NEW CARDIAC QUIZ

798. A nurse is administering 40 mg of furosemide (Lasix) intravenously. Which sensation reported by the client does the nurse consider when determining that it is being administered too quickly? 1. "Bladder feels full" 2. "Ears are plugged up" 3. "Heart is beating fast" 4. "Left arm feels numb"

2 "Rapid administration of furosemide (Lasix) can cause tinnitus, loss of hearing, and ear pain."

730. Which drug requires the nurse to monitor the client for signs of hyperkalemia? 1. Furosemide (Lasix) 2. Metolazone (Zaroxolyn) 3. Spironolactone (Aldactone) 4. Hydrochlorothiazide (HydroDIURIL)"

3 " Spironolactone (Aldactone) is a potassium-sparing diuretic; hyperkalemia is an adverse effect."

736. Metoprolol (Lopressor) is prescribed for a client. The nurse should question the prescription if the client has which diagnosis? 1. Hypertension 2. Angina pectoris 3. Sinus bradycardia 4. Myocardial infarction

3 "Metoprolol (Lopressor) is a beta blocker; it decreases the heart rate and thus is contraindicated with bradycardia."

726. A client is diagnosed with an 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 "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 psychosocial 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."

34. What client response indicates to the nurse that a vasodilator medication is effective? 1. Pulse rate decreases from 110 to 75 2. Absence of adventitious breath sounds 3. Increase in the daily amount of urine produced 4. Blood pressure changes from 154/90 to 126/72

4 "Vasodilation will lower the blood pressure."

"728. Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? 1. Chlorothiazide (Diuril) 2. AcetaZOLAMIDE (Diamox) 3. Bendroflumethiazide (Naturetin) 4. Demecarium bromide (Humorsol)"

2 "AcetaZOLAMIDE (Diamox) is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack."

748. For what client response must the nurse monitor to determine the effectiveness of amiodarone (Cordarone)? 1. Results of fasting lipid profile 2. Presence of cardiac dysrhythmias 3. Degree of blood pressure control 4. Incidence of ischemic chest pain

2 "Amiodarone (Cordarone) is a class III antidysrhythmic used to treat ventricular and supraventricular tachycardia, and conversion of atrial fibrillation."

88. A nurse is caring for a client who is receiving a thiazide diuretic for hypertension. Which food selected by the client indicates to the nurse that dietary teaching about thiazide diuretics was effective? 1. Apples 2. Broccoli 3. Cherries 4. Cauliflower"

2 "Thiazide diuretics are potassium-depleting agents; broccoli provides 267 mg of potassium"

733. What should the nurse include in a teaching plan to help reduce the side effects associated with diltiazem (Cardizem)? 1. Lie down after meals. 2. Change positions slowly. 3. Avoid dairy products in diet. 4. Take the drug with an antacid.

2 "Changing positions slowly will help prevent the side effect of orthostatic hypotension."

39. A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies the following foods. Select all that apply. "1. Olive oil 2. Chicken broth 3. Enriched whole milk 4. Red meats, such as beef 5. Vegetables and whole grains 6. Liver and other glandular organ meats

2 3 4 6 "1 This is an unsaturated fat, which is a healthy choice. 2 This is high in sodium and should be avoided to prevent fluid retention and an elevated blood pressure. 3 This is high in saturated fats and contributes to hyperlipidemia; skim milk is the healthier choice. 4 These are high in saturated fats and should be avoided. 5 Vegetables and whole grains are low in fat and have soluble fiber, which may reduce the risk for heart disease. 6 These are high in cholesterol and should be avoided."

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 "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."

740. What instructions should a nurse give a client for whom nitroglycerin tablets are prescribed? 1. Limit the number of tablets to four per day. 2. Discontinue the medication if a headache develops. 3. Ensure that the medication is stored in a dark container. 4. Increase the number of tablets if dizziness is experienced.

3 "Nitroglycerin is sensitive to light and moisture, so it must be stored in a dark, airtight container."

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 "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, hyperlipidemia, and hyperuricemia." Excerpt From: Linda Anne Silvestri. "Saunders Comprehensive Review for the NCLEX-RN® Examination." iBooks.

37. A client is taking labetalol (Normodyne). The nurse monitors the client for which frequent side effect of the medication? a. tachycardia b. impotence c. increased energy level d. night blindness

b Impotence is a common side effect of labetalol and may be distressing to the client. Other side effects of this medication are bradycardia, weakness, and fatigue. Night blindness is unrelated to this medication, although this medication can cause blurred vision and dry eyes.

25. A nurse is caring for a client with glaucoma who receives a daily dose of acetazolamide (Diamox). Which of the following would indicate to the nurse that the client is experiencing an adverse effect of the medication? a. constipation b. difficulty swallowing c. dark-colored urine and stools d. irritability

c Acetazolamide (Diamox) is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity can occur and is manifested by dark-colored urine and stools, pain in the lower back, jaundice, dysuria, crystalluria, and renal colic and calculi. Bone marrow depression may also occur.

15. A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature, decreased blood pressure, and diaphoresis. A myocardial infarction is diagnosed. Which should the nurse consider as a valid reason for one of this client's physiologic responses? 1. Parasympathetic reflexes from the infarcted myocardium cause diaphoresis. 2. Inflammation in the myocardium causes a rise in the systemic body temperature. 3. Catecholamines released at the site of the infarction cause intermittent localized pain.

2 "Temperature may increase within the first 24 hours as a result of the inflammatory response to tissue destruction and persist as long as a week."

33. A client being treated for hypertension reports having a persistent hacking cough. What class of antihypertensive should the nurse identify as a possible cause of this response when reviewing a list of this client's medications? 1. ACE inhibitors 2. Thiazide diuretics 3. Calcium channel blockers 4. Angiotensin receptor blockers.

1 "ACE (angiotensin-converting enzyme) increases the sensitivity of the cough reflex, leading to the common adverse effect sometimes referred to as an ACE cough."

55. A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide (Bumex) and digoxin (Lanoxin). What does the nurse determine is the cause of the depletion? 1. Diuretic therapy 2. Sodium restriction 3. Continuous dyspnea 4. Inadequate oral intake

1 " Diuretic therapy that affects the loop of Henle generally involves the use of drugs (e.g., bumetanide [Bumex]) that directly or indirectly increase urinary sodium, chloride, and potassium excretion.

722. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/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 to 2 ng/mL 2. 1.2 to 2.8 ng/mL 3. 3.0 to 5.0 ng/mL 4. 3.5 to 5.5 ng/mL

1 " Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. The ranges in the remaining options are incorrect."

"742. A client who is obtund has a blood pressure of 80/35 mm Hg after a blood transfusion. In an effort to support renal perfusion, the nurse administers DOPamine (Intropin) at 2 mcg/kg/min as prescribed. What is the most relevant outcome indicating effectiveness of the medication for this client? 1. A decrease in blood pressure 2. An increase in urinary output 3. A decrease in core temperature 4. An increase in level of consciousness"

2 "As renal perfusion increases, urinary output also should increase; doses greater than 10 mcg/kg/min can cause renal vasoconstriction and decreased urinary output."

724. The nurse is 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 blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication

2 "Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored."

734. A nurse is providing discharge instructions for a client with angina who has a prescription for sublingual nitroglycerin tablets. The nurse should teach the client that the nitroglycerin sublingual tablets have lost their potency when: 1. sublingual tingling is experienced. 2. the tablets are more than three months old. 3. the pain is unrelieved, but facial flushing is increased. 4. onset of relief is delayed, but the duration of relief is unchanged.

2 "Nitroglycerin tablets are affected by light, heat, and moisture. Loss of potency can occur after 3 months, reducing the drug's effectiveness in relieving pain. A new supply should be obtained routinely."

40. Which instructions should the nurse include in the teaching plan for a client who will be taking simvastatin (Zocor) when discharged? Select all that apply. 1. Increase dietary intake of potassium. 2. Avoid prolonged exposure to the sun. 3. Schedule regular ophthalmic examinations. 4. Take the medication at least a half hour before meals. 5. Contact your health care provider if skin becomes gray-bronze..

2 3 5 "1 Simvastatin (Zocor) does not affect levels of potassium. 2 Simvastatin increases photosensitivity; the client should avoid sun exposure and use sunblock. 3 The client should be monitored for the adverse effects of glaucoma and cataracts. 4 The medication is most effective when taken at bedtime because cholesterol synthesis is highest at night. 5 Gray-bronze skin and unexplained muscle pain are signs of rhabdomyolysis. Rhabdomyolysis, a life-threatening response, is the disintegration of muscle associated with myoglobin in the urine."

45. "What instructions about the use of nitroglycerin should the nurse provide to a client with angina? 1. "Identify when pain occurs, and place 2 tablets under the tongue." 2. "Place 1 tablet under the tongue, and swallow another when pain is intense." 3. "Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs. "4. "Place 1 tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent recurrence."

3 "Anginal pain, which can be anticipated during certain activities, may be prevented by dilating the coronary arteries immediately before engaging in the activity."

739. A client with a history of arthritis has an acute episode of right ventricular heart failure and is receiving furosemide (Lasix). The health care provider lowers the client's usual dosage of aspirin. The client asks the nurse the reason for the lower dose. What is the nurse's best response? 1. "Aspirin accelerates metabolism of furosemide and decreases the diuretic effect." 2. "Aspirin in large doses after an acute stress episode increases the bleeding potential." 3. "Competition for renal excretion sites by the drugs causes increased serum levels of aspirin." 4. "Use of furosemide and aspirin concomitantly increases formation of uric acid crystals in the nephron.

3 "Because furosemide (Lasix) and aspirin compete for the same renal excretory sites, salicylate toxicity may occur even with lower dosages."

738. A nurse concludes that the simvastatin (Zocor) being administered to a client is effective. A decrease in what clinical finding supports this conclusion? 1. INR 2. Heart rate 3. Triglycerides 4. Blood pressure

3 "Therapeutic effects of simvastatin (Zocor) include decreased levels of serum triglycerides, LDL, and cholesterol."

68. A client who had a myocardial infarction is in the coronary care unit on a cardiac monitor. The nurse observes ventricular irritability on the screen. What medication should the nurse prepare to administer? 1. Digoxin (Lanoxin) 2. Furosemide (Lasix) 3. Amiodarone (Cordarone) 4. Norepinephrine (Levophed)

3 "Amiodarone (Cordarone) decreases the irritability of the ventricles by prolonging the duration of the action potential and refractory period. It is used in the treatment of ventricular dysrhythmias."

35. What should the nurse assess to determine if a client is experiencing the therapeutic effect of valsartan (Diovan)? 1. Lipid profile 2. Apical pulse 3. Urinary output 4. Blood pressure.

4 "Angiotensin II receptor blockers (ARBs) lower the blood pressure; they block the receptor sites in smooth muscles and adrenal glands so vasoconstriction is prevented."

43. A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client: a. to take the medication with food only b. to rise slowly from a lying to a sitting position c. to discontinue the medication if nausea occurs d. that a therapeutic effect will be noted immediately

b Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.

27. A nurse has formulated a nursing diagnosis of Disturbed Body Image for a client who is taking spironolactone (Aldactone). The nurse based this diagnosis on assessment of which side effect of the medication? a. edema b. weight gain c. excitability d. decreased libido

d Spironolactone (Aldactone) is a potassium-sparing diuretic. The nurse should be alert to the fact that the client taking spironolactone may experience body image changes due to threatened sexual identity. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females. Since the medication is a diuretic, edema and weight gain should not occur. Excitability is not associated with the use of this medication; rather, drowsiness may occur.

19. A nurse is caring for a child with CHF provides instructions to the parents regarding the administration of digoxin (Lanoxin). Which statement by the mother indicates a need for further instructions? a. "If my child vomits after I give the medication, I will not repeat the dose" b. "I will check my child's pulse before giving the medication" c. "I will check the dose of the medication with my husband before I give the medication" d. "I will mix the medication with food"

d The medication should not be mixed with food or formula because this method would not ensure that the child receives the entire dose of medication. Options a, b, and c are correct. Additionally, if a dose is missed and is not identified until 4 or more hours later, that dose is not administered. If more than one consecutive dose is missed, the physician needs to be notifie

37. Which instructions should the nurse include in the teaching plan for a client with hyperlipidemia who is being discharged with a prescription for cholestyramine (Question)? 1. "Increase your intake of fiber and fluid." 2. "Take the medication before you go to bed." 3. "Check your pulse before taking the medication." 4. "Contact your health care provider if your skin or sclera turn yellow.

1 "Fiber and fluids help prevent the most common adverse effect of constipation and its complication—fecal impaction."

756. Which medication should the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? 1. Morphine 2. Phenobarbital 3. HydrOXYzine 4. Chloral hydrate"

1 "Morphine binds with the same receptors as natural opioids. However, it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation."

745. One week after being hospitalized for an acute myocardial infarction, a client reports a loss of appetite and feeling nauseated. Which of the client's prescribed medications should be withheld and the health care provider notified? 1. Digoxin (Lanoxin) 2. Furosemide (Lasix) 3. Propranolol (Inderal) 4. Spironolactone (Aldactone)

1 "Toxic levels of digoxin (Lanoxin) stimulate the medullary chemoreceptor trigger zone, resulting in anorexia, nausea, and vomiting."

737. Which client's health problem motivates the nurse to question a prescription for a beta blocker? 1. Heart failure 2. Hypertension 3. Sinus tachycardia 4. Coronary artery disease

1 "Beta blockers reduce cardiac output, so they are contraindicated for clients with uncontrolled heart failure."

54. A client with left ventricular heart failure is taking digoxin (Lanoxin) 0.25 mg daily. What changes does the nurse expect to find if this medication is therapeutically effective? Select all that apply. 1. Diuresis 2. Tachycardia 3. Decreased edema 4. Decreased pulse rate 5. Reduced heart murmur 6. Jugular vein distention

1 3 4 "1 Digoxin increases kidney perfusion, which results in urine formation and diuresis. 2 Digoxin increases the force of contractions (inotropic effect) and decreases the heart rate (chronotropic effect). 3 Because of digoxin's inotropic and chronotropic effects, the heart rate will decrease. 4 The urine output increases because of improved cardiac output and kidney perfusion, resulting in a reduction in edema. 5 Digoxin does not affect a heart murmur. 6 This is a specific sign of right ventricular heart failure; it is treated with diuretics to reduce the intravascular volume and venous pressure."

747. A nurse is providing discharge instructions about digoxin (Lanoxin). Which response should a nurse include as a reason for a client to withhold the digoxin? 1. Chest pain 2. Blurred vision 3. Persistent hiccups 4. Increased urinary output

2 "Visual disturbances, such as blurred and/or yellow vision, may be evidence of digoxin (Lanoxin) toxicity."

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, 9.8 mg/dL; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/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 "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 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia."

59. While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the health care provider to prescribe? 1. Digoxin (Lanoxin) 2. Lidocaine (Xylocaine) 3. Amiodarone (Cordarone) 4. Atropine sulfate (Atropine)

4 "Atropine blocks vagal stimulation of the SA node, resulting in an increased heart rate."

793. Valsartan (Diovan), an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. 1. Constipation 2. Hypokalemia 3. Irregular pulse rate 4. Change in visual acuity 5. Orthostatic hypotension

3 5 "1 Diarrhea, not constipation, may occur with valsartan (Diovan). 2 Hyperkalemia, not hypokalemia, may occur with valsartan. 3 Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (CVA). 4 Valsartan does not cause altered visual acuity. 5 Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur."

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 3.1 mEq/L 3. B-natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL 4. Urine output increases from 10 mL/hour to greater than 50 mL hourly

4 "Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 2, and 3 are incorrect."

36. What information should the nurse include when teaching a client with heart disease about cholesterol? 1. Can be found in both plant and animal sources 2. Causes an increase in serum high-density lipoprotein 3. Should be eliminated because it causes the disease process 4. Decreases when unsaturated fats are substituted for saturated fats .

4 "Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats."

42. Amlodipine (Norvasc) is prescribed for a client with hypertension. Which response to the medication should the nurse instruct the client to report to the health care provider? 1. Blurred vision 2. Dizziness on rising 3. Excessive urination 4. Difficulty breathing

4 "Dyspnea may indicate development of pulmonary edema, which is a life-threatening condition"

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 "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 health care provider (HCP)."

728. The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/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 "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."

32. What should the nurse teach a client who is taking antihypertensives to do to minimize orthostatic hypotension? 1. Wear support hose continuously. 2. Lie down for 30 minutes after taking medication. 3. Avoid tasks that require high-energy expenditure. 4. Sit on the edge of the bed for 5 minutes before standing.

4 "Sitting on the edge of the bed before standing up gives the body a chance to adjust to the effects of gravity on circulation in the upright position."