Pharm test 3 (ONE MINUTE NURSE)

A patient is prescribed a beta-blocker. What must be assessed prior to administration of the medication?

heart rate and blood pressure. -Beta-blockers can decrease heart rate and blood pressure, so it's important to know both parameters to ensure the medication is safe to administer and to monitor for any adverse effects.

Which blood pressure reading is considered hypotensive?

86/42 mm Hg 86/42 mm Hg is the lowest of these readings and considered hypotensive. Any blood pressure below 90/60 mm Hg is considered hypotensive

Which is not a cause of hypotension?

Activation of the sympathetic nervous system Activating the sympathetic nervous system would increase blood pressure and heart rate rather than decreasing blood pressure. A vagal response, shock, and hypovolemia would all cause low blood pressure.

Which finding is not an adverse effect of nitroglycerin?

Constipation Constipation is not a known adverse effect of nitroglycerin. However, hypotension, headache, and weakness are all adverse effects associated with it

A patient is prescribed captopril. About what adverse effect should the nurse educate the patient?

Angioedema -The patient taking an angiotensin-converting-enzyme (ACE) inhibitor should be educated about the adverse effect of angioedema, a swelling of the lips and tongue.

An emergency department nurse is admitting four patients. Which patient is a candidate for immediate percutaneous coronary intervention (PCI)?

A patient with a STEMI who reports severe left arm pain. Rationale: A STEMI is a medical emergency and needs emergent PCI.

What is the drug of choice to treat supraventricular tachycardia (SVT)?

Adenosine The goal for treating SVT is to break or slow down the heart rate; adenosine will accomplish this. Atenolol is a beta blocker, amlodipine is a calcium channel blocker, and atropine is indicated for bradycardia.

A patient is diagnosed with hypovolemic shock. What does the nurse anticipate being included in the plan of care

Administration of blood products and intravenous fluids Hypovolemic shock requires blood products and/or fluids. Antibiotics are indicated for septic shock, and vitamin K and protamine sulfate are antidotes for warfarin and heparin. They will not help unless anticoagulants are the cause.

A patient has been diagnosed with atrial fibrillation. What class of medications is expected to be prescribed?

Anticoagulants Anticoagulants are expected to be prescribed for a patient with atrial fibrillation to prevent blood pooling in the ventricles and causing clots, which can lead to pulmonary embolism or stroke. Anticholinergics, proton pump inhibitors and histamine blockers are indicated for gastroesophageal reflux disease.

What is the initial treatment for a patient experiencing myocardial infarction (MI)?

Aspirin, oxygen, morphine, nitroglycerin The initial treatment for MI can be recalled with the use of the mnemonic MONA: morphine, oxygen, nitroglycerin, and aspirin.

What is happening in the compensatory stage of shock?

Blood is being shunted to vital organs to maintain nearly normal vital signs. During the compensatory stage of shock, the sympathetic nervous system is stimulated, and the body experiences the fight-or-flight response. The body shunts blood to vital organs, including the heart, brain, and lungs. Blood pressure and heart rate may be normal or show subtle changes. Organs fail during the irreversible stage. The heart is unable to meet oxygen demands during the progressive stage. The patient is asymptomatic with basic cellular changes during the initial stage.

Which are anticipated vital signs for a patient with neurogenic shock?

Blood pressure 74/42 mm Hg and heart rate 48 bpm A patient in neurogenic shock is expected to be hypotensive and hypovolemic due to the unopposed parasympathetic nervous system. Their blood pressure would be low, as in a reading of 74/42 mm Hg, and their heart rate would also be low, as in a reading of 48 bpm.

What condition indicates the need to administer nitroglycerin?

Chest pain Chest pain is an indication that there is a lack of oxygen in the coronary arteries. Nitroglycerin is administered to dilate the vessels to promote better blood flow. It is not indicated for headache, dizziness, or palpitations.

A patient has a baseline blood pressure of 86/42 mm Hg and is resting comfortably in their room talking on their phone. Their current blood pressure is 84/42 mm Hg. What is the nurse's best course of action?

Continue to monitor the patient. -This patient is comfortable, not in distress, and has a blood pressure consistent with their baseline. Although this patient is hypotensive, they are stable, and the most appropriate action is continuing to monitor them.

What is the main cause of myocardial infarction (MI)?

Coronary artery disease Rationale: Coronary artery disease is the primary cause of MI. Vasospasm, cocaine injection, and severe anemia may also cause MI.

What is the priority intervention for a patient in ventricular fibrillation?

Defibrillation Think "V-fib = defib." Cardioversion is done when the patient is unstable with a pulse. Action is required for ventricular fibrillation beyond monitoring. Notifying the family is not the priority.

Which is a symptom of hypotension?

Dizziness Dizziness from not getting enough blood to the brain is a symptom of low blood pressure. Increased energy, polyuria, and dilated pupils are not symptoms associated with hypotension

A patient is diagnosed with cardiogenic shock. Which medication will the RN expect to be prescribed?

Dobutamine Dobutamine is a medication used to improve contractility and is the drug of choice for cardiogenic shock. Dopamine, desmopressin, and diazepam are not indicated for improving contractility.

What is the first intervention when working with a patient who is hypotensive?

Ensure the patient is safe. Ensuring safety is the first priority since hypotension can put a patient at risk for falls. The nurse should make sure the patient is lying down and out of harm's way before proceeding with other interventions

What is not a symptom of myocardial infarction (MI)?

Headache Headache is not a symptom of MI. Chest pain that occurs suddenly and continues despite rest and medication is the primary symptom of MI. Shortness of breath, indigestion, nausea, and anxiety are additional symptoms of MI.

What is the preferred route to administer epinephrine during anaphylactic shock?

Intramuscularly Epinephrine is given intramuscularly during anaphylactic shock. It is given intravenously when the patient does not have a pulse. It is never given orally or subcutaneously.

How does nitroglycerin work?

It vasodilates veins, arteries, and capillaries. Nitroglycerin is a potent vasodilator that improves blood flow within the heart. It does not constrict blood vessels or increase contractility and metabolic demand

A patient is receiving nitroglycerin sublingually. How should the nurse instruct the patient to take this medication?

Let the pill dissolve under the tongue Medications given sublingually should be dissolved under the tongue for best absorption. Swallowing and chewing the pill or mixing it in juice could interfere with absorption

Which are causes of bradycardia? Select all that apply.

Sleeping, Vagal nerve stimulation, Spinal cord injury Causes of bradycardia include sleeping, vagal nerve stimulation, and spinal cord injury. Infection and fever typically cause tachycardia.

A nurse is administering nitroglycerin to a patient. What is the priority intervention?

Stay with the patient It is important to stay with the patient to frequently monitor their vital signs and ensure safety. Monitoring vital signs every 15 minutes is too infrequent. There is no indication to send the patient to the cardiac catheterization lab, and incentive spirometry is not a priority for this patient.

What is the best way to treat sinus tachycardia?

Treat the underlying cause. Rationale: The best way to treat sinus tachycardia is to treat the underlying cause. Beta blockers may be needed to do this and deep breathing could help, but addressing the underlying cause will solve the problem. Cardioversion is not indicated for sinus tachycardia.

The provider has given the patient a new prescription for losartan. Which current medication order would cause the nurse to question the new order for losartan?

lisinopril 10 mg PO daily -Both losartan and lisinopril are medications that can lower blood pressure and belong to the same class of antihypertensives (losartan is an angiotensin II receptor blocker and lisinopril is an ACE inhibitor). Administering them together may increase the risk of hypotension and other adverse effects.

A patient is prescribed propranolol. Other than hypertension, for what condition might this patient be taking the medication?

migraines -Propranolol is often used as a preventive treatment for migraine headaches. It can also be used for anxiety, particularly performance anxiety, but its primary non-hypertensive indication is migraine prevention.

A patient is due to receive a dose of verapamil. Their heart rate is 98 beats per minute, and their blood pressure two hours ago was 95/46 mmHg. What is the nurse's best action?

obtain the current blood pressure. -Verapamil is a calcium channel blocker that can lower blood pressure, and with the patient already having a low blood pressure reading, it's important to assess their current status before administering the medication. This will help ensure patient safety and allow for appropriate clinical decision-making. After obtaining the blood pressure, the nurse can then determine the next steps, including whether to notify the provider.

Which cardiac enzyme is the most cardiac specific?

troponin Rationale: Troponin is the most cardiac-specific enzyme. Creatine kinase is used to differentiate unstable angina from NSTEMI. Myoglobin levels will rise first but lack cardiac specificity. Lactate results from acidosis and would be elevated in severe cardiogenic shock but not with myocardial infarction.