Pharm Exam 2

The clinical use of class III agents rather than class I agents is preferred for patients with heart disease because the class III agents are associated with A.) less ventricular fibrillation B.) increased mortality C.) more sustained effects D.) milder adverse effects

A. Clinical use of class III agents is increasing because they are associated with less ventricular fibrillation, more relief of symptoms, and decreased mortality compared with class I drugs.

A nurse is monitoring a patient who has been receiving quinidine in the critical care unit. The laboratory technician calls to report that the patient's serum quinidine level is 8 mcg/mL. The patient has also developed diarrhea. The priority action is to A.) Report the findings to the provider immediately. B.) Administer the medication as ordered. C.) Anticipate that the dosage of the medication will increase. D.) Anticipate that the dosage of the medication will decrease.

A. The serum level of quinidine is elevated (therapeutic serum levels: 2-6 mcg/mL), and levels greater than 6 mcg/mL are toxic. Monitoring urine pH may be warranted because alkaline urine decreases renal excretion of quinidine, and serum levels can increase. The most common adverse effects of quinidine are tinnitus, vomiting, severe diarrhea, vertigo, and headache.

The home care nurse is visiting a patient who has a history of heart failure. The patient is taking digoxin (Lanoxin) 0.125 mg orally each day. During the assessment, the patient states he has been nauseated since the home care visit 3 days ago. The nurse suspects he has developed digoxin toxicity. Which of the following factors makes this patient more prone to the development of digoxin toxicity? A.) creatinine level of 2.0 mg/dL B.) potassium level of 4.0 mEq/L C.) calcium level of 8.5 mg/100 mL D.) magnesium level of 2.0 mg/100 mL

A.) A creatinine level of 2.0 mg/dL is indicative of impaired renal function. Impaired renal function requires the dosage of digoxin (Lanoxin) to be reduced to prevent toxicity.

A 35-year-old woman has been prescribed enalapril maleate (Vasotec). What should the nurse teach the patient? A.) Use effective contraception. B.) Double the dose if one is missed. C.) If dizziness occurs, it is not a concern. D.) There is no change in dose with impaired renal function.

A.) Enalapril maleate (Vasotec) is teratogenic and can cause birth defects or fetal demise. Because this patient is of childbearing age, she should be instructed to use effective contraception.

Which of the following best describes the action of milrinone lactate (Primacor)? A.) It relaxes the smooth muscles of the blood vessels to make the vessels wider. B.) Titration of the medication provides an inotropic effect. C.) It produces vasoconstriction to increase both the preload and afterload. D.) The medication decreases the levels of cyclic adenosine monophosphate (cAMP).

A.) Milrinone lactate (Primacor) causes vasodilation by relaxing the vascular smooth muscle. In addition, milrinone lactate increases the force of contraction of the ventricles by inhibiting phosphodiesterase, an enzyme that metabolizes cyclic adenosine monophosphate (cAMP). Increased cAMP in the myocardial cells enhances myocardial contractility by relaxing the cardiac smooth muscle.

How does digoxin (Lanoxin) exert a negative chronotropic effect? A.) Digoxin has a direct depressant effect on cardiac conduction tissue. B.) Digoxin increases electrical impulses through the ventricles. C.) Digoxin depresses the vagal nerve to increase contractility. D.) Digoxin prevents calcium from entering the myocardial cell.

A.) Negative chronotropic effects are probably caused by several factors. First, digoxin has a direct depressant effect on cardiac conduction tissue, decreasing the number of electrical impulses that are allowed to reach the ventricles from supraventricular sources. Second, digoxin indirectly stimulates the vagus nerve. Increased efficiency of myocardial contraction and vagal stimulation decreases compensatory tachycardia, which results from the sympathetic nervous system response to inadequate circulation.

A patient is diagnosed with heart failure. Which of the following nonpharmacological interventions will be a priority in decreasing edema? A.) Administer a diuretic agent. B.) Limit dietary sodium. C.) Place the patient on bed rest. D.) Increase dietary protein.

B.) Limiting dietary sodium decreases fluid volume and assists in decreasing edema.

A patient is coughing and short of breath. He has productive frothy sputum. He is diagnosed with heart failure. Which of the following nursing diagnoses is most appropriate given the assessment data? A.) Ineffective Tissue Perfusion B.) Activity Intolerance C.) Impaired Gas Exchange D.) Anxiety

C. A patient with shortness of breath and a productive cough with frothy sputum has a nursing diagnosis of impaired gas exchange related to venous congestion and fluid accumulation in the lungs.

Ms. Ferguson, age 58, is admitted to the coronary care unit for treatment of an acute anterior myocardial infarction. That evening, she experiences frequent runs of ventricular tachycardia. The provider tells the nurse to prepare an IV bolus dose of lidocaine. Why is lidocaine administered intravenously at this time—and not orally? A.) Lidocaine absorption is too erratic when administered orally. B.) Lidocaine is inactivated by hydrochloric acid. C.) Most of an absorbed oral dose of lidocaine undergoes first-pass metabolism in the liver. D.) The onset of action for oral lidocaine is greater than 8 hours.

C. Lidocaine goes through extensive first-pass effect in the liver, making oral dosages ineffective. After intravenous (IV) administration of a bolus dose, therapeutic effects occur rapidly, within several minutes. It is important to check that the solution of lidocaine does not contain epinephrine. Solutions of lidocaine with epinephrine are used for local anesthesia but not for IV administration.

A patient is taking furosemide (Lasix), 40 mg daily, to decrease extracellular fluid related to heart failure. During patient teaching, which of the following points is most important for the nurse to convey? A.) Sodium intake should be increased due to fluid loss. B.) Administration of the medication with food will decrease absorption. C.) The skin should be protected from sun exposure using sunscreen. D.) Foods that contain potassium should be limited to prevent hyperkalemia.

C.) An adverse effect of the administration of furosemide (Lasix) is photosensitivity.

During the administration of milrinone lactate (Primacor), the patient's blood pressure decreases from 170/96 mm Hg to 96/60 mm Hg. What is the most appropriate nursing action? A.) Call the physician. B.) Administer a vasoconstrictor. C.) Reduce the infusion rate. D.) Reassess the blood pressure.

C.) If a patient receiving milrinone lactate (Primacor) experiences a significant decrease in blood pressure, the infusion rate should be reduced, and then the health care provider should be notified.

A patient being digitalized in the cardiac intensive care unit is noted to have frequent PVCs. What should the nurse suspect in this patient? A.) myocardial infarction B.) pulmonary embolism C.) digitalis toxicity D.) hyperkalemia

C.) digitalis toxicity

Mr. Conley, who is 53 years of age, is about to be discharged from the hospital after treatment for recurrent ventricular fibrillation. To prevent breakthrough ventricular ectopy, his prescriber orders amiodarone (Cordarone), 1000 mg PO daily as a loading dose for 2 weeks. What patient teaching implications are important regarding this loading dose? A.)Most of the drug is destroyed in the gastrointestinal tract, and thus a large dose needs to be given. B.) Males require large dosages because of their faster metabolic rate. C.) A history of ventricular dysrhythmia necessitates a higher dose. D.) The drug has a long serum half-life.

D. Amiodarone is highly lipid soluble, and the drug and its metabolites accumulate in the liver, lung, fat, skin, and other tissues. With IV administration, the onset of action usually is within several hours. With oral administration, the onset of action may be delayed from a few days up to a week or longer. However, because of the long serum half-life of amiodarone, loading doses are often given; higher loading doses can reduce the time required for therapeutic effects. Low doses (100-200 mg/d) may prevent recurrence of atrial fibrillation with less toxicity than higher doses.

Which of the following patient goals indicates that the patient will maintain adequate follow-up care related to heart failure? A.) maintain weight reduction B.) experience less fatigue C.) administer medications D.) maintain regular medical appointments

D. The patient goal of maintaining regular appointments with the health care provider relates to ensuring that the patient's condition and therapy will continue to be monitored on an ongoing basis.

A patient is being treated for hypothyroidism. She is also taking digoxin (Lanoxin) for chronic heart failure. Which of the following factors places the patient at risk for digoxin toxicity? A.) impaired renal function B.) impaired liver function C.) tachycardia D.) decreased metabolic rate

D.) A patient who is being treated for hypothyroidism has a decreased metabolic rate. A decreased metabolic rate places the patient at risk for digitalis toxicity.

What is the purpose of administering an angiotensin II-receptor blocker to a patient with heart failure? A.) It will increase vasoconstriction to increase myocardial contractility. B.) It will block the influx of calcium across the sinoatrial node. C.) It will inhibit the enzyme that catalyzes cholesterol synthesis. D.) It will block the renin-angiotensin II system to increase vasodilation.

D.) Angiotensin II-receptor blockers, such as losartan potassium (Cozaar), block the renin-angiotensin II system to decrease vasoconstriction and allow for increased myocardial output.

A patient is taking digoxin (Lanoxin) for atrial fibrillation. Which of the following assessment findings would indicate that the digoxin should be held and the health care provider should be notified? A.) respiratory rate of 20 breaths/min B.) pulse rate of 80 beats/min C.) respiratory rate of 12 breaths/min D.) pulse rate of 52 beats/min

D.) Digoxin (Lanoxin) decreases the heart rate to increase myocardial contractility and output. If the patient's heart rate is less than 60 beats/min, the digoxin should be withheld, and the health care provider should be notified due to potential toxicity.

A patient is admitted to the emergency department with uncontrolled shortness of breath and is diagnosed with acute heart failure. The patient is given nesiritide (Natrecor), 140 mcg by IV bolus. Which of the following symptoms would result in the discontinuation of nesiritide? A.) bradycardia B.) tachycardia C.) hypertension D.) hypotension

D.) The development of hypotension (systolic blood pressure less than 90 mm/Hg) necessitates discontinuation of nesiritide (Natrecor).