Pharmacology - Cardiovascular

The nurse is reviewing the health care provider's prescription sheet for the preoperative client, which states that the client must be on nothing by mouth (NPO) status after midnight. The nurse would clarify whether which medication would be given to the client rather than withheld?

Atenolol

The client has been prescribed nifedipine. The nurse is instructing the client about nifedipine. Which client statement indicates a need for further teaching?

"If I see empty tab shells in my stool, I need to report it to my doctor."

A client recently began medication therapy with propranolol. The nurse would be most concerned after noting the presence of which effect in this client?

Audible expiratory wheezes

A client is scheduled to receive digoxin 0.125 mg by mouth. The licensed practical nurse (LPN) reads the medication label and notes that each tablet contains 0.25 mg. The LPN would perform which action?

Administer half of a medication tablet.

A client with a history of hypertension has been prescribed triamterene. The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit?

Bananas

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse would plan to monitor the client for hypokalemia as a side effect of therapy if the client is receiving which medication?

Bumetanide

The nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride is prescribed for the child. The nurse determines that this medication has been prescribed to achieve which result?

Control hypertension.

A client has arrived at the emergency department complaining of weakness, an irregular heartbeat, and lethargy. The nurse is attempting to discover what caused these symptoms. The nurse asks the client "Have you been prescribed any new medications?" The client tells the nurse "About 2 weeks ago I was prescribed a drug to make me pee, but I don't know the name." The nurse determines that the client is referring to which medication?

Furosemide

A child with a right-to-left cardiac shunt is receiving propranolol. The health care provider visits the child and writes prescriptions in the child's record. The licensed practical nurse (LPN) reviews the prescriptions and notes that the child is placed on a nothing-by-mouth (NPO) status. The LPN consults with the registered nurse and prepares to monitor which parameter closely?

Glucose level

The nurse has a prescription to give a client a scheduled dose of digoxin. Before administering the medication, the nurse routinely screens for which signs/symptoms that could indicate early signs of digoxin toxicity?

Loss of appetite, nausea, and vomiting

Warfarin sodium is prescribed for a client. The nurse expects that the primary health care provider will prescribe which laboratory tests to monitor for a therapeutic effect of the medication? Select all that apply.

Prothrombin time (PT) International normalized ratio (INR)

A physician tells the nurse that a potassium-retaining diuretic is being prescribed for the client with heart failure. The nurse reviews the health care physician's prescriptions expecting that which medication will be prescribed?

Spironolactone

The nurse is caring for a client who is taking metoprolol. The nurse measures the client's blood pressure (BP) and apical pulse immediately before administration. The client's BP is 122/78 mm Hg and the apical pulse is 58 beats per minute. Based on this data, which is the appropriate action?

Withhold the medication.

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as characteristic of which description?

Within the therapeutic range The normal aPTT varies between 20 and 36 seconds depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. Thus, the client's aPTT is within the therapeutic range, and the dose should remain unchanged.

The nurse is planning to administer hydrochlorothiazide to a client. Which are concerns related to the administration of this medication?

Hypokalemia, hyperglycemia, sulfa allergy

The nurse is reinforcing medication instructions to a client who has been prescribed simvastatin. Which is the action of simvastatin?

It inhibits hepatic synthesis of cholesterol.

The nurse is preparing a list of client care activities to be done during the shift. For which of the following clients would the nurse instruct the assistive personnel (AP) to use an electric razor for shaving? Select all that apply.

A client with thrombocytopenia A client receiving an antiplatelet medication

The nurse is monitoring a client receiving spironolactone by mouth daily. Which data would indicate to the nurse that the client is experiencing a side effect related to the medication?

A potassium level of 5.2 mEq/L

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noting which signs and symptoms? Select all that apply.

Visual disturbances Nausea and vomiting Serum digoxin level of 2.3 ng/mL (2.93 nmol/L)

A client with angina pectoris has just been started on medication therapy with nitroglycerin. In planning care for this client, the nurse would place priority on measuring which data?

Vital signs

The nurse notes that a client in a long-term care facility is receiving a daily dose of furosemide. The nurse writes in the care plan to monitor which parameter on a daily basis?

Weight

The nurse has completed client teaching about heart failure and prescribed medications that include digoxin and furosemide. The nurse documents that the teaching goals have been met if the client states knowing to report which symptom?

Weight gain of 2 to 3 pounds in a few days

A primary health care provider (PHCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to do which?

Withhold the medication and call the PHCP if the pulse is less than 60 beats per minute.

A child is being sent home on digoxin after being diagnosed with a congenital heart defect. The medication needs to be given once a day. Which would the nurse reinforce in the teaching plan for the family?

"Give the medication in the morning 20 to 30 minutes before a feeding."

The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril orally daily. The nurse evaluates the need for further teaching when the client makes which statement?

"I can skip a dose once a week."

The nurse has reinforced instructions to a client receiving enalapril maleate. Which statement by the client indicates a need for further teaching?

"I need to notify the primary health care provider if nausea occurs."

A client receiving total parenteral nutrition (TPN) has a history of heart failure. The primary health care provider has prescribed furosemide 40 mg orally daily to prevent fluid overload. The nurse is giving instructions about taking furosemide in relation to the client's health plan. Which statement by the client indicates a need for further teaching?

"I need to talk to my doctor about increasing my digoxin."

A client is being discharged following treatment for left-sided heart failure. The nurse is reinforcing teaching the client the purpose, actions, adverse effects, and use of digoxin and hydrochlorothiazide prescribed for daily use. Which statement by the client indicates a need for further teaching?

"I should decrease my intake of foods high in potassium such as bananas."

Thrombolytic therapy was administered to a client following an acute inferior myocardial infarction. The nurse giving discharge instructions to the client evaluates a need for further teaching when the client makes which statement?

"I will apply pressure for 10 minutes for minor bleeding."

A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication?

Acetylsalicylic acid

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level?

Activated partial thromboplastin time (aPTT) of 55 seconds

The nurse prepares to administer digoxin to a 3-year-old with a diagnosis of heart failure and notes that the apical heart rate is 120 beats per minute. Which nursing action is appropriate?

Administer the digoxin.

The nurse is caring for a client with chronic heart failure who is taking digoxin 0.125 mg daily. Before administering the medication, the nurse reviews the serum digoxin level that was drawn earlier in the day. The result is 1 ng/mL. Which action would the nurse take based on this laboratory result?

Administer the dose of the medication as scheduled.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium. The nurse is told that the client's prothrombin time is 18 seconds with a control of 11 seconds. Which action would the nurse plan?

Administer the next dose of warfarin sodium.

The nurse is caring for a hospitalized client with a mechanical heart valve who is receiving maintenance therapy of warfarin sodium. The client's international normalized ratio (INR) is 3. The nurse anticipates which prescription?

Administering the next dose of warfarin sodium

The nurse is reinforcing dietary instructions to a client who is taking triamterene. The nurse instructs the client that it is acceptable to consume which food item daily?

Apple

A potassium-retaining diuretic is prescribed for a client with heart failure. Which foods would the nurse instruct the client to avoid?

Bananas

A client has been given a prescription for gemfibrozil. The nurse plans to instruct the client to limit intake of which food while taking this medication?

Beef

A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is most important for the nurse to check before administering a second dose of the medication?

Blood pressure

The nurse is caring for a client who is receiving hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameters?

Blood pressure

A client is being treated for heart failure and is receiving digoxin. The client's vital signs are blood pressure 85/50 mm Hg, pulse 96 beats per minute, and respirations 26 breaths per minute. To evaluate therapeutic effectiveness of this medication, the nurse would expect which change in the client's vital signs?

Blood pressure 98/60 mm Hg, pulse 80 beats per minute, respirations 24 breaths per minute

The nurse is planning to administer amlodipine to a client. The nurse would plan to check which before giving the medication?

Blood pressure and heart rate

The nurse is assisting in monitoring a client who received hydralazine hydrochloride to treat autonomic dysreflexia. Which finding accurately indicates that the medication is effective?

Blood pressure declines.

A client is diagnosed with pulmonary embolism and is to be treated with thrombolytic therapy. The nurse would report which priority data collection finding to the registered nurse before initiating this therapy?

Blood pressure of 198/110 mm Hg

A pediatric client with a ventricular septal defect repair is placed on a maintenance dose of digoxin. The safe dose is 0.03 mg/kg/day, and the client's weight is 7.2 kg. The primary health care provider (PHCP) prescribes the digoxin to be given twice daily. How much digoxin would the nurse administer to the client at each dose?

Calculate the dosage by weight first; therefore, 0.03 mg/day × 7.2 kg = 0.21 mg/day. Next, note that the PHCP prescribes digoxin to be given twice daily; therefore, 2 doses in 24 hours will be administered, and 0.21 mg/day divided by 2 doses = 0.1 mg for each dose.

A client returning to the medical nursing unit following cardiac catheterization has a stat prescription to receive a dose of procainamide. The licensed practical nurse assisting in caring for the client obtains which piece of equipment to adequately determine the client's response to this medication?

Cardiac monitor

Atenolol hydrochloride is prescribed for a hospitalized client. The nurse would perform which as a priority action before administering the medication?

Check the client's blood pressure.

A hospitalized client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions would the nurse take? Select all that apply.

Check the client's pain level. Check the client's blood pressure. Administer a second nitroglycerin, 0.4 mg, sublingually.

A client with heart failure who is taking furosemide and digoxin calls the nurse and complains of anorexia and nausea. The nurse would take which action?

Check the result of the potassium level drawn 3 hours ago.

The nurse is reinforcing dietary instructions to a client who is taking spironolactone. The nurse instructs the client to avoid which food in the daily diet?

Citrus fruits

A client is being treated with atenolol for hypertension. The client tells the nurse, "I am very tired and weak since I began taking the medication." Based on the client's statement, the nurse determines that the client is experiencing which problem?

Common side effect

The nurse instructs a client at risk for hypokalemia from thiazide diuretic therapy about foods that are high in potassium. The nurse determines that there is a need for further teaching if the client states that which foods are high in potassium and should be included in the diet plan? Select all that apply.

Eggs White bread with butter

A client taking an aldosterone antagonist known as eplerenone for hypertension asks about side effects of this medication. The nurse tells the client that which sign/symptom is a side effect?

Elevated potassium level

A client arrives at the health care clinic for follow-up care and evaluation of the effectiveness of prazosin. Which finding indicates a therapeutic effect related to the use of this medication?

Decrease in blood pressure

A client has taken his first dose of lisinopril about 2 hours ago and begins to develop fullness in his face and hoarseness. Which action would the nurse take first?

Determine the client's ability to breathe effectively.

The nurse is preparing to administer digoxin to an infant with heart failure (HF). Before administering the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute, and obtains a rate of 88 beats per minute. Based on this finding, which is the appropriate nursing action?

Digoxin is effective within a narrow therapeutic range (0.5 to 2 ng/mL). Safety in dosing is achieved by double-checking the dose and counting the apical heart rate for 1 full minute. If the heart rate is less than 100 beats per minute in an infant, the nurse should withhold the dose and notify the registered nurse and primary health care provider. The remaining options are incorrect actions.

The nurse notes that a client is being treated with nesiritide. The nurse would expect this client to be experiencing which disorder?

Heart failure

A hospitalized client with angina continues to have chest pain after the initial administration of a sublingual nitroglycerin tablet. The nurse would take which action?

Provide a second sublingual dose in 5 minutes.

Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The parent of the child asks the nurse why the child needs the medication. The nurse correctly responds that the purpose of this medication is which explanation?

Provides adequate oxygen saturation and maintains cardiac output

The nurse reinforces dietary instructions to a client who will be taking warfarin sodium. The nurse tells the client to avoid which food item?

Spinach

A client who was recently prescribed warfarin is being instructed on diet changes necessary with this medication. The client reports enjoying all of these food items. Which items would the nurse instruct the client to limit consuming? Select all that apply.

Spinach salad Mustard greens

A client who takes a diuretic every evening expresses frustration with the medication and wants to stop therapy. When the nurse explores the reasoning, the client says, "It keeps me up all night. I feel as though I should bring my pillow into the bathroom!" Which action can the nurse suggest to assist the client in successfully adapting to this therapy?

Switching to a morning administration of the medication

Isosorbide mononitrate is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action would the nurse suggest to the client?

Take the medication with food.

A client is being treated for moderate hypertension and has been taking diltiazem for several months. The client is seen by the primary health care provider, and Prinzmetal's angina is diagnosed. The nurse is instructing the client about diltiazem. Which client statement indicates a need for further teaching?

"I have to limit my coffee, but I can drink all the fruit juice I want."

A client is being discharged home, and the health care provider has prescribed spironolactone for the client. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching by the nurse?

"I know I need to eat foods that are high in potassium because of the diuretic effect of the medication."

Warfarin sodium has been prescribed for a client, and the nurse teaches the client and family about the medication. Which statement by the client indicates a need for further teaching?

"I will not take any over-the-counter medications except aspirin."

A client with chronic atrial fibrillation is being started on amiodarone as maintenance therapy for dysrhythmia suppression. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching?

"I will stop taking the prescribed anticoagulant after starting this new medication."

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium. Which statement made by the client reflects the need for further teaching?

"I will take enteric-coated aspirin for my headaches because it is coated."

A client with heart failure is being discharged to home and will be taking furosemide. The nurse determines that teaching has been effective if the client makes which statement?

"I will weigh myself every day."

A client is taking nicotinic acid for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions?

"Ibuprofen taken 30 minutes before the nicotinic acid should decrease the flushing."

Nifedipine has been prescribed for a client with Raynaud's disease, and the nurse reinforces medication instructions with the client about the medication. Which statement by the client indicates a need for further teaching?

"Nausea and drowsiness are expected, and if they occur, I don't really need to worry about it."

The nurse is reinforcing discharge teaching to a client who was given a prescription for nifedipine for blood pressure management. Which instructions would the nurse reinforce? Select all that apply.

"Take pulse rate each day." "Weigh at the same time each day." "Palpitations may occur early in therapy." "Be careful when rising from sitting to standing."

The nurse is monitoring a client receiving furosemide 40 mg orally daily. Which indicator would inform the nurse that a therapeutic effect has occurred?

A blood pressure of 128/80 mm Hg

A client reports to the clinic for follow-up after a 1-month treatment with acebutolol. The nurse determines that a therapeutic effect of the medication has occurred if which response is noted?

A blood pressure of 130/84 mm Hg

The nurse is reviewing laboratory results of a digoxin level for the client taking digoxin. The digoxin level is 2.5 ng/mL, which indicates digoxin toxicity. Which signs and symptoms would the nurse note? Select all that apply.

Nausea Syncope Bradycardia

Clients who are given a prescription for sildenafil should be taught that a potentially fatal medication interaction can occur with which medication?

Nitroglycerin

The nurse is preparing to administer digoxin, 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?

Heart rate

A client with chronic atrial fibrillation is being started on maintenance therapy with atenolol for dysrhythmia suppression. The nurse determines that the client needs further teaching about this medication when making which statement?

I can stop taking the prescribed digoxin after starting this new medication."

A client who has begun taking fosinopril is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. Which suggestion would provide the best support for the client?

Inform the client that impaired taste is expected and generally disappears in 2 to 3 months.

A client takes digoxin 0.25 mg by prescription every day. When the nurse enters the client's room with the medication, the client's meal tray is untouched and the client says he has no appetite. Which action is the most appropriate?

Listen to the client's apical pulse. If it is less than 60 beats per minute, withhold the medication.

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia?

Low blood glucose level

A client is being discharged with a prescription for propranolol. When reinforcing instructions to the client about the medication, the nurse would include which information?

Medication should be withheld if the pulse rate drops below 60 beats per minute.

The nurse is assisting in preparing a plan of care for a client who will be receiving a calcium antagonist to prevent preterm delivery. Which action does the nurse include in the plan of care for the client to detect a side effect of the medication?

Monitor for increases in maternal and fetal heart rates.

A hospitalized client states he has chest pain, and the nurse notes a prescription for "sublingual nitroglycerin 1 tablet every 5 minutes times 3 to relieve chest pain prn." How would the nurse administer the medication?

Place one pill under the tongue and reassess for relief in 5 minutes.

A registered nurse (RN) asks a licensed practical nurse (LPN) to obtain a vial of mannitol for administration to a client. The LPN notes that the vial contains a few small crystals. Based on this observation, which would the LPN expect the RN to do?

Place the vial in warm water until the crystals dissolve.

The nurse is reinforcing instructions to a client with essential hypertension about medication therapy with irbesartan. Which client statement would indicate a need for further teaching?

"The medication reduces my need for exercise."

A client with aldosteronism has been instructed on spironolactone treatment. Which client statement indicates that the client needs further teaching about the medication?

"This medication will decrease my blood glucose."

A client is experiencing impotence after taking an antihypertensive medication. The client states, "I would sooner have a stroke than keep living with the side effects of this medication." The nurse would make which appropriate response to the client?

"You are concerned about the side effects of your medication?"

A client is being treated for acute heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats per minute; and respirations, 24 breaths per minute. After the initial dose, which is the priority assessment?

Monitoring blood pressure

The nurse is discharging a client from the hospital who was given a prescription for atorvastatin. The nurse would tell the client to report which adverse effect to the primary health care provider immediately?

Muscle pain and weakness

The nurse is preparing to administer furosemide to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to review before administering this medication?

Potassium level

The nurse is assisting in developing a plan of care for a client receiving warfarin sodium. The nurse selects which problem as the priority in caring for this client?

Potential for injury

A client is receiving heparin sodium by continuous intravenous (IV) infusion. The licensed practical nurse (LPN) is concerned that the client received a bolus of medication when the tubing was removed from the IV pump during a gown change. The LPN immediately notifies the registered nurse or primary health care provider and then checks to see whether which medication is available in the medication supply area in case it is prescribed?

Protamine sulfate

Enoxaparin sodium is prescribed for the client following hip replacement surgery. The nurse prepares to have which available in the event that an overdose of the medication occurs?

Protamine sulfate

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

Protamine sulfate

The nurse is asked to assist in preparing a heparin sodium infusion for a client with a diagnosis of thrombophlebitis. Which items would the nurse have available for this procedure? Select all that apply.

Protamine sulfate Intravenous tubing Intravenous infusion controller Intravenous insertion equipment

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?

Monitor for signs of bleeding.

The nurse is attending an in-service education session on the therapeutic use of calcium-channel blockers. The instructor of the session determines that teaching has been effective when the nurse correctly identifies that these medications are used for which disorders? Select all that apply.

Angina Hypertension Dysrhythmias

The nurse is caring for a client receiving digoxin. The nurse monitors the client for which early manifestation of digoxin toxicity?

Anorexia

The nurse is preparing to administer digoxin to an adult client. The nurse checks which important item before administering the medication?

Apical pulse rate

The nurse is assisting in preparing a diet plan for a client who is taking the anticoagulant, warfarin. The nurse instructs the client to limit which food from the diet?

Broccoli

The nurse is collecting data from a client with hypertension being treated with diuretic therapy. The nurse would monitor the client for hypokalemia if the client is receiving which diuretic?

Bumetanide

A client with angina pectoris who was given a first dose of newly prescribed nitroglycerin sublingual tablets complains of slight dizziness and headache. The nurse takes which action first?

Takes the client's blood pressure.

A client with no history of heart disease has experienced an acute myocardial infarction and been given thrombolytic therapy with tissue plasminogen activator (tPA). The nurse interprets that the client is likely experiencing a complication of this therapy if which occurs?

Tarry stools

A 1-year-old child has been prescribed digoxin to treat heart failure (HF). When would the nurse plan on withholding the prescribed dose of the medication?

The child's pulse is less than 80 beats per minute.

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol?

The development of audible expiratory wheezes

The nurse is scheduled to administer a dose of digoxin to a client with atrial fibrillation. The client has a potassium level of 4.6 mEq/L. Which would be the nurse's next action?

The dose should be administered as prescribed.

A client taking an angiotensin-converting enzyme (ACE) inhibitor reviewed the medication information sheet and notes that the medication is used to treat hypertension. He states, "I have heart failure. Why am I taking this medicine?" The nurse responds by making which statement?

The medication prescriptions."2"The medication causes relaxation in your arteries and veins and decreases the heart's work."

The nurse is reviewing the postoperative prescriptions for a client who has just returned from surgery and notes that the surgeon has prescribed lepirudin. Which is this medication prescribed to prevent?

Thromboembolic complications

The nurse is caring for a client who has been prescribed furosemide and is monitoring for adverse effects associated with this medication. Which would the nurse recognize as potential adverse effects? Select all that apply.

Tinnitus Hypotension Hypokalemia

The nurse is reviewing the primary health care provider's (PHCP) prescriptions for a client scheduled for a cardiac catheterization and notes that the PHCP has prescribed tirofiban. The nurse understands that this medication has been prescribed for which purpose?

To inhibit thrombus formation

A client who is taking hydrochlorothiazide has also been prescribed triamterene. The client asks the nurse why both medications are required. Which response is the most accurate to give to the client?

Triamterene is a potassium-retaining (sparing) diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic.