adaptive quizzing 22, 23, 24, 25

A patient has been started on oral quinidine 324 mg every 6 hours. The patient calls the clinic and tells the nurse that he has had a lot of "ringing" in his ears. What is the nurse's best response? 1 "Earplugs are helpful at night." 2 "Take half a tablet every 6 hours." 3 "Stop the medication immediately." 4 "I'll talk to the prescriber right away."

"I'll talk to the prescriber right away."

A patient taking is taking an alpha1 blocker. What assessment finding indicates a therapeutic effect to this medication therapy? 1 Increased heart rate 2 Increased urinary output 3 Increased blood pressure 4 Increased respiratory rate

Correct2 Increased urinary output Alpha1 blockers should increase urinary flow rates and increase urinary output. They should also decrease blood pressure. They should not increase respiratory rate or heart rate.

An intravenous bolus dose of diltiazem 0.25 mg/kg over 2 minutes is ordered for a patient in the cardiac intensive care unit. Diltiazem is available in a 25-mg vial 5 mg/mL. The patient weighs 168 pounds. How many milliliters will the nurse administer? Round the final answer to the nearest tenths. _____ mL

Correct Answer Feedback 168 / 2.2 = 76.36kg 76.36 × 0.25 mg = 19.09mg mg----------- × mL = 3.8 mL 5 mg

The health care provider discontinues a patient's quinidine and prescribes procainamide. The patient asks the nurse about the possible side effects of this medication. What is the nurse's best response? 1 "Take this medication with food to relieve an upset stomach." 2 "Use over-the-counter steroid cream if a red, swollen rash occurs." 3 "Taking an antacid with this medication will relieve digestive problems." 4 "Diphenhydramine can be taken with the medication if you develop a rash or breathing problems."

Correct1 "Take this medication with food to relieve an upset stomach." All antidysrhythmics can be taken with food to relieve an upset stomach. The patient should be instructed to notify the prescriber if any type of rash or breathing problems develop. These may be signs of hypersensitivity or a systemic lupus erythematous-like syndrome that can develop in about 30% of patients taking procainamide long term. If the patients develops a rash, it should be reported to the prescriber versus recommending taking diphenhydramine. Antacids should be taken 2 hours before or 2 hours after taking antidysrhythmic drugs to avoid interfering with drug absorption.

The nurse is caring for a patient who is taking the drug amiodarone. The patient has also been on a treatment regimen that includes digoxin. Based on this information, the nurse knows to monitor the patient closely for evidence of which response? 1 AV block 2 Bradycardia 3 Prolonged QT interval 4 Decreased digoxin levels

Correct1 AV block The interaction of amiodarone and digoxin can result in AV block. The interaction of sotalol and amiodarone is known to cause bradycardia. A prolonged QT interval is an effect of amiodarone and other drugs such as antifungals and quinidine, not digoxin. Amiodarone and digoxin can lead to and increase in digoxin levels by 50 percent.

Which food selection would be an inappropriate choice for a patient undergoing treatment with an antidysrhythmic drug? 1 Chef salad 2 Bacon and eggs 3 Turkey sandwich 4 Hamburger with onions

Correct1 Chef salad The patient who is being treated with these medications should maintain a well-balanced diet and avoid consuming an excessive amount of alkaline ash foods such as citrus fruits, vegetables, and milk.

A patient has been prescribed amiodarone. What topic(s) should the nurse include when teaching the patient about this medication? Select all that apply. 1 GI upset 2 Sunscreen use 3 High-fiber diet 4 Decreased fluid intake 5 Photophobia and wearing sunglasses

Correct1 GI upset Correct2 Sunscreen use Correct3 High-fiber diet Correct5 Photophobia and wearing sunglasses Amiodarone may lead to gastrointestinal upset, which may be prevented or decreased by taking the drug with food or a snack. Photosensitivity (sunburn and other exaggerated skin reactions to the sunlight) and photophobia (light sensitivity) are other concerns with this drug. With photosensitivity, protective clothing/hat and sunscreen are needed. Emphasize protection of the eyes with wearing of sunglasses and/or tinted contact lenses to patients taking this medication. Recommend consumption of a high-fiber diet and forcing of fluids to minimize the constipation that is a common adverse effect of antidysrhythmic drugs.

Which medication acts by blocking sodium channels, accelerating repolarization, and decreasing the duration of the action potential? 1 Lidocaine 2 Verapamil 3 Propafenone 4 Dronedarone

Correct1 Lidocaine Lidocaine acts by blocking the sodium channels, accelerating repolarization, and decreasing the action potential duration. Verapamil is a calcium channel blocker, which works by inhibiting the calcium channels, resulting in a shortening of the action potential. Verapamil delays repolarization. Propafenone also acts by blocking sodium channels but has little effect on repolarization or action potential duration. Dronedarone increases the action potential duration by prolonging repolarization in phase 3.

A patient is prescribed a nonselective beta blocker. What nursing intervention is a priority for this patient? 1 Respiratory assessment 2 Assessment of blood glucose levels 3 Teaching about potential tachycardia 4 Orthostatic blood pressure assessment

Correct1 Respiratory assessment Nonselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and orthostatic blood pressure and teaching about tachycardia will not be priorities.

Which medication increases the duration of the action potential by prolonging repolarization in phase 3? 1 Sotalol 2 Verapamil 3 Flecainide 4 Adenosine

Correct1 Sotalol Sotalol increases the action potential duration by prolonging repolarization in phase 3. It also has beta-blocking properties. Verapamil acts by blocking the calcium channels. Flecainide blocks the sodium channel but does not have a pronounced effect on the duration of the action potential or repolarization. Adenosine acts by several mechanisms and does not fall under one particular category.

The nurse is caring for a patient who is currently being treated with digoxin. The physician plans to begin treatment with amiodarone. The nurse anticipates that the interaction of the two drugs will require which dosage adjustment? 1 The dose of digoxin will be reduced by 50%. 2 The dose of digoxin will be increased by 50%. 3 The dose of amiodarone will be reduced by 50%. 4 The dose of amiodarone will be increased by 50%.

Correct1 The dose of digoxin will be reduced by 50% When amiodarone is started in patients who are already taking an antidysrhythmic drug, the dose of digoxin should be reduced by 50% to compensate for the interaction of the two medications. The digoxin level increases, not decreases, with amiodarone administration; therefore the dose should be reduced, not increased. Digoxin levels can be monitored; therefore dose adjustments are made to digoxin, not amiodarone.

A patient prescribed amiodarone reports nausea and vomiting, so the nurse administers antacids. When teaching the patient about taking these two medications together, which statement by the nurse is appropriate? 1 "These medications must both be taken with food." 2 "These medications should be taken at least 2 hours apart." 3 "These medications must both be taken on an empty stomach." 4 "Take the antacid 1 hour after taking the amiodarone with food."

Correct2 "These medications should be taken at least 2 hours apart." Amiodarone may cause nausea and vomiting and is often prescribed concurrently with an antacid. However, antacids may interfere with the absorption of amiodarone, reducing its effectiveness, so these medications should be spaced at least 2 hours apart. The two medications should not be taken with food, because this can interfere with the absorption of amiodarone. Taking the antacid 1 hour after amiodarone with food can also interfere with the absorption of amiodarone.

A nurse is caring for a patient who is prescribed procainamide. Which nursing action is the priority when providing care to the patient? 1 Monitoring for tachycardia 2 Measuring blood pressure regularly 3 Assessing for signs of thrombophlebitis 4 Asking the patient about any changes in vision

Correct2 Measuring blood pressure regularly A patient who is prescribed procainamide may develop hypotension; therefore, the nurse should measure the patient's blood pressure regularly to assess for this complication. Tachycardia is an adverse effect of propafenone. Thrombophlebitis is an adverse effect of phenytoin. A patient who is on flecainide might experience visual disturbances.

The nurse is caring for a patient who is being treated with amiodarone. The nurse notes that the patient is experiencing a hacking cough. What is the nurse's priority action? 1 Document the findings in the patient's chart. 2 Notify the physician regarding this symptom. 3 Administer medication to help the patient rest. 4 Administer the cough syrup that has been ordered.

Correct2 Notify the physician regarding this symptom The most serious adverse effect of this drug is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli. A hacking cough should be reported to the physician, not just documented as if it is an expected finding. The hacking cough could be a sign of a serious problem and should be addressed before administering any medication to help the patient rest. Cough syrup may mask an underlying problem if the cough is indicative of pulmonary toxicity,

The nurse is caring for a patient who is being treated with amiodarone. After the patient is on the medication for 6 weeks, lab work drawn on the patient shows evidence of hypothyroidism developing. What does the nurse interpret this information to mean? 1 This is indicative of a toxic dosage of the medication. 2 This is an expected adverse reaction to the medication. 3 This is indicative of an inadequate dosage of the medication. 4 The patient is developing an anaphylactic reaction to the medication.

Correct2 This is an expected adverse reaction to the medication. Hypothyroidism or hyperthyroidism may develop as a result of taking the medication because of its lipophilic nature and the use of iodine in its chemical structure. Hypothyroidism is an expected finding and is not indicative of toxicity or inadequate dosage. Signs of anaphylaxis usually appear quickly, not slowly over 6 weeks, and can manifest as wheezing, shortness of breath, and extreme difficulty breathing

A patient taking atenolol and amiodarone by mouth complains of not being able to complete his usual exercise routine. The patient attributes this complaint to the medication, because the atenolol is a new medication. What is the nurse's best response? 1 "Feeling tired is normal when you exercise a lot." 2 "As we age, exercising is a challenge, and fatigue is normal." 3 "You should report your fatigue to your health care provider." 4 "You should not be exercising at all while taking this medication."

Correct3 "You should report your fatigue to your health care provider." When beta blockers are used with an antidysrhythmic, any shortness of breath, weight gain, changes in baseline blood glucose levels, or excess fatigue must be reported to the prescriber immediately. The patient is complaining of excess fatigue in this case, because exercise is an activity he "usually" completes without complaint, as inferred from the patient's statement.

The nurse recognizes which drug as a Class III antidysrhythmic? 1 Atenolol 2 Lidocaine 3 Verapamil 4 Amiodarone

Correct4 Amiodarone Class III drugs, such as amiodarone, prolong repolarization in phase 3. Atenolol is a class II beta blocker that depresses phase 4 of depolarization. Lidocaine is a class I membrane-stabilizing antidysrhythmic. Verapamil is a Class IV calcium channel blocker that depresses phase 4 depolarization

The nurse is assessing patients who are prescribed acebutolol. A patient with which condition would benefit from the administration of digoxin? 1 Bradycardia 2 Hypotension 3 Bronchospasm 4 Cardiac failure

Correct4 Cardiac failure A patient who has cardiac failure due to acebutolol toxicity should be managed by digoxin because digoxin is a cardiac glycoside that improves the contractility of the heart. A patient who has hypotension is managed by administering vasopressors. A patient who has bradycardia should be managed by administering 1 to 3 mg of atropine. A patient who has bronchospasm is given beta2-adrenergic or theophylline medications to alleviate the toxic effects of acebutolol.

Which medication prolongs the effective refractory period? 1 Atenolol 2 Lidocaine 3 Propafenone 4 Procainamide

Correct4 Procainamide Procainamide prolongs the effective refractory period. Atenolol blocks beta-adrenergic cardiac stimulation. Lidocaine decreases myocardial excitability in the ventricles. Propafenone produces a dose-related depression of cardiac conduction, especially in the bundle of His/Purkinje system.

The nurse is caring for four patients who are on antidysrhythmic medications. Which patient should the nurse recognize as being at risk for developing a systemic lupus erythematosus (SLE)-like syndrome? 1 The patient who is taking quinidine. 2 The patient who is taking flecainide. 3 The patient who is taking amiodarone. 4 The patient who is taking procainamide.

Correct4 The patient who is taking procainamide. The patient who is taking procainamide might develop systemic lupus erythematosus (SLE)-like syndrome because of its anticholinergic effect. The patient who is taking quinidine might develop hypotension, QT prolongation, and anorexia. The patient who is taking flecainide might experience dizziness and visual disturbances. The patient who is taking amiodarone might experience bradycardia, hypotension, and visual disturbances.

Which patient does the nurse know will benefit most from a prescribed beta-adrenergic medication? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

Patient C is experiencing bradycardia as the result of amiodarone toxicity. A beta-adrenergic medication would alleviate the patient's bradycardia. Patient A is experiencing convulsions as the result of lidocaine toxicity, for which diazepam or thiopental is given. Patient B has a reduced heart rate caused by flecainide toxicity, and dopamine or dobutamine are used to manage it. Patient D is experiencing cardiac arrest caused by disopyramide toxicity, for which neostigmine is indicated. These patients would not benefit from the administration of a beta-adrenergic medication.

Which statement indicates that the patient understands teaching about the purpose of nitrate therapy for their angina? 1 "Nitrates dilate blood vessels." 2 "Nitrates have no adverse effects." 3 "Nitrates increase blood pressure." 4 "Nitrates slow conduction in the heart."

Correct1 "Nitrates dilate blood vessels. Nitrates dilate blood vessels and increase blood flow to the heart muscle. Nitrates have several potentially adverse effects. They do not increase blood pressure or slow conduction in the heart.

Which patient will benefit from the administration of a nitrate? 1 A patient with unstable angina 2 A patient with angina and hypotension 3 A patient with chest pain who has a history of severe anemia 4 A patient with a severe head injury who complains of chest pain

Correct1 A patient with unstable angina A patient with unstable angina will benefit from nitroglycerin therapy, because it decreases the intensity of angina pain. The vasodilatory effects of nitrates can worsen hypotension and head injury in a patient. Nitrates will compromise the already-reduced tissue oxygenation in patients with anemia due to hypotension.

Before the nurse administers isosorbide mononitrate, what is a priority nursing assessment? 1 Blood pressure 2 Serum electrolytes 3 Level of consciousness 4 Blood urea nitrogen and creatinine

Correct1 Blood pressure Isosorbide mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering it. Electrolytes, level of consciousness, and blood urea nitrogen and creatinine do not need to be assessed before the administration of isosorbide mononitrate.

A calcium channel blocker has been prescribed for a patient. Which condition in the patient's history is a contraindication to this medication? 1 Hypotension 2 Hypokalemia 3 Dysrhythmias 4 Increased intracranial pressure

Correct1 Hypotension Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension. They are not contraindicated for the patient with a history of hypokalemia, dysrhythmias, or increased intracranial pressure.

A patient is receiving nesiritide. Which symptoms would indicate an overdose? Select all that apply. 1 Insomnia 2 Dysrhythmia 3 Hypertension 4 Hyperglycemia 5 Abdominal pain

Correct1 Insomnia Correct2 Dysrhythmia Correct5 Abdominal pain Nesiritide is recombinant human B-type natriuretic peptide. Insomnia, dysrhythmia, and abdominal pain are adverse effects of nesiritide. The drug decreases blood pressure and causes hypotension. It does not cause hypertension. Nesiritide does not have any effect on blood glucose concentrations; therefore, it does not cause hyperglycemia.

A 100-mg IV bolus of lidocaine is prescribed for a patient experiencing ventricular dysrhythmias. Which available lidocaine medication should the nurse use to prepare this bolus? 1 Lidocaine vial of clear solution 2 Lidocaine 1% vial of light yellow solution 3 Lidocaine with epinephrine vial of clear solution 4 Lidocaine premixed in 50 mL of normal saline prepared within the past 48 hours

Correct1 Lidocaine vial of clear solution Lidocaine vials should contain clear solution labeled as cardiac or not for cardiac use. The plain solution is used for cardiac conditions. Lidocaine with epinephrine must never be used intravenously and is only to be used as a topical anesthetic. Parenteral solutions of these drugs are usually stable for only 24 hours.

The nurse knows that which structure in the heart is referred to as the "pacemaker"? 1 SA node 2 AV node 3 Bundle of His 4 Purkinje fibers

Correct1 SA node The SA node is the pacemaker because it can spontaneously depolarize faster and more easily than the other areas. After the pacemaker (SA node) triggers an electrical impulse, the electrical pulse travels through the AV node to the Bundle of His and purkinje fibers.

Which assessment finding in a patient receiving nitrate therapy requires immediate nursing intervention? 1 Headache 2 Severe anemia 3 Anginal episode 4 Ischemic heart disease

Correct2 Severe anemia If a patient with severe anemia is administered nitrates, the vasodilatory effects of the nitrates can worsen the anemia. Headache is a side effect of nitrates therapy. Nitrates will minimize the frequency of angina episodes in a patient with ischemic heart disease.

A patient has been receiving hydralazine. What findings indicate the patient is experiencing adverse effects of this medication therapy? Select all that apply. 1 The patient is constipated. 2 The patient complains of being dizzy. 3 The patient has a "pounding headache." 4 The patient has been vomiting and has diarrhea. 5 The patient is disoriented to person, place, and time. 6 The patient is having difficulty walking to the bathroom.

Correct2 The patient complains of being dizzy. Correct3 The patient has a "pounding headache." Correct4 The patient has been vomiting and has diarrhea. Adverse effects of hydralazine include dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, and rash. Constipation, disorientation, and difficulty walking are not reported side effects.

The nurse is administering amlodipine. What assessment finding requires immediate action? 1 Calcium level of 8 mEq/dL 2 Potassium level of 5 mEq/dL 3 Apical pulse of 100 beats/min 4 Blood pressure of 80/60 mm Hg

Correct4 Blood pressure of 80/60 mm Hg Amlodipine is the most common calcium channel blocker used for hypertension. Blood pressure that goes below 100 mm Hg should be reported to the health care provider immediately, and the medication should be held. The patient's calcium and potassium levels and apical pulse are within normal limits and do not require immediate action.

While reviewing the medical record of a patient who is receiving digoxin therapy, the nurse notes that the patient has atrial tachycardia and impaired renal function. Arrange the order of the nursing interventions for this patient. 1. Administer digoxin immune Fab as prescribed. 2. Administer potassium supplements as prescribed. 3. Monitor cardiac dysrhythmias by electrocardiograph. 4. Determine serum digoxin and electrolyte concentrations. 5. Discontinue administration of digoxin and notify the health care provider.

Atrial tachycardia indicates of digoxin toxicity, and impaired renal function may predispose patients to increased toxicity. The nurse should immediately discontinue administration of digoxin. Electrocardiograph monitoring should begin to check for cardiac dysrhythmias so an antidysrhythmic drug can be administered accordingly. Serum digoxin and electrolyte concentrations should be monitored to check whether there is an electrolyte imbalance, because digoxin toxicity reduces potassium and magnesium concentrations. Potassium supplements should be administered accordingly after checking the electrolyte balance. Digoxin immune Fab is an antidote for digoxin, so it should be administered after monitoring cardiac dysrhythmia and electrolyte balance.

What does the nurse instruct the patient to do for effective application of nitroglycerin ointment? 1 "Apply a line on the applicator paper in the amount prescribed." 2 "Apply the ointment to the skin and cover with the applicator paper." 3 "Using gloves, massage the ointment into the skin of your upper torso." 4 "Use gloved fingers to spread the ointment evenly over a 3-inch area on your lower torso."

Correct1 "Apply a line on the applicator paper in the amount prescribed." The ointment is applied onto the applicator paper in a line, in the amount prescribed, such as "1 inch." The paper can then be rubbed together to spread out the ointment, and it is applied on a nonhairy portion of the upper torso. The nurse should wear gloves when applying the ointment to prevent absorption of the drug into the skin. The ointment is measured as one thin line on the nitroglycerin applicator and is gently spread over the paper and applied to, but not rubbed into, the skin. The medication should not be rubbed in.

Which statement by a patient about nitroglycerin indicates effective learning? 1 "I will keep the nitroglycerin stored in the original container." 2 "I will refill my prescription once a year to maintain potency." 3 "I will take a nitroglycerin tablet 2 hours before I engage in physical activity." 4 "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone."

Correct1 "I will keep the nitroglycerin stored in the original container." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. The prescription should be refilled or replaced every 3 to 6 months to maintain potency. Nitroglycerin is used just prior to engaging in activity that is known to cause chest pain or every 5 minutes for pain relief.

The nurse is monitoring an adult patient who has been administered digoxin. The nurse suspects that the patient is developing digoxin toxicity. What symptoms will the nurse monitor? Select all that apply. 1 Anorexia 2 Vomiting 3 Dry cough 4 Dysrhythmia 5 Visual disturbances

Correct1 Anorexia Correct2 VomiCorrect5 Visual disturbancesting The early symptoms of digoxin toxicity are anorexia, nausea, vomiting, and loss of appetite. The patient may also have visual disturbances such as halo vision. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. Dysrhythmia is a sign seen in children with digoxin toxicity and is seen at the later stages of digoxin toxicity in adults.

Which assessment is most important before administering digoxin? 1 Apical pulse 2 Homans sign 3 Breath sounds 4 Weight in kilograms

Correct1 Apical pulse It is crucial to measure the patient's apical pulse rate (auscultate the apical heart rate, found at the apical impulse located at the fifth left midclavicular intercostal space) for 1 full minute before administering digoxin. The Homans sign is checked to deduce clots. Breathing sounds are assessed to check chronic obstructive pulmonary disease. Weight is checked before administration of any medication related to cardiovascular disease.

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction should the nurse include in the patient's teaching plan? 1 "Apply the patch to the same site each day." 2 "Apply the patch to a nonhairy area of the upper torso or arm." 3 "If you have chest pain, apply a second patch next to the first patch." 4 "If you have a headache, remove the patch for 4 hours and then reapply."

Correct2 "Apply the patch to a nonhairy area of the upper torso or arm." A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. Sublingual nitroglycerin should be used to treat chest pain, and the patient should only have one patch on at a time. The drug should be continued if headache occurs, because tolerance will develop.

What is the most appropriate outcome criterion for a patient who has been prescribed an antidysrhythmic medication? 1 Cardiac output increased 2 Weight gain of 5 lb in one week 3 Systolic blood pressure 90 mm Hg 4 Palpated radial pulses > pedal pulses

Correct1 Cardiac output increased The most appropriate outcome criteria when taking antidysrhythmic medications are that the patient's symptoms of dysrhythmia and subsequent decreased cardiac output are decreased and/or alleviated. Weight gain of five pounds or more in one week is of concern, and the prescriber should be notified. Heart failure may be developing or worsening if the patient already has known heart failure. The systolic blood pressure should be greater than 90 mm Hg. The patient's peripheral pulses should be equal, strong, and regular bilaterally with warm, pink extremities.

Which finding would the nurse expect to see in a patient who is prescribed milrinone? 1 Decreased platelet count 2 Decreased liver enzyme levels 3 Increased serum potassium levels 4 Increased serum magnesium levels

Correct1 Decreased platelet count Milrinone is a phosphodiesterase inhibitor. It decreases the number of platelets in the blood and results in thrombocytopenia. It increases, not decreases, liver enzyme levels. It decreases, not increases, serum potassium levels, which leads to hypokalemia. It does not interfere with serum magnesium levels.

A patient experiencing acute decompensated heart failure is prescribed nesiritide by the primary health care provider. Which other drug prescription should the nurse question? 1 Diuretics 2 Stimulants 3 Antihistamines 4 Sodium antacids

Correct1 Diuretics Nesiritide should not be coadministered with drugs that reduce blood pressure, because it produces hypotension. Diuretics increase the urinary output and thus decrease the blood volume, resulting in hypotension. Stimulants act like adrenergic drugs and cause hypertension. Antihistamines block the vasodilation caused by histamine, resulting in hypertension. Sodium antacids do not cause hypotension; instead, they cause hypertension by increasing sodium and fluid levels. Thus, they can be safely administered with nesiritide.

Verapamil has been administered to a patient parenterally. The nurse should closely monitor for which adverse effects of this drug? Select all that apply. 1 Dizziness 2 Decreased blood pressure 3 Complaints of constipation 4 Equivocal atrial and ventricular rates 5 Heart block evident on cardiac monitor

Correct1 Dizziness Correct2 Decreased blood pressure Correct3 Complaints of constipation Correct5 Heart block evident on cardiac monitor

The health care provider prescribes a sodium nitroprusside intravenous infusion to manage a patient's blood pressure of 230/120 mm Hg. Which action(s) should the nurse implement before starting the infusion? Select all that apply. 1 Evaluate the electrocardiogram. 2 Perform a neurologic assessment. 3 Assess oxygenation and ventilation. 4 Obtain an intravenous infusion pump. 5 Draw baseline serum electrolyte levels. 6 Assess the patient for peripheral edema

Correct1 Evaluate the electrocardiogram. Correct2 Perform a neurologic assessment. Correct3 Assess oxygenation and ventilation. Correct4 Obtain an intravenous infusion pump. Before starting the infusion, the nurse gathers baseline assessment data, including cardiovascular, neurologic, and respiratory status. This is because nitroprusside can alter the cardiac rhythm; if severe hypotension occurs, the patient may lose consciousness as a result of hypoperfusion. In addition, in a hypoperfused state, the patient may sustain cerebral and cardiac ischemia. Regarding the patient's respiratory status, the patient is at risk for respiratory failure in the event of thiocyanate/cyanide toxicity. The medication should be infused only via an intravenous pump, not by gravity drip. Although obtaining baseline electrolyte levels is a reasonable nursing action in a patient who is in crisis, laboratory tests related to nitroprusside administration include platelet count, renal function testing, and hematologic assessments. This medication is unlikely to cause edema.

The nurse is caring for a patient who is prescribed diltiazem for Prinzmetal angina. Upon reviewing the patient's medical history, the nurse notes that the patient is also prescribed atenolol for hypertension. What nursing assessment is a priority before medication administration? 1 Heart rate 2 Pain level 3 Blood glucose 4 Urinary output

Correct1 Heart rate Diltiazem is a calcium-channel blocker (CCB) used for treating Prinzmetal angina. Atenolol is a beta blocker used for hypertension. When these two medications are coadministered, bradycardia can occur; therefore, the nurse should assess the patient's heart rate before administering these medications. Although assessing pain is important, it is not required before administering these two medications together. A nurse would not need to specifically monitor urine output when administering these two medications concurrently. Although beta blockers can alter blood glucose levels, assessment of blood glucose is generally only necessary in patients who have diabetes mellitus and should not affect patients who do not have predisposing conditions.

A patient with acute heart failure is admitted to the emergency department of a hospital. The patient's medical reports indicate that the patient has asthma and takes telithromycin. Which prescription does the nurse need to obtain from the primary health care provider? 1 Lisinopril 2 Milrinone 3 Eplerenone 4 Hydralazine

Correct1 Lisinopril Lisinopril is an ACE inhibitor that prevents the left ventricular dysfunction that arises in the acute period after a myocardial infarction and is thus used to treat acute heart failure. ACE inhibitors are the drugs of choice to initiate treatment for heart failure. Milrinone is a phosphodiesterase inhibitor used to treat heart failure because of its positive inotropic and vasodilatory effects. However, milrinone has adverse effects, such as difficulty breathing, so its use is contraindicated in patients with asthma. Eplerenone, when administered with antifungals like telithromycin, inhibits the action of cytochrome P-450 enzyme 3A4, which results in a decrease in the breakdown of eplerenone in the body. It also increases the risk of side effects such as difficulty breathing, allergy, and drowsiness. Hydralazine is known to decrease the time to hospitalization for heart failure in African-American patients.

The patient demonstrates understanding of the nurse's teaching about quinidine when the patient makes which statement? 1 "I should always take this medicine on an empty stomach." 2 "I should call my doctor immediately if my ears are ringing." 3 "There are different salt forms that I can take interchangeably." 4 "Lightheadedness is expected. I should just change positions slowly."

Correct2 "I should call my doctor immediately if my ears are ringing." During treatment with quinidine (or with any of the antidysrhythmics), immediately report any patient complaint of tinnitus, lightheadedness, angina, hypotension, loss of appetite, or diarrhea to the prescriber. Advise patients that oral dosage forms of antidysrhythmics are generally better tolerated if taken with food and fluids to help minimize gastrointestinal upset, unless otherwise ordered. Quinidine comes in different salt forms, and these are not interchangeable

A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? 1 Monitor blood pressure continuously. 2 Administer digoxin via intravenous infusion with the milrinone. 3 Administer furosemide via intravenous infusion after the milrinone. 4 Maintain an infusion of lactated Ringer solution with the milrinone infusion.

Correct1 Monitor blood pressure continuously. Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via intravenous infusion. Lactated Ringer solution does not have to be administered with milrinone.

Which form of nitroglycerin is likely to have a large first-pass effect? 1 Oral 2 Sublingual 3 Intravenous 4 Transdermal

Correct1 Oral Oral nitroglycerin travels first to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from the circulation. This is known as a large first-pass effect. Sublingual, intravenous, and transdermal preparations do not pass through the liver. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly, because the area under the tongue is highly vascular. Intravenous nitroglycerin is quickly absorbed in the blood, and it has an onset of action of 1 to 2 minutes. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris, because it allows for the continuous slow delivery of nitroglycerin.

A child admitted to the hospital with significant growth retardation and severe heart failure is found to have a ventricular septal defect. Which is the best treatment approach for this patient? 1 Septal repair surgery 2 Diuretics such as furosemide 3 Cardiac glycoside such as digoxin 4 Exercise and other physical activity

Correct1 Septal repair surgery A ventricular septal defect is a birth defect in the heart in which there is a hole in the wall (septum) that separates the two ventricles of the heart. For septal defects, surgery is indicated. However, in complex situations, heart transplantation is the only option. Intake of diuretics such as furosemide would help to improve the pumping ability of the heart. It does not treat ventricular septal defect. Digoxin also increases the contractility of the cardiac musculature but it does not lead to closure of the septa. Children with a ventricular septal defect have exercise intolerance; exercise may be beneficial to improve the child's functional ability but would not be helpful to treat ventricular septal defect.

What intervention is recommended for a patient with angina who is going to engage in a known stressful behavior? 1 Take a sublingual nitroglycerin prophylactically. 2 Take an extra dose of the long-acting nitroglycerin. 3 Take a nonsteroidal antiinflammatory medication before the activity. 4 Take a bronchodilator before the activity.

Correct1 Take a sublingual nitroglycerin prophylactically Sublingual nitroglycerin is prescribed for patients in whom any physical activity may cause an unexpected angina episode. A long acting nitroglycerin preparation would not provide immediate relief at the time of the stressful behavior. A nonsteroidal antiinflammatory medication would not produce the vasodilation needed to increase blood flow to the heart muscle. A bronchodilator would not assist in alleviating symptoms of angina.

The nurse has administered quinidine parenterally and should carefully monitor the patient for which adverse effects? Select all that apply. 1 Tinnitus 2 Diarrhea 3 Hypertension 4 Blurred vision 5 Increased appetite

Correct1 Tinnitus Correct2 Diarrhea Correct4 Blurred vision Adverse effects for the class I antidysrhythmic drugs include tinnitus, diarrhea, blurred vision, hypotension, anorexia, rash, ECG changes, bitter taste, gingival hyperplasia, and decreased blood pressure and pulse rate.

The nurse is preparing to administer a first dose of an ACE inhibitor medication to a patient who is also being treated with lithium. What result should the nurse anticipate that from the interaction of the two drugs? 1 Toxic level of lithium 2 Decreased level of lithium 3 Toxic level of the ACE inhibitor 4 Decreased level of the ACE inhibitor

Correct1 Toxic level of lithium The interaction of an ACE inhibitor and lithium will result in lithium toxicity.

Which medication blocks angiotensin II receptors? 1 Valsartan 2 Lisinopril 3 Metoprolol 4 Eplerenone

Correct1 Valsartan Valsartan is an angiotensin II receptor blocker. It prevents angiotensin II from binding with angiotensin II receptors, thereby blocking the action of angiotensin II. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Metoprolol is a beta blocker. Eplerenone is an aldosterone inhibitor.

A patient with acute heart failure is prescribed a phosphodiesterase inhibitor drug. Which actions of the drug are beneficial for patients with heart failure? Select all that apply. 1 Vasodilation effect 2 Decreased heart rate 3 Increased blood pressure 4 Positive inotropic effects 5 Positive chronotropic effects

Correct1 Vasodilation effect Correct4 Positive inotropic effects Correct5 Positive chronotropic effects Phosphodiesterase inhibitor drugs exert both a positive inotropic effect and a vasodilatory effect. Hence, these classes of drugs are referred as inodilators. These drugs also affect the heart rate by accelerating the rate of impulse formation in the sinoatrial node and therefore exhibit a positive chronotropic effect. Cardiac glycosides cause a negative chronotropic effect by reducing the heart rate. The vasodilation effect produced by these drugs decreases blood pressure.

The nurse is assessing a patient who is taking a correct dose of digoxin but is not experiencing the desired therapeutic effects. What will the nurse assess while reviewing the patient's medication history? 1 Whether the patient is taking sucralfate 2 Whether the patient is taking verapamil 3 Whether the patient is taking amiodarone 4 Whether the patient is taking cyclosporine

Correct1 Whether the patient is taking sucralfate Sucralfate interferes with the absorption of digoxin, resulting in decreased absorption of digoxin. Thus, the nurse should check whether the patient has been taking sucralfate. Verapamil, amiodarone, and cyclosporine interact with digoxin and decrease the clearance of digoxin. Therefore, coadministration of these drug may result in increased concentration of digoxin in the body.

Which effect indicates that a patient is experiencing an adverse effect of enalapril? 1 Persistent dry mouth 2 A dry, hacking cough 3 Serum potassium of 4.2 mEq/L 4 Serum sodium of 147 mEq/L

Correct2 A dry, hacking cough One of the major side effects of angiotensin-converting enzyme (ACE) inhibitors such as enalapril is a dry, irritating, nonproductive cough. This cough is a major reason for the discontinuation of ACE inhibitors. The cough is a result of increased bradykinin in the lungs, which induces increased prostaglandin and nitric oxide production and causes the cough. Persistent dry mouth is an adverse effect of adrenergic medications. A potassium level of 4.2 mEq/L is normal; ACE inhibitors are more likely to increase the serum potassium level. A sodium level of 147 mEq/L is above normal; ACE inhibitors are more likely to decrease the serum sodium level.

Which patient should not receive amlodipine as prescribed at 8:00 AM? 1 A patient with tachycardia 2 A patient with hypotension 3 A patient with angina pectoris 4 A patient with a subarachnoid hemorrhage

Correct2 A patient with hypotension A patient who is scheduled to receive a calcium channel blocker should have blood pressure assessed before administration. Hypotension would be a contraindication to administering this medication. Tachycardia is not a contraindication, and some calcium channel blockers decrease the heart rate. Patients with angina may receive calcium channel blockers for their vasodilating effects. The medication will not do anything to worsen the condition of a patient who has suffered a subarachnoid hemorrhage.

What assessment finding indicates that a patient is having a therapeutic response to a beta blocker administered for angina? 1 Decreased heart rate 2 Absence of chest pain 3 Decreased blood glucose 4 Blood pressure less than 130/90 mm Hg

Correct2 Absence of chest pain Beta blockers are administered to patients with angina to prevent chest pain. Although beta blockers may cause fluctuations in blood glucose levels and heart rate, this is not the therapeutic outcome desired for a patient with angina. A blood pressure less than 130/90 mm Hg is not the therapeutic response for a patient who has angina.

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? 1 Absence of dizziness 2 Absence of chest pain 3 Patient feeling stronger 4 Decreased swelling in the ankles and feet

Correct2 Absence of chest pain The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina because afterload is decreased. Dizziness may be a side effect of the medication. Calcium channel blockers may cause fatigue. Diuretics are used to decrease edema in the ankles and feet.

Which medications should be used cautiously in a patient who has been prescribed nitrate therapy? Select all that apply. 1 Diuretics 2 Beta blockers 3 Phenothiazines 4 Calcium channel blockers 5 Phosphodiesterase 5 (PDE5) inhibitors

Correct2 Beta blockers Correct3 Phenothiazines Correct4 Calcium channel blockers Correct5 Phosphodiesterase 5 (PDE5) inhibitors Nitrates interact with beta blockers, phenothiazines, and calcium channel blockers and may worsen hypotension in a patient taking one of these. Nitrates have also been known to cause death in patients as a result of an interaction with erectile dysfunction drugs (PDE5). Diuretics do not interact with nitrates.

A patient who is taking digoxin for congestive heart failure (CHF) has severe vomiting. The nurse prepares ginseng tea for the patient to relieve vomiting. What symptom may occur as a result of this nursing action? 1 Tachycardia 2 Bradycardia 3 Hypertension 4 Hyperkalemia

Correct2 Bradycardia Digoxin increases the force of the contractions in the heart and consequently decreases the heart rate. Ginseng increases the serum concentrations of digoxin. Ginseng tea would relieve vomiting but would also rapidly decrease the patient's heart rate. Digoxin toxicity causes bradycardia but not tachycardia. Digoxin decreases potassium concentrations, and small amounts of potassium will be lost because of vomiting, so the patient would not develop hyperkalemia but would develop hypokalemia. Digoxin, an indirect vasodilator, does not cause hypertension.

The nurse is monitoring a patient during intravenous (IV) nitroglycerin infusion. Which assessment finding requires immediate nursing intervention? 1 Flushing 2 Chest pain 3 Heart rate of 100 beats/min 4 Blood pressure of 110/90 mm Hg

Correct2 Chest pain If a patient continues to have chest pain while on IV nitroglycerin, this is a serious finding. This would prompt the nurse to intervene. Headache and flushing are common side effects of nitroglycerin. A heart rate of 100 beats/min is still within normal range. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin.

What are the expected outcomes associated with digoxin therapy? Select all that apply. 1 Increased heart rate 2 Decreased heart rate 3 Decreased blood pressure 4 Slowed cardiac conduction speed 5 Strengthened cardiac contractions

Correct2 Decreased heart rate Correct4 Slowed cardiac conduction speed Correct5 Strengthened cardiac contractions Digoxin affects automaticity, conduction velocity, the refractory period, and cardiac contractility. The results of these physiologic changes are decreased heart rate, slowed cardiac conduction speed, and strengthened cardiac contractions. Stimulation of beta1 receptors leads to an increase in heart rate. Centrally acting adrenergic drugs can cause decreased blood pressure.

While administering a milrinone infusion, the nurse observes that the patient has severe hypotension. What are the priority interventions by the nurse? Select all that apply. 1 Administer milrinone through the inhalation route. 2 Discontinue the medication and contact the prescriber. 3 Administer a sympathomimetic medication to the patient. 4 Contact the prescriber and decrease the rate of drug infusion. 5 Decrease the dose of the medication administered to the patient.

Correct2 Discontinue the medication and contact the prescriber. Correct4 Contact the prescriber and decrease the rate of drug infusion. Patients who have been administered milrinone must be examined for signs of hypotension. If there is a large decrease in blood pressure, the medication must be discontinued and the nurse must report to the primary health care provider. If the hypotension is not very intense, then the primary health care provider must be notified and the rate of the infusion must be reduced until the primary health care provider arrives. When administered through inhalation route, milrinone would also cause hypotension. Administering sympathomimetic agents to increase blood pressure without notifying the prescriber may worsen the health condition of the patient. Administering the medication by decreasing the dose would still aggravate the symptoms of hypotension if the patient already has severe hypotension.

A patient with angina is prescribed ranolazine. Which assessment finding will the nurse report to the primary health care provider? 1 Migraine 2 Elevated liver enzymes 3 History of ischemic heart disease 4 Blood pressure of 130/90 mm Hg

Correct2 Elevated liver enzymes Ranolazine is used in patients who fail to benefit from other antianginal therapy. It is important to assess hepatic function in the patient to determine whether the drug is excreted properly. Migraine or headache does not affect the use of ranolazine. Ranolazine is an antianginal drug and is effective in patients with ischemic heart disease. A normal blood pressure is not a concern; however the drug is expected to lower the blood pressure.

The nurse is caring for a patient who needs medication to treat hypertension and to improve survival after experiencing a myocardial infarction. The nurse should anticipate that the patient will be prescribed which medication? 1 Bosentan 2 Eplerenone 3 Treprostinil 4 Sodium nitroprusside

Correct2 Eplerenone Eplerenone is indicated to both treat hypertension and to improve survival after a myocardial infarction. Currently bosentan is specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe heart failure. Like bosentan, treprostinil is indicated specifically for treatment of pulmonary artery hypertension in patients with moderate to severe heart failure. Sodium nitroprusside (Nitropress) is used in the intensive care setting for severe hypertensive emergencies and is titrated to effect by intravenous infusion.

A patient received sublingual nitroglycerine and complains of flushing and headache. What is the best action by the nurse? 1 Administer aspirin. 2 Have the patient sit and rest. 3 Administer an antihistamine. 4 Call the health care provider.

Correct2 Have the patient sit and rest. Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use. The nurse should instruct the patient to sit and rest. For patients with cardiac disease, administering therapeutic acetaminophen for a headache is preferred over therapeutic aspirin. An antihistamine will not help. The health care provider does not have to be called for this side effect.

Which complication may be experienced by a patient who is prescribed lisinopril? 1 Insomnia 2 Hyperkalemia 3 Abdominal pain 4 Cardiac dysrhythmia

Correct2 Hyperkalemia Lisinopril is an angiotensin-converting enzyme inhibitor, which causes the kidney to retain potassium, leading to hyperkalemia. Insomnia and abdominal pain are known side effects of nesiritide, not lisinopril. Cardiac dysrhythmia is a side effect of milrinone, not lisinopril.

A nurse is assessing four patients. Which patient should the nurse expect to be prescribed flecainide? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

Correct2 Patient B Patient B has Wolff-Parkinson-White syndrome, for which class Ic medications such as flecainide or class Ia medications such as disopyramide can be used. Patient A has atrial flutter, for which class III antiarrhythmic drugs such as amiodarone or calcium channel blockers such as diltiazem can be prescribed. Patient C has premature ventricular contractions, for which class Ia antiarrhythmic medications or class Ib antiarrhythmic medications such as lidocaine can be prescribed. Patient D has atrial tachydysrhythmia caused by digitalis toxicity. In these cases, phenytoin would be administered to help optimize the heart rate.

A patient is receiving intravenous nitroglycerin. What intervention is essential? Select all that apply. 1 Insert a Foley catheter. 2 Regulate the infusion via a pump. 3 Monitor blood pressure continuously. 4 Calculate the prescribed drip rate carefully. 5 Administer a diuretic to decrease fluid load.

Correct2 Regulate the infusion via a pump. Correct3 Monitor blood pressure continuously. Correct4 Calculate the prescribed drip rate carefully. The nitroglycerin drip must be regulated on an infusion pump. The patient's blood pressure should be monitored continuously. The drip rate should be carefully calculated. The patient does not need to have a Foley catheter inserted, and a diuretic medication is not essential when the patient is on nitroglycerin therapy.

The nurse is reviewing a medication history for a patient taking captopril. The nurse should contact the health care provider if the patient is also taking which medication? 1 Furosemide 2 Spironolactone 3 Morphine sulfate 4 Docusate sodium

Correct2 Spironolactone Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic, which may cause hyperkalemia when administered with an ACE inhibitor.

A patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. During a review of the patient's list of current medications, which medication(s) should alert the nurse for a possible interaction with this new prescription? Select all that apply. 1 Warfarin, 5 mg by mouth daily 2 Spironolactone, 25 mg by mouth daily 3 Ibuprofen, 400 mg by mouth twice daily 4 Alprazolam, 0.25 mg by mouth twice daily 5 Potassium chloride, 20 mEq by mouth daily

Correct2 Spironolactone, 25 mg by mouth daily Correct3 Ibuprofen, 400 mg by mouth twice daily Correct5 Potassium chloride, 20 mEq by mouth daily Hyperkalemia may occur with any ACE inhibitor. Potassium supplementation and potassium-sparing diuretics, such as spironolactone, need to be used with caution. The use of nonsteroidal antiinflammatory drugs (NSAIDs) along with ACE inhibitors may also predispose patients to the development of acute renal failure. There is no interaction between ACE inhibitors and anticoagulants, such as warfarin, or benzodiazepines, such as alprazolam.

A patient has recently started a treatment regimen that includes sodium nitroprusside. The nurse suspects that the patient has developed a toxic level of this drug. What is the best action by the nurse? 1 Monitor the blood pressure. 2 Stop the infusion of the drug. 3 Notify the health care provider. 4 Maintain the intravenous line with normal saline.

Correct2 Stop the infusion of the drug. When excessive hypotension occurs with sodium nitroprusside administration, discontinuation of the infusion has an immediate effect, because the drug is metabolized very rapidly. This is the best action by the nurse.

The nurse asks an elderly patient to lie in a supine position and administers a dose of nitroglycerin. What assessment finding requires immediate nursing intervention? 1 The patient complains of dizziness. 2 The patient has a blood pressure of 90/45 mm Hg. 3 The patient has a blood pressure of 140/90 mm Hg. 4 The patient's heart rate increased from 80 to 90 beats/min.

Correct2 The patient has a blood pressure of 90/45 mm Hg. A systolic blood pressure of 90 mm Hg or less indicates hypotension; nitroglycerin results in a fall in blood pressure of about 10 mm Hg. As a result, the patient may experience syncope. Dizziness resulting from hypotension can be prevented by asking the patient to change positions slowly or rest for 30 minutes. In a supine position, the nitrate dose can increase the heart rate up to 10 beats/min. However, it does not last more than 30 minutes.

Which event is likely to increase orthostatic hypotension in a patient who is using nitroglycerin therapy for angina? 1 The patient stops the medication. 2 The patient takes a hot shower after a walk. 3 The patient takes a bronchodilator for asthma. 4 The patient drinks 2 to 3 liters of fluid per day.

Correct2 The patient takes a hot shower after a walk A hot shower or hot temperature increases orthostatic hypotension in a patient who is on nitroglycerin therapy, as a result of vasodilation. The other situations will not worsen hypotension, but they may cause other problems. If the drug is stopped suddenly, angina may result. Drinking fluid should help to decrease hypotension. A bronchodilator does not increase the risk of hypotension and could actually cause hypertension.

The nurse is administering several medications at 8:00 am. Which medication will decrease vasoconstriction by blocking angiotensin II receptor sites? 1 Enalapril 2 Valsartan 3 Metoprolol 4 Furosemide

Correct2 Valsartan The category of medications that blocks angiotensin II receptor sites are medications ending in "sartan." Valsartan is in this category. Medications ending in "pril" are angiotensin-converting enzyme (ACE) inhibitors. Medications ending in "lol" are beta blockers. Furosemide is a loop diuretic. Topics

A patient who is receiving 50 mg of losartan daily for hypertension reports taking ibuprofen four times daily for relief of pain from osteoarthritis. The nurse should be concerned about which potential interaction? 1 Ibuprofen can potentiate the effect of losartan. 2 When combined with losartan, ibuprofen can lead to potential renal failure. 3 When combined with losartan, ibuprofen increases the risk for hypokalemia. 4 When ibuprofen and losartan are taken concurrently, the risk for the side effect of cough is increased.

Correct2 When combined with losartan, ibuprofen can lead to potential renal failure. When nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, are taken concurrently with angiotensin II receptor blockers (ARBS), such as losartan, there is potential for the development of renal failure. When NSAIDs are taken concurrently with ARBs, the effects of the ARB are decreased. Therefore, the intended effect of lowering the blood pressure with losartan may not be met. ARBs increase the risk for hyperkalemia, not hypokalemia, and cough is associated with administration of angiotensin-converting enzyme (ACE) inhibitors, not ARBs.

A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dinitrate. To minimize side effects, what instruction will the nurse give to the patient? 1 "Measure your pulse rate before taking the medication." 2 "Eat a potassium-rich diet while taking the medication." 3 "Change position carefully while taking the medication." 4 "Eat a magnesium-rich diet while taking the medication."

Correct3 "Change position carefully while taking the medication." Using hydralazine/isosorbide dinitrate may cause syncope, which makes patients unable to maintain postural tone. Therefore, it is important that the nurse instruct the patient to change position carefully. Pulse rate should be checked before taking digoxin, because it reduces heart rate. Digoxin and loop diuretics reduce the potassium levels. This makes it important to eat a potassium-rich diet while taking them. Also, magnesium levels are reduced when taking digoxin and loop diuretics. This necessitates eating a magnesium-rich diet and taking magnesium supplements to compensate for the loss.

A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dinitrate. What instruction should the nurse give the patient to minimize side effects? 1 "Measure your pulse rate before taking the medication." 2 "Eat a potassium-rich diet while taking the medication." 3 "Change position carefully while taking the medication." 4 "Eat a magnesium-rich diet while taking the medication."

Correct3 "Change position carefully while taking the medication." Using hydralazine/isosorbide dinitrate may cause syncope, which makes patients unable to maintain postural tone. Therefore, it is important that the nurse instruct the patient to change position carefully. Pulse rate should be checked before taking digoxin, not hydralazine/isosorbide, because digoxin reduces heart rate. Hydralazine/isosorbide relaxes smooth muscle in arteries and veins. This combination drug therapy does not have the inotropic and potassium and magnesium depleting effects of digoxin and loop diuretics.

A patient with type 1 diabetes mellitus and angina has been told by the health care provider that beta blockers are contraindicated. The patient states "my mother takes a beta blocker for angina, so why can't I?" What should the nurse include in the response? Select all that apply. 1 "This medication will interact with your insulin therapy." 2 "This medication will predispose you to other health problems." 3 "This medication may cause your blood glucose to go very low." 4 "This medication may cause your blood glucose to go very high." 5 "This medication may make it more difficult for you to tell when you are having episodes of hypoglycemia."

Correct3 "This medication may cause your blood glucose to go very low." Correct4 "This medication may cause your blood glucose to go very high." Correct5 "This medication may make it more difficult for you to tell when you are having episodes of hypoglycemia." Beta blockers can cause both hypoglycemia and hyperglycemia in patients with diabetes mellitus and should be avoided if possible. They may also block the normal response to hypoglycemia, such as tachycardia, and make it more difficult for the patient to notice the symptoms. The medication would not interact with insulin or predispose the patient to other health problems.

What is the elimination half-life of valsartan? 1 1 hour 2 2 hours 3 6 hours 4 12 hours

Correct3 6 hours Valsartan is an angiotensin II receptor blocker. The elimination half-life of valsartan is 6 hours. The elimination half-life of lisinopril is 1 hour. The onset of action of valsartan is 2 hours. The duration of action of valsartan is 12 hours

A patient is admitted to the hospital after experiencing chest pain while jogging. Which nursing action is a priority? 1 Assess lung sounds. 2 Administer heparin subcutaneously. 3 Administer oxygen 2 L/min via nasal cannula. 4 Administer nitroglycerin 5 to 20 mcg/min intravenously.

Correct3 Administer oxygen 2 L/min via nasal cannula. A nurse who is providing care to a patient who was admitted after having chest pain prioritizes care to administer oxygen first, then starts nitroglycerin intravenously. Lung sounds should be assessed routinely, and heparin should be administered daily while the patient is on bed rest.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. The nurse should instruct the patient to immediately seek medical attention if which adverse effect occurs? 1 Fatigue 2 Diarrhea 3 Angioedema 4 Dry, nonproductive cough

Correct3 Angioedema Angioedema is a strong vascular reaction involving inflammation of submucosal tissue (e.g., laryngeal edema) and can result in anaphylaxis. Fatigue and a dry, nonproductive cough are possible adverse reactions but are not life-threatening. Diarrhea is not an adverse effect of ACE inhibitors.

The nurse is preparing to administer a sublingual nitroglycerin dose to a patient for chest pain. What precautions should the nurse take before administering the drug? Select all that apply. 1 Assess heart rate. 2 Assess blood glucose. 3 Assess blood pressure. 4 Take a detailed medical history. 5 Measure patient's height and weight.

Correct3 Assess blood pressure. Correct1 Assess heart rate The nurse should assess the patient's heart rate and blood pressure before administering sublingual nitroglycerin and ask the patient to sit or lie down. Glucose is not affected by sublingual nitroglycerin. A detailed history and measurement of height and weight need to be completed, but not during an emergency problem such as chest pain. The goal is to increase oxygen to the heart via vasodilation.

The nurse is caring for a patient who has been experiencing ventricular dysrhythmias without atrial involvement. The nurse anticipates that the patient will be placed on which class of drug? 1 Class II drug 2 Class Ia drug 3 Class Ib drug 4 Class Ic drug

Correct3 Class Ib drug

The patient who is receiving antidysrhythmic drugs exhibits increased cardiac output, increased activity tolerance, blood pressure 130/75, pulse 86, and has voided 400 mL of urine during the past 8-hour shift. What is the nurse's best action? 1 Notify the health care provider. 2 Increase the continuous intravenous fluid rate. 3 Document the findings in the patient's medical record. 4 Place the patient in the Trendelenburg's position to improve venous return.

Correct3 Document the findings in the patient's medical record. Therapeutic effects in general for antidysrhythmic drugs include improved cardiac output; decreased chest discomfort; decreased fatigue; improved vital signs, skin color, and urinary output; and conversions of irregularities to normal rhythm. The findings are reassuring. The health care provider does not need to be notified and the patient does not require repositioning. The dose requires no adjustment reveal therapeutic effectiveness of the drugs.

For what side effects should the nurse monitor after administering lisinopril to a patient? Select all that apply. 1 Anemia 2 Hematuria 3 Dry cough 4 Blurred vision 5 Hyperkalemia

Correct3 Dry cough Correct5 Hyperkalemia Lisinopril is used as an angiotensin-converting enzyme inhibitor. Dry cough and hyperkalemia are side effects of lisinopril. The drug does not affect the hemoglobin concentrations and therefore does not cause anemia. Lisinopril does not have any effect on blood cells. Therefore, it does not cause hematuria. Lisinopril also does not affect vision and so does not cause blurred vision.

The nurse prepares to administer digoxin to a patient who has heart failure. The nurse should evaluate the serum potassium level if the patient is taking which other drug? 1 Valsartan 2 Lisinopril 3 Furosemide 4 Spironolactone

Correct3 Furosemide Furosemide is a loop diuretic, which acts to prevent the reabsorption of sodium; as a result, the patient excretes sodium, water, and potassium. For this reason, the nurse checks the patient's serum potassium before administering digoxin, because hypokalemia increases the risk of digoxin toxicity and related dysrhythmias. Valsartan is an angiotensin II receptor blocker used to prevent vasoconstriction. Lisinopril is an angiotensin-converting enzyme inhibitor that also tends to be potassium sparing but is not used for diuresis. Spironolactone is a potassium-sparing diuretic.

A patient develops syncope after receiving a drug for a heart failure. Which heart failure drug was administered to the patient? 1 Milrinone 2 Nesiritide 3 Hydralazine 4 Spironolactone

Correct3 Hydralazine Syncope is a condition of a brief loss of consciousness caused by a sudden decrease in blood pressure. Hydralazine is a vasodilator drug that may cause hypotension, leading to lightheadedness or syncope. Milrinone is a phosphodiesterase inhibitor that does not affect blood pressure. Nesiritide causes adverse effects such as cardiac dysrhythmias, headache, hypokalemia, tremor, thrombocytopenia, and elevated liver enzyme concentrations. It does not cause syncope. Spironolactone is a diuretic that increases loss of fluid from the body and does not cause hypotension. Topics

A patient receiving the adrenergic medication clonidine reports experiencing constipation. What should be included in the plan of care for this patient? Select all that apply. 1 Restrict dietary fiber intake. 2 Limit fluids to 1000 mL/day. 3 Increase the amount of fruits and vegetables in the diet. 4 Inform the patient that this is a common adverse effect of the medication. 5 Discuss incorporation of psyllium-based products in the plan of care with the health care provider.

Correct3 Increase the amount of fruits and vegetables in the diet. Correct4 Inform the patient that this is a common adverse effect of the medication. Correct5 Discuss incorporation of psyllium-based products in the plan of care with the health care provider. Constipation is one of the most common adverse effects of adrenergic medications such as clonidine, and the patient should be made aware of this. Increasing (not restricting) dietary fiber through increased intake of fruits and vegetables, increasing fluid intake (if not contraindicated), and taking psyllium-based products should assist with preventing constipation.

The patient's blood pressure is 200/120 mm Hg, and the health care provider prescribes sodium nitroprusside. What is the nurse's priority action? 1 Measure hourly output. 2 Administer with a full glass of water. 3 Monitor blood pressure continuously. 4 Make certain the patient does not crush the pill.

Correct3 Monitor blood pressure continuously. Sodium nitroprusside is a direct-acting peripheral vasodilator that works almost immediately. The patient needs continuous blood pressure monitoring. Hourly output measurement is not necessary. This medication is administered intravenously, not by mouth, and does not require a glass of water.

What is the primary indication for the use of calcium channel blockers (CCBs)? 1 To prolong the QT interval 2 To reduce elevations in heart rate 3 To decrease the workload of the heart 4 To treat acute myocardial infarction (MI

Correct3 To decrease the workload of the heart CCBs decrease afterload and reduce the workload of the heart by decreasing muscle contraction and promoting muscle relaxation. CCBs do not prolong the QT interval. CCBs are contraindicated in patients with acute MI. Some calcium channel blockers decrease elevations in heart rate; however, this is not the primary indication for the use of calcium channel blockers.

The nurse is caring for a patient who needs antihypertensive medication to treat pulmonary artery hypertension related to severe heart failure. Which medication should the nurse anticipate that the patient will be prescribed? 1 Bosentan 2 Eplerenone 3 Treprostinil 4 Sodium nitroprusside

Correct3 Treprostinil Treprostinil is indicated to treat pulmonary artery hypertension in patients with severe heart failure. The remaining options are not.

What should the nurse assess within an hour after administering a diuretic? Select all that apply. 1 Weight 2 Heart rate 3 Urinary output 4 Blood pressure 5 Neurologic status

Correct3 Urinary output Correct4 Blood pressure The nurse should assess urinary output and blood pressure within an hour after administering a diuretic. Weight assessment is not the best way to monitor a diuretic given for hypertension. Heart rate is not a measure of diuretic effectiveness. Neurologic status should not change.

What patient instruction will help prevent tolerance to nitrate therapy? 1 "Apply the nitroglycerin patch every other day." 2 "Use the nitroglycerin patch for acute episodes of angina only." 3 "Use sublingual nitroglycerin if your systolic blood pressure is 140 mm Hg." 4 "Apply the nitroglycerin patch in the morning, and remove it for 10 hours at night."

Correct4 "Apply the nitroglycerin patch in the morning, and remove it for 10 hours at night." Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. The patch is removed for 8 to 12 hours every night, and a new patch is applied in the morning. Applying the patch every other day will not have the therapeutic effects. Sublingual nitroglycerin is administered for treating acute episodes of angina. Sublingual nitroglycerin is more effective for chest pain.

The nurse is teaching a patient about the proper diet while taking drugs to treat heart failure. What will the nurse include in the teaching? 1 "Drink large amounts of water with heart failure drugs." 2 "Take sodium antacids along with the heart failure drugs." 3 "Avoid eating bran completely when using heart failure drugs." 4 "Avoid consuming milk products 2 hours before and after taking the medication."

Correct4 "Avoid consuming milk products 2 hours before and after taking the medication." Milk products such as cheese, yogurt, and ice cream decrease the absorption of heart failure drugs, so they should not be taken 2 hours before and after taking the medication. Drinking large amounts of water increases blood pressure and increases the workload on the heart in patients with heart failure. Bran, rich in fiber and protein, should be avoided only 2 hours before or after the medication, not completely. Bran slows down the absorption of the medication only if taken within 2 hours of taking the medication. Antacids form complexes with the medication and render it unavailable for absorption. Also, antacids may increase the blood sodium and fluid levels, resulting in hypertension.

The nurse is teaching a group of nursing students about beta blockers. Which statement by the student indicates understanding of the teaching? 1 "Beta blockers increase myocardial contractility." 2 "Beta blockers increase the patient's urine output." 3 "Beta blockers increase dilation of the peripheral vessels." 4 "Beta blockers decrease sympathetic stimulation of the heart."

Correct4 "Beta blockers decrease sympathetic stimulation of the heart." Beta-blockers reduce or block the effect of the sympathetic nervous system on the heart muscles and the conduction system. This results in a reduced heart rate, delayed atrioventricular node conduction, reduced myocardial contractility, and decreased myocardial automaticity. Diuretics decrease the circulating blood volume by inhibiting sodium and water resorption and thus increase the urine output. Nesiritide, a synthetic version of human B-type natriuretic peptide, and milrinone, a phosphodiesterase inhibitor, cause vasodilation, thereby reducing the force with which the heart must pump to eject its volume of blood

A patient taking adrenergic drugs for hypertension is being given discharge teaching about the therapy. What information should be included in this teaching plan? 1 "This therapy will cause bruising." 2 "Take this medication after dinner." 3 "Take this medication before dinner 4 "Do not drink alcohol when using this therapy."

Correct4 "Do not drink alcohol when using this therapy." Alcohol and other central nervous system depressants can cause increased central nervous system depression when taken with these medications. The medication will not cause bruising and does not have to be taken before or after dinner.

Which comment by the patient indicates understanding about the use of enalapril for treatment of hypertension? 1 "I cannot go out in the sun while on this therapy." 2 "I should stop the drug if I have ringing in my ears." 3 "If I feel tired, I should call the health care provider." 4 "If I develop a chronic cough, I need to notify my health care provider."

Correct4 "If I develop a chronic cough, I need to notify my health care provider." A patient taking an angiotensin-converting enzyme inhibitor such as enalapril needs to report a nonproductive chronic cough, because this is a potential side effect. There is no treatment other than to change the medication therapy. The other statements are not correct.

The home health nurse visits a patient and observes a used transdermal nitroglycerin patch in a wastebasket in the patient's living room. What should the nurse teach the patient about drug disposal? 1 "Place the patch in its original package for disposal." 2 "Cut the patch into small pieces and then place it in a trash container." 3 "Wrap the patch in a piece of paper and discard it in your kitchen trash." 4 "Place the patch in a secure disposal container or flush it down the toilet."

Correct4 "Place the patch in a secure disposal container or flush it down the toilet." Used patches still contain active medication. Proper disposal is important to prevent others, especially small children and animals, from being exposed to the drug. The used patch should be placed in a secure disposal container or flushed down the toilet to prevent contact with the residual drug. The patch needs to be discarded safely, not placed in its original package or cut into small pieces. It is not safe to dispose of the patch in the kitchen trash, because people may come in contact with the residual drug.

A patient is prescribed methyldopa during pregnancy. What teaching is essential for this patient? 1 "Do not take the medication with food." 2 "Only take this medication in the morning." 3 "Take the medication with potassium supplements." 4 "Sit on the side of the bed before getting up, and get up slowly."

Correct4 "Sit on the side of the bed before getting up, and get up slowly." The patient should be taught about the possibility of orthostatic hypotension and should sit on the side of the bed and rise slowly when taking this medication. The medication does not have to be taken on an empty stomach, and does not have to be taken in the morning or with potassium, because it does not deplete potassium. The medication is not commonly used and is primarily used to treat hypertension in pregnancy. It is not a first-line drug for hypertension other than in this situation.

The nurse is teaching a patient about idiopathic hypertension. What statement should be included in the teaching plan? 1 "This type of hypertension is not treatable." 2 "Once you have surgery, this will go away." 3 "This type of hypertension has a definitive cause." 4 "The cause of your hypertension is unknown, but treatable."

Correct4 "The cause of your hypertension is unknown, but treatable." Idiopathic hypertension is essential hypertension. The specific cause is unknown but it is treatable. Surgical treatment may cure secondary hypertension but not idiopathic hypertension.

The nurse is teaching a patient about the reason for the administration of calcium channel blockers. What statement should be included in the teaching plan? 1 "This medication will help your body to get rid of sodium." 2 "This medication will work to cause your body to get rid of fluid." 3 "This medication will help you to lose weight to lower your blood pressure." 4 "This medication will vasodilate your blood vessels to lower your blood pressure."

Correct4 "This medication will vasodilate your blood vessels to lower your blood pressure." Calcium channel blockers cause vasodilation and are used for hypertension to lower blood pressure. They cause direct vasodilation by blocking calcium influx in smooth muscles in the blood vessels. This medication class does not help to rid the body of fluids, decrease sodium, or help the patient to lose weight.

What is the duration of action of a nitroglycerin transdermal patch? 1 3 to 5 minutes 2 0.5 to 1 hour 3 4 to 6 hours 4 8 to 12 hours

Correct4 8 to 12 hours The duration of action of a nitroglycerin transdermal patch is 8 to 12 hours. The duration of action of intravenous nitroglycerin is 3 to 5 minutes. The duration of action of a sublingual tablet is 0.5 to 1 hour. The duration of action of an immediate-release tablet is 4 to 6 hours.

Which patient with hypertension would benefit most from receiving an alpha1 blocker? 1 A pregnant patient 2 A patient with asthma 3 A patient with an increased heart rate 4 A patient with benign prostatic hyperplasia

Correct4 A patient with benign prostatic hyperplasia An alpha1 blocker will increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contraction in the bladder neck and urethra. This can be beneficial to a patient with benign prostatic hyperplasia. A pregnant patient, a patient with asthma, or a patient with an increased heart rate would not benefit from this medication.

A patient is undergoing standard heart failure therapy that does not include a diuretic. The patient's weight has increased by 2 lb (0.9 kg) since yesterday. What action does the nurse implement first? 1 Explaining how to read food labels 2 Instructing the patient to seek emergency care 3 Telling the patient to reduce the daily sodium intake 4 Asking the patient about the food eaten in the past 24 hours

Correct4 Asking the patient about the food eaten in the past 24 hours An overnight weight gain of 2 lb (0.9 kg) implies that the patient has been nonadherent to the therapy regimen in some manner; the patient has missed some medication, eaten foods containing high levels of sodium, or measured weight differently. Before planning the care, the nurse must complete the patient assessment, which includes asking the patient about the diet the patient was eating in the past 24 hours. The care implemented by the nurse depends on the patient's response. Reduction of sodium consumption is an effective method of controlling total body fluid. Sodium is a component of many foods and is found in all processed foods, so teaching the patient how to read food labels could be effective, but it is not the first action to implement. Emergency treatment is not necessary, but the fluid accumulation must be resolved to prevent exacerbation of the heart failure.

The nurse administers candesartan to a patient. Which patient assessment finding should the nurse use as a clinical indicator of therapeutic effectiveness of the medication? 1 Cool, dry, pale extremities 2 Serum sodium of 140 mEq/L 3 Serum potassium of 3.8 mEq/L 4 Blood pressure of 120/72 mm Hg

Correct4 Blood pressure of 120/72 mm Hg The nurse uses the patient's blood pressure, which is within normal limits, to determine that an angiotensin II receptor blocker (ARB) is effective, because ARBs decrease blood pressure by causing dilation of arterioles and veins. Because ARBs promote vasodilation, the nurse expects the patient's extremities to be warm and pink. The patient's sodium level is normal; because ARBs block the secretion of aldosterone, the patient's sodium level is likely to be unaffected by ARB administration. The patient's potassium level is normal; ARBs are less likely than ACE inhibitors to affect the potassium level.

The nurse is caring for a patient who is hypertensive and has liver dysfunction. The nurse should anticipate that the patient will most likely be placed on which antihypertensive drug? 1 Losartan 2 Ramipril 3 Enalapril 4 Captopril

Correct4 Captopril Captopril and lisinopril are the only two angiotensin-converting enzyme inhibitors that are not prodrugs. A prodrug is a drug that is inactive in its administered form and must be metabolized to its active form in the body, generally by the liver, to be effective.

The nurse assesses a patient who is using topical nitroglycerine for angina. The patient has a rash on the chest where the medication was applied. What is the best action by the nurse? 1 Stop the medication. 2 Assess the patient's diet. 3 Administer an antihistamine. 4 Change the area of administration.

Correct4 Change the area of administration. The patient is exhibiting contact dermatitis. The nurse can change the site of administration and evaluate the skin. Changing the area of administration to a less sensitive skin area may diminish or stop the reaction. This is not caused by the patient's diet. Antihistamines are not administered for localized contact dermatitis. If it continues, another intervention is needed.

Which assessment may indicate a myocardial infarction (MI) in a patient who is taking nitroglycerin for angina? 1 The patient has hypotension. 2 The patient has a headache after taking nitroglycerin. 3 The patient complains of feeling dizzy when trying to move. 4 Chest pain is unrelieved after three doses of sublingual nitroglycerin.

Correct4 Chest pain is unrelieved after three doses of sublingual nitroglycerin. If chest pain is not relieved after taking nitroglycerin, it may indicate a myocardial infarction. The primary health care provider needs to be notified immediately. Hypotension may occur with nitroglycerin, but it does not indicate that a myocardial infarction is occurring. Headache is a common side effect of nitroglycerin therapy. It diminishes soon after the therapy is started. Dizziness is result of vasodilation and possibly hypotension.

A patient is admitted to the hospital for an intestinal obstruction and has been placed on strict nothing by mouth (NPO) status. The nurse is reconciling the patient's home medications and notes that the patient's daily dose of the antihypertensive lisinopril has not been prescribed by the health care provider. Which action should the nurse take? 1 Address hypertensive episodes only when they arise. 2 Obtain a prescription to administer the lisinopril intravenously. 3 Obtain a prescription for the daily lisinopril and give with a sip of water. 4 Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed.

Correct4 Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed. Because the patient has an intestinal obstruction and must maintain strict NPO status, a parenteral form of an ACE inhibitor is needed to keep the patient's blood pressure under control. Enalapril is the only ACE inhibitor that is available in parenteral form. All medications should be reconciled on admission, so collaboration with the health care provider is essential.

A patient has been prescribed an angiotensin II receptor blocker to treat hypertension. The patient is also being treated with rifampin. What result should the nurse anticipate from the interaction of these drugs? 1 Increased effect of the rifampin 2 Decreased effect of the rifampin 3 Increased effect of the angiotensin II receptor blocker drug 4 Decreased effect of the angiotensin II receptor blocker drug

Correct4 Decreased effect of the angiotensin II receptor blocker drug The interaction of rifampin and the angiotensin II receptor blocker will result in a decreased effect of the angiotensin II receptor blocker drug.

A patient who is receiving digoxin reports headache, dizziness, nausea, and blurred vision. After assessing the patient, the nurse finds that the patient's pulse rate is 48 beats/min. Which medication should the nurse expect the primary health care provider to prescribe? 1 Milrinone 2 Nesiritide 3 Dobutamine 4 Digoxin immune Fab

Correct4 Digoxin immune Fab Headache, dizziness, nausea, blurred vision, and slowed pulse are symptoms of digoxin toxicity. Digoxin immune Fab should be administered to the patient to manage the digoxin toxicity. Digoxin immune Fab is an antibody that recognizes digoxin as an antigen and forms an antigen-antibody complex with the drug, thus inactivating the free digoxin. It prevents further complications. Milrinone, nesiritide, and dobutamine do not have any effect on serum digoxin concentrations. Therefore, these drugs are not useful for the management of digoxin toxicity. Milrinone is a phosphodiesterase inhibitor and is used in the treatment of heart failure. Nesiritide is a recombinant human B-type natriuretic peptide used to treat life-threatening heart failure. Dobutamine is a beta 1-selective vasoactive adrenergic drug used to treat heart failure.

A patient with myocardial infarction is given intravenous milrinone. Which other intravenous medication in the patient's medication prescriptions should the nurse question? 1 Digoxin 2 Lisinopril 3 Carvedilol 4 Furosemide

Correct4 Furosemide Furosemide is a diuretic drug that is prescribed to reduce edema. When taken intravenously, furosemide reacts with milrinone and precipitates it, thereby reducing its therapeutic effect. Therefore, it is not usually prescribed in an intravenous formulation. Digoxin does not cause any adverse reaction with milrinone, so they can be administered together. Lisinopril is an angiotensin-converting enzyme that is prescribed for myocardial infarction. It does not cause any interaction with milrinone. Carvedilol is a nonspecific beta blocker prescribed for myocardial infarction. It does not cause any reaction with milrinone.

When preparing a teaching plan for a patient started on amiodarone, which food or drink should the nurse advise the patient to avoid? 1 Gluten 2 Poultry 3 Whole milk 4 Grapefruit juice

Correct4 Grapefruit juice Grapefruit juice can inhibit the metabolism of several antidysrhythmics such as amiodarone, disopyramide, and quinidine. The other food and drink options are not as necessary to restrict in the patient's diet.

Which beverage is contraindicated when the patient is taking nifedipine? 1 Tea 2 Milk 3 Mango juice 4 Grapefruit juice

Correct4 Grapefruit juice Grapefruit juice can reduce the metabolism of calcium channel blockers, especially nifedipine. Tea, milk, and mango juice do not cause an interaction when ingested with calcium channel blockers.

Which assessment finding will alert the nurse to suspect digitalis toxicity? 1 Dehydration and constipation 2 Blood pressure of 100/60 mm Hg 3 Heart rate of 110 beats per minute 4 Loss of appetite with slight bradycardia

Correct4 Loss of appetite with slight bradycardia Symptoms of digitalis toxicity include anorexia, nausea and vomiting, diarrhea, loss of appetite, bradycardia, hypotension, headache, fatigue, confusion, convulsions, and colored vision. Dehydration and constipation, blood pressure of 100/60 mm Hg, and heart rate of 110 beats per minute are not indications of digitalis toxicity.

Which antihypertensive medications are most likely to cause tachycardia? Select all that apply. 1 Aliskiren 2 Valsartan 3 Lisinopril 4 Diazoxide 5 Eplerenone 6 Hydralazine

D. Diazoxide (Hyperstat)F. Hydralazine (Apresoline)Direct-acting vasodilators such as hydralazine and diazoxide work by dilating the peripheral vasculature and are likely to cause tachycardia because vasodilators decrease the blood pressure by way of direct action on vascular smooth muscle. As the body tries to compensate for a sudden decrease in oxygenated blood, the baroreceptors are stimulated, thereby increasing the heart rate to improve oxygen delivery to the tissues. Valsartan (angiotensin II receptor blocker), lisinopril (angiotensin-converting enzyme inhibitor), eplerenone (aldosterone blocker), and aliskiren (renin inhibitor) are less likely to cause reflex tachycardia because none of these agents acts by exerting direct smooth muscle relaxation.

Which patients with heart disease would be classified within class III of the New York Heart Association's (NYHA) functional classification for cardiac disease? 1 Patients with no limitation of physical activity 2 Patients with slight limitation of physical activity 3 Patients with inability to perform physical activity 4 Patients with marked limitation of physical activity

Correct4 Patients with marked limitation of physical activity Patients with cardiac disease who have a marked limitation in physical activity are classified as class III according to the NYHA's functional classification for cardiac disease. They are comfortable at rest. Activities requiring minimal effort in such patients would cause fatigue, palpitation, dyspnea, or anginal pain. Patients with cardiac disease who have no limitation of physical activity are classified under class I of the NYHA's functional classification. Patients with cardiac disease who are comfortable at rest but in whom ordinary physical activities result in fatigue, palpitation, difficulty breathing, or anginal pain belong to class II of the NYHA's functional classification. Patients with cardiac disease resulting in an inability to perform any physical activity without discomfort are classified in class IV of the NYHA's functional classification. Symptoms of heart failure or anginal syndrome may be present even at rest.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed to ensure safe drug administration? 1 Liver enzyme concentration 2 Blood glucose concentration 3 Serum calcium concentration 4 Serum potassium concentration

Correct4 Serum potassium concentration Digoxin is a cardiac glycoside. The serum potassium concentration is assessed before digoxin is administered, because low concentrations of potassium (hypokalemia) may precipitate digoxin toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

A patient telephones the clinic and asks the nurse if he should still take today's "heart pills" since he noticed a waxy shell that looked like a pill capsule in his bowel movement yesterday. What is the nurse's best response? 1 "Wait 24 hours to make sure all of yesterday's dose is out of your system." 2 "The wax is part of the capsule shell, but the drug is still getting absorbed." 3 "I need to discuss this situation with the prescriber, and I will call you back." 4 "After today's bowel movement, take the medication if there is no waxy shell."

orrect2 "The wax is part of the capsule shell, but the drug is still getting absorbed." Some dosage forms are delivered in a sustained-released tablet or capsule that may be composed of a wax matrix, and this matrix may be visible in the patient's stool. This extended-release dosage form provides for a slow release of the medicine, and the wax substance may then be passed out of the body through the stool. The nurse should advise patients that the passing of the matrix through the stool occurs after the drug has been absorbed, and although the matrix is often visible to the naked eye, it is of no major concern. The patient does not need to wait 24 hours or for the next bowel movement to take the next dose. The waxy shell is an expected finding, and the prescriber does not need to be notified.