the drug on an empty stomach at the same time each day Food and antacids interfere with the absorption of the drug. Digoxin should be taken on an empty stomach at approximately the same time each day. If the client takes an antacid, the client should separate the dose of antacid and digoxin by 2 to 4 hours.
A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?
Take the drug regularly without skipping a dose The nurse should instruct the patient to take the drug regularly without skipping a dose. The patient should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The patient should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as it alters the plasma digoxin levels.
The nurse monitors which client for an increased risk of digoxin toxicity?
The client with renal dysfunction The client with renal dysfunction is at an increased risk for digoxin toxicity.
A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac arrhythmia. If the nurse is correct, which action is likely to be taken?
The patient will be given digoxin immune fab Digoxin is stopped, not merely reduced, in patients experiencing toxicity. If digoxin toxicity is accompanied by serious arrhythmias, several drugs may be used, including potassium chloride (if serum potassium is low) and digoxin immune fab (if toxicity is serious).
A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess?
Yellow or green vision The visual disturbance the nurse should assess for is yellow or green vision with a white halo. Visual disturbances occur in digoxin toxicity. Blurring of vision and borders around dark objects are the other visual disturbances. Double vision, difficulty of near vision, and complete loss of vision do not occur in digitalis toxicity.
A 37-year-old client presents with a blood pressure of 128/78 mm Hg. What lifestyle change should the nurse suggest related to this assessment finding?
"Be aware of your salt intake and limit hidden salt." This client may reduce the likelihood of developing hypertension with a reduction in salt intake. There is no need for this client to be placed on a calcium channel blocker or to increase potassium intake. Adequate sleep is important, but this is not directly related to blood pressure control.
A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement?
"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider." ACE inhibitors like ramipril may precipitate a cough and may necessitate discontinuation of the drug. This is not, however, an emergency or an indication of lung infection or lung inflammation.
An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for additional health education?
"I'll only need to take these drugs on days when my blood pressure is particularly high." Antihypertensive drug therapy is usually long term and is taken regularly, except in instances of hypotension or bradycardia. Therapy should not be seen as a response to short-term hypertensive readings. The other listed statements are appropriate responses to diagnosis and treatment.
A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response?
"Many clients require two or more drugs for high blood pressure." Many clients require two or more drugs to achieve adequate blood pressure. Current guidelines suggest thiazide diuretic alone or with an angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), or calcium channel blocker (CCB)
A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication?
"This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction.
Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?
"When was your last menstrual period?" It would be important to know when the patient's LMP occurred and that the client is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the client who is beginning angiotensin II receptor blocker therapy.
The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease" Hypertension causes damage to blood vessels within the body that may lead to cardiovascular and kidney damage. Hypertension may be treated with or without medications. It is not within the scope of the nurse to decide whether or not the client needs medications, but to provide the education regarding the disease process and medications.
How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)
- Monitoring for drug effects - Promoting compliance with the prescribed pharmacologic modifications - Promoting compliance with the prescribed lifestyle modifications Whether the client or another member of the household is taking antihypertensive medications, the home care nurse may be helpful in teaching about the drugs, monitoring for drug effects, and promoting compliance with the prescribed regimen (pharmacologic and lifestyle modifications). The nurse would not provide financial assistant with daily expenses though the nurse would help the client and family discover resources that might provide what is needed.
What is the total dose range of digoxin for rapid digitalization?
0.75 to 1.5 mg Digitalization may be accomplished rapidly by giving a total dose of 0.75 to 1.5 mg of digoxin in divided doses. A digoxin dose range of 2.0 to 4.0 mg is too large. A digoxin dose range of 0.125 to 0.5 mg is too small.
A 6-year-old child weighing 60 lbs (27.3 kg) has been prescribed oral digoxin 30 mcg/kg as a loading dose. How many milligrams should the nurse administer? Provide your answer to two decimal places.
0.82 First, determine the dose in micrograms: 30 mcg/kg x 27.3 kg = 819 mcg. Since there are 1,000 mcg in 1 mg: 819 mcg ÷ 1000 mcg/mg = 0.819 mg, which rounds to 0.82 mg.
A patient is receiving milrinone IV. The nurse would administer the bolus over which time frame?
10 min Milrinone is administered by IV bolus over 10 minutes.
A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following?
130/80 mmHg The blood pressure goal for a client with diabetes or kidney disease is 130/80 mm Hg. Values of 140/90 mm Hg and 150/100 mm Hg indicate the blood pressure is not under good control. Blood pressure of 100/70 mm Hg can increase the risk or orthostatic hypotension.
A nurse obtains the serum digoxin level and immediately reports a level greater than which value?
2.0 ng/mL. A nurse must immediately report serum digoxin levels greater than 2.0 ng/mL. Therapeutic drug levels are between 0.8 and 2 ng/mL.
A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner?
2.2 Ng/mL A plasma digitalis level of more than 2 ng/ml would require the nurse to report to the practitioner; therefore plasma digitalis levels of 2.2 ng/ml indicate digitalis toxicity. In such circumstances, the nurses should immediately report to the practitioner. The therapeutic levels of plasma digitalis are 0.5 to 2 ng/ml.
A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained?
3.5-5.0 mEq/L Electrolyte imbalance must be monitored during digoxin therapy, and the potassium level should be maintained at 3.5-5.0 mEq/L. A potassium level of 1.5-2.0 mEq/L is too low. Potassium levels of 6.0-80 and 8.5-10 mEq/L are too high.
A client reports seeing halos around lights. The client takes digoxin by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity?
4.0 ng/mL Therapeutic serum levels of digoxin are 0.8 to 2 ng/mL. Levels above that would indicate toxicity, and those below would not yet be therapeutic.
A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information?
ACE inhibitors are contraindicated during pregnancy because they are teratogenic. It is important to instruct women of childbearing age to take measures to prevent pregnancy while taking captopril or other ACE inhibitors because the drugs are teratogenic. This therapy must be discontinued if pregnancy occurs.
A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?
Angiotensin II receptor blockers Losartan is an angiotensin II receptor blocker (ARB) and is recommended for clients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease. Antihyperlipidemic drugs help to reduce cholesterol. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls, these are recommended with caution in pregnant women. Selective aldosterone blockers do not show reduction of end-stage renal disease but are effective in treating severe CHF.
When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?
Atropine Atropine should be administered to patients who develop bradycardia. Bradycardia may be seen in digitalis toxicity. Inamrinone and milrinone are miscellaneous inotropics used in heart failure. Cholestyramine is used to lower blood cholesterol levels. Inamrinone, milrinone, and cholestyramine are not used in the treatment of bradycardia.
A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia?
Atropine Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity.
A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed?
Atropine If severe bradycardia occurs, atropine may be ordered. Milrinone is a miscellaneous inotropic drug used to treat heart failure. Activated charcoal is an antidote for poisoning with certain toxic substances, but not digoxin. It also decreases serum digitalis levels. Propafenone increases serum digitalis levels and would not be used.
Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure?
Bronchiole Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock. The medication has no effect on the muscles suggested by the other options.
A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?
By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.
A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient?
Check for jugular vein distention The nurse should check for jugular vein distention as part of the pre-administration assessment for the patient prescribed a cardiotonic. The nurse need not inspect joints for swelling, inspect skin for rash, or obtain blood glucose levels as these interventions will not provide necessary information with regard to administration of a cardiotonic.
A client is being treated for heart failure. What assessment finding would the nurse interpret as most indicative of improved health status?
Decreased pitting edema A decrease in pitting edema is an indication of diminished fluid volume, which is indicative of an improved blood supply to the body tissues. Increased skin turgor may represent an increase in fluid volume. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status.
When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to:
Decreased venous return Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. The heart rate increases in an attempt to meet the demands of the body
A 71-year-old male client is being treated for hypertension. Which measurement is a partial indication of effective treatment and management?
Diastolic blood pressure below 90 mm Hg Successful treatment involves reducing blood pressure below hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
Key behavioral determinants of blood pressure are related to what factor?
Dietary consumption of calories and salt Key behavioral determinants of blood pressure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.
Which would the nurse identify as a cardiac glycoside?
Digoxin Digoxin is a cardiac glycoside. Inamrinone and milrinone are phosphodiesterase inhibitors. Captopril is an angiotensin-converting enzyme inhibitor.
A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment?
Digoxin Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, ACE inhibitors, or hydrochlorothiazide also may be used, but these drugs are not the most common ones used.
A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason?
Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading Digoxin dosages must be interpreted with consideration of specific client characteristics, including age, weight, gender, renal function, general health state, and concurrent drug therapy. Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.
A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason?
Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Digoxin dosages must be interpreted with consideration of specific client characteristics, including age, weight, gender, renal function, general health state, and concurrent drug therapy. Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:
Falls Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression.
A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?
Frequent assessment of the client's cardiac status Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihypertensive, but it is unnecessary to supervise all of the client's ADLs.
A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?
Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body. Subsequently, the client is at risk for hypokalemia. Amiloride, spironolactone, and triamterene are potassium-sparing diuretics. The client using these diuretics would need to be monitored for hyperkalemia because potassium is not lost along with sodium.
The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock?
Hypoperfusion of tissues Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response
A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?
Implement interventions to lower blood pressure. Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. While appropriate, none of the other options have priority over decreasing the blood pressure.
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity?
Increased cardiac output
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity?
Increased cardiac output Positive inotropes increase cardiac output. Decreased heart rate is a negative chronotropic effect. Increased preload is a result of increased venous tone and circulating volume. Changes in conduction velocity are chronotropic effects, not inotropic.
Which would be considered a therapeutic effect of digoxin?
Increased force of contraction
A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?
Instant bronchodilation For acute asthma attacks, subcutaneous administration of epinephrine usually produces bronchodilation instantly; maximal effects may occur within 20 minutes helping to eventually decrease the respiratory rate. None of the remaining options identify expected results of subcutaneous epinephrine.
A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route?
Intravenous Inamrinone is administered only by the intravenous route.
Milrinone is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?
Intravenously Milrinone (Primacor) is only to be given intravenously. The other routes are not used.
The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?
It directly relaxes vascular smooth m. Allowing dilation of peripheral arteries and veins Nitroprusside, which is used in hypertensive crisis, directly relaxes vascular smooth muscle, allowing the dilation of peripheral arteries and veins. Angiotensin II receptor blockers block the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. Selective aldosterone blockers bind selectively to the mineralocorticoid receptors, thereby blocking aldosterone from binding to these receptors, while calcium channel blockers inhibit the movement of calcium ions across cell membranes.
The nurse in a physician's office knows that heart failure clients will need which laboratory tests to best monitor their condition? (Select all that apply.)
K+ and Na+ levels Creatinine clearance Digoxin levels The nurse is aware that the nurse will monitor the client's serum electrolytes, renal function, and serum digoxin level.
After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?
Left ventricle The area of highest pressure in the system is always the left ventricle during systole. This pressure propels the blood out of the aorta and into the system.
A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long?
Lifelong Once primary hypertension develops, management of the disorder becomes a lifetime task. Diet and exercise with weight loss can help to lower blood pressure, however, there are many factors even genetics that contribute to hypertension.
A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II
Losartan Losartan is an example of an angiotensin II receptor blocker. Moexipril is an ACE inhibitor. Minoxidil is a vasodilator. Amlodipine is a calcium channel blocker.
The client's digoxin level is 0.125. How does the nurse interpret this level?
Low The therapeutic serum digoxin level is 0.8 to 2.0 ng/mL. Higher serum levels are associated with an increased risk of adverse effects and toxicity without clear evidence of improved efficacy.
The nurse is providing education to a client who has been prescribed digoxin for symptomatic heart failure. What teaching point would the nurse convey to this client?
Make sure to take your pulse for a minute before taking your digoxin Clients should measure their heart rate for a full minute before taking a dose of digoxin. The drug can be taken with food, and potassium intake should be increased, not decreased. The client's daily dose of digoxin should never be increased in response to short-term changes in symptoms.
The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema?
Measurement of intake and output Measurement of intake and output is a nursing intervention related to the edema in the patient receiving cardiotonic drugs. Auscultation of the lungs, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the patient.
The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication?
Monitor the infant's apical pulse The nurse must assess the client's apical pulse before administering digoxin because it has a narrow therapeutic index and can cause the heart rate to go too low, so the nurse takes the apical pulse and holds the medication if it is below a certain level (depending upon age of the client.)
The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?
Monitoring for complications and side effects of treatment General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. The other options are correct but not more important functions of nursing care than monitoring for complications and side effects of treatment.
The nurse is developing the care plan for a client recently diagnosed with hypertension. What outcome would the nurse identify as most important?
Multiple diastolic blood pressure readings less than 90 mm Hg The diastolic blood pressure below 80 mm Hg is the most important outcome in this client. Verbalization of understanding of the medical regime is a client-related outcome that is important but not the most important outcome. Compliance with antihypertensive medications is important but does not confirm a decreased blood pressure. Compliance with a low-sodium diet will assist in decreasing blood pressure but will not confirm that the blood pressure is decreased.
The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse's best response?
Myocardium hypertrophy Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
When dosing digoxin (Lanoxin), which factors are considered?
Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics All of the answers are factors to consider when dosing digoxin (Lanoxin).
After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure?
Peripheral edema Peripheral edema would be associated with right-sided heart failure. Hemoptysis, dyspnea, and polyuria would be associated with left-sided heart failure.
The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?
Positive iontropic A positive inotropic effect improves the contractility and pumping ability of the heart.
A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?
Potassium Aliskiren is associated with hyperkalemia. Therefore, the nurse would need to closely monitor potassium levels. Diuretics can lead to hyponatremia, hypomagnesemia, and hypokalemia.
A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor?
Potassium levels Although it is important to monitor the client's ECG, it is more important to closely monitor potassium levels when the client is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The client's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels.
During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment?
Secondary hypertension Secondary hypertension results as a consequence of renal impairment. In secondary hypertension there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension it is called essential hypertension. Rebound hypertension occurs when a patient abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state that has to be lowered immediately.
A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse?
Slow the rate of the infusion Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.
A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension?
Stage 2 A client is diagnosed with stage 2 hypertension when their systolic blood pressure is greater than or equal to 160 mm Hg or their diastolic blood pressure is greater than or equal to 100 mm Hg. Stage I hypertension is defined as a systolic pressure between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg. Prehypertension is defined as a systolic pressure between 120 and 130 mm Hg or a diastolic pressure between 80 and 89 mm Hg. Normotension is defined as a systolic pressure of less than or equal to 120 mm Hg or a diastolic pressure of less than or equal to 80 mm Hg.
The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client's systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first?
Stop the infusion and administer diluted phentolamine. Extravasation (infiltration of IV fluids outside of the vein) of the norepinephrine IV site has occurred as noted by redness and edema. The nurse's first action is to stop the infusion and immediately administer diluted phentolamine, the antidote to minimize sloughing and necrosis of the tissue. The nurse can then establish a new patent IV site and titrate the drug to keep SBP greater than 90 mm Hg. After increasing the drip, the nurse would assess the SBP again. The nurse can assess urine output and report if it is less than 30 mL/h.
A client has been prescribed spironolactone therapy for the treatment of heart failure. What treatment goal related to the medication will the nurse include in the care plan?
The client will experience a decrease in edema Spironolactone is used to decrease edema in clients with heart failure. The goal is not to negate the need for other medications, as spironolactone is part of combination therapy. Prediagnosis levels of stamina are not normally achieved, and increased electrolyte levels are not an identified goal.
A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client?
The dose should be decreased in this client. The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The client should be taught to limit sodium intake in the diet. The client's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function.
Vasodilators used to treat heart failure include nitrates and ACE inhibitors.
True Drug therapies used to treat heart failure include vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, which decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function.
Heart failure was once called dropsy.
True HF, a condition that was once called "dropsy" or decompensation, is a syndrome that usually involves dysfunction of the cardiac muscle, of which the sarcomere is the basic unit.
A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications?
Visual disturbances Adverse reactions associated with cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias. Diarrhea, constipation, and restlessness are not adverse reactions of cardiotonic medications.
How does captopril contribute to a reduction of a client's blood pressure?
blocking the conversion of angiotensin I to angiotensin II ACE inhibitors such as captopril block the enzyme that normally converts angiotensin I to the potent vasoconstrictor angiotensin II. Calcium channel blockers dilate peripheral arteries and relax vascular smooth muscle. Angiotensin II receptor blockers mitigate the hypertensive effects of angiotensin II and diuretics increase water excretion.
A client newly diagnosed with heart failure questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. How would the nurse respond?
it rapidly brings your serum digoxin levels up to therapeutic levels Digitalization is the administration of a loading dose (a dose larger than the regularly prescribed daily dosage) of digoxin to reach the therapeutic index rapidly. None of the options accurately describe the reasoning behind this practice of dose loading.
When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition?
myocardial hypertrophy Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition?
pulmonary edema Pulmonary edema is one of the cardinal signs of left-sided heart failure. This health problem does not typically cause venous ulcers, chest pain, or palpitations.
After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify:
renal failure. Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, cardiomyopathy, valvular disease, and hypertension are commonly associated with heart failure.
