Cardiac Drug Practice Questions Exam 3

The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. Head is tilted down while inhaling the medication 3. Client waits 5 minutes between puffs. 4. Mouth is rinsed with water following administration 5. Client lies supine for 15 minutes following administration.

1 and 4.

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose? 1. 5.0 ml 2. 7.5 ml 3. 9.5 ml 4. 10 ml

2

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to: 1. Promote expectoration 2. Suppress the cough 3. Relax smooth muscles of the bronchial airway 4. Prevent infection

3. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway.

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? 1. Corticosteroids promote bronchodilation 2. Corticosteroids act as an expectorant 3. Corticosteroids have an anti-inflammatory effect 4. Corticosteroids prevent development of respiratory infections.

3. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? 1. Removes the cap and shakes the inhaler well before use. 2. Presses the canister down with finger as he breathes in. 3. Inhales the mist and quickly exhales. 4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

3. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug? 1. Constipation 2. Bradycardia 3. Diplopia 4. Restlessness

4. Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias. Constipation and diplopia are not side effects of pseudoephedrine. Tachycardia, not bradycardia, is a side effect of pseudoephedrine.

A patient has a new prescription for an adrenergic drug. During a review of the patient's list of current medications, which would cause concern about a posssible interaction with this new prescription: A. A benzodiazepine taken as needed for allergies B. A multivitamin with iron C. An oral anticoagulant D. NSAIDS

A. A benzodiazepine taken as needed for allergies

When giving antihypertensive drugs, the nurse must consider giving the first dose at bedtime for which of the following classes of drugs? A. Alpha blockers B. Diuretics C. ACE inhibitors D. Vasodilators

A. Alpha blockers

A patient has a potassium level of 6.0 and a digoxin level of 3.0 What medication would the nurse be giving: A. Digabind B. Sodium citrate C. Epinephrine D. Lidocaine

A. Digabind

Which statement by the patient reflects the need for additional patient education about the CCB diltiazem(Cardizem)? A. I can take this drug to stop acute anginal attacks B. I understand that food and antacids alter the absorption of this oral drug C. When the long-acting forms are taken, the drug cannot be crushed D. This drug may cause my blood pressure to drop, so I should be careful when getting up

A. I can take this drug to stop acute anginal attacks

When applying a nitro patch it should placed on A. Non hairy part of the chest B. thigh C. upper back D. buttocks

A. Non hairy part of the chest

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnose asthma. When teaching the patient about this drug, the nurse should explain that it may cause: A. Nasal congestion B. Nervousness C. Lethargy D. Hyperkalemia

Answer B. Albuterol may cause nervousness. The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia. Otther adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps.

Before administering ephedrine, Nurse Tony assesses the patient's history. Because of ephedrine's central nervous system (CNS) effects, it is not recommended for: A. Patients with an acute asthma attack B. Patients with narcolepsy C. Patients under age 6 D. Elderly patients

Answer D. Ephedrine is not recommended for elderly patients, who are particularly susceptible to CNS reactions (such as confusion and anxiety) and to cardiovascular reactions (such as increased systolic blood pressure, coldness in the extremities, and anginal pain). Ephedrine is used for its bronchodilator effects with acute and chronic asthma and occasionally for its CNS stimulant actions for narcolepsy. It can be administered to children age 2 and older.

When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse shoud alert the patient to watch for: A. Visual changes B. Flickering lights or halos C. Dizziness when standing up D. Increased urine output

B. Flickering lights or halos

Which of the following adverse effects is of most concern for the older adult patient taking antihypertensive drugs A. Dry mouth B. Hypotension C. Restlessness D. Constipation

B. Hypotension

A 68 year old man has been taking the nitrate isosorbide dinitrate for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil(Viagra). Which response would the nurse most likely hear from the prescriber? A. He will have to be switched to isosorbide mononitrate if he wants take sildenafil B. Taking sildenafil with the nitrate may result in severe hypotension C. I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose D. These drugs are compatible with each other, and so I'll write a prescription

B. Taking sildenafil with the nitrate may result in severe hypotension

When a patient is being taught abouut the potential adverse effects of an ACE inhibitor, which of the following should be mentioned as possibly occurring when this drug is taken to treat hypertension? A. Hypokalemia B. Nausea C. Dry, nonproductive cough D. Sedation

C. Dry, nonproductive cough

A nurse with adequate knowledge about the administration of IV nitroglycerin will recognize that which of the following statements is correct? A. The intravenous form is given by bolus injection B. Because the IV forms are short-lived, the dosing must be every 2 hours C. IV nitroglycerin must be protected from exposure to light throught use of special tubing D. IV nitroglycerin can be given via gravity drip infusions

C. IV nitroglycerin must be protected from exposure to light throught use of special tubing

A client with congestive heart failure is recieving digoxin. What is the desired effect: A. Neck vein distention B. Decreased appetite C. Increased urinary output D. Increased pedal edema

C. Increased urinary output

During assessment of a patient who is receiving digoxin, which finding would indicate an increased possiblility of toxicity? A. Apical pulse rate of 60 bpm B. Digoxin level of 1.5 C. Serum potassium level of 2.0 D. Serum potassium level of 4.8

C. Serum potassium level of 2.0

Before beginning oral digoxin therapy, the nurse would note that which of the gollowing drugs would cause a decrease in the absorption of the digoxin if the two are taken together? A. Loop diuretics B. Antidepressants C. Potassium D. Antidiarrheals

D. Antidiarrheals

While assessing a patient with angina who is to start Beta Blocker therapy, the nurse is aware that the presence of which conition may be a problem if these drugs are used: A. Hypertension B. Essential tremors C. Exertional angina D. Asthma

D. Asthma

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

a. "Apply the patch to a nonhairy area of the upper torso or arm."

A client is taking enoxaparin (Lovenox) daily. Which client statement requires additional monitoring? a. "I take aspirin daily for headaches." b. "I take ibuprofen (Motrin) at least once a week for joint pain." c. "Whenever I have a fever, I take acetaminophen (Tylenol)." d. "I take my medicine first thing in the morning."

a. "I take aspirin daily for headaches."

A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? a. Administer ordered dose of digoxin. b. Hold future digoxin doses. c. Administer potassium. d. Call the health care provider.

a. Administer ordered dose of digoxin.

Which is a priority nursing diagnosis for a client taking an antihypertensive medication? a. Alteration in cardiac output related to effects on the sympathetic nervous system b. Knowledge deficit related to medication regimen c. Fatigue related to side effects of medication d. Alteration in comfort related to nonproductive cough

a. Alteration in cardiac output related to effects on the sympathetic nervous system

A nurse is caring for a client who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? a. Call the health care provider to switch the medication. b. Assess the client for other symptoms of upper respiratory infection. c. Instruct the client to take antitussive medication until the symptoms subside. d. Tell the client that the cough will subside in a few days.

a. Call the health care provider to switch the medication.

A client with congestive heart failure, CHF, is prescribed digoxin (Lanoxin) and furosemide (Lasix). Nursing interventions will include: (Choose all that apply) a. Checking apical pulse before administering med. b. Encourage intake of water and fruit juices. c. Monitor serum electrolytes. d. Monitor Hemoglobin and Hematocrit levels. e. Restrict intake of green leafy vegetables.

a. Checking apical pulse before administering med. c. Monitor serum electrolytes. Rationale: Digoxin is a cardiac glycoside which can slow heart rate and an apical heart rate is checked prior to administration. Lasix is a loop diuretic used in treatment of CHF which promotes water loss, but also electrolytes. A low potassium level increases risk of digoxin toxicity. Fluids are often restricted with CHF. H and H level do not need to be checked and green leafy vegetables would not need to be restricted.

Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? a. Client states that she has no chest pain. b. Client states that the swelling in her feet is reduced. c. Client states the she does not feel dizzy. d. Client states that she feels stronger.

a. Client states that she has no chest pain.

When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

a. Coronary thrombosis b. Acute myocardial infarction c. Deep vein thrombosis (DVT) d. Cerebrovascular accident (CVA) (stroke) e. Venous disorders

The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug? a. Diuretic b. Alpha blocker c. ACE inhibitor d. Alpha/beta blocker

a. Diuretic

A client is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the client states, "There are yellow halos around the lights." Which action will the nurse take? a. Evaluate digoxin levels. b. Withhold the furosemide c. Administer potassium. d. Document the findings and reassess in 1 hour.

a. Evaluate digoxin levels.

A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin (Select all that apply.) a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. c. Apply Transderm-Nitro patch to a hairy area to protect skin from burning. d. Call the health care provider after taking 5 tablets if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

a. Have the client lie down when taking a nitroglycerin sublingual tablet. b. Teach client to repeat taking a tablet in 5 minutes if chest pain persists. e. Warn client against ingesting alcohol while taking nitroglycerin.

The nurse preparing to administer HCTZ (Hydrodiuril) 25 mg to a client with hypertension checks laboratory values and finds the potassium level is 2.8 mEq. The appropriate action is to: a. Hold the medication, and notify the health care provider. b. Administer the drug with orange juice. c. Administer the drug as ordered, and continue to monitor the potassium level. d. Give the client a banana, and recheck the potassium level.

a. Hold the medication, and notify the health care provider. Rationale: The normal serum potassium level is 3.5-5.0. HCTZ is a potassium-depleting drug. The drug should be held until a consultation with the health care provider takes place.

The nurse acknowledges that which condition could occur when taking furosemide? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

a. Hypokalemia

The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin? a. Increase the serum digoxin sensitivity level b. Decrease the serum digoxin sensitivity level c. Not have any effect on the serum digoxin sensitivity level d. Cause a low average serum digoxin sensitivity level

a. Increase the serum digoxin sensitivity level

Nursing interventions for a client receiving enoxaparin (Lovenox) may include: a. Teaching the client or family to give subcutaneous injections at home. b. Monitoring multiple lab tests. c. Teaching to observe for excessive bleeding. d. Monitoring for development of deep vein thrombosis.

a. Teaching the client or family to give subcutaneous injections at home. Rationale: Lovenox is a low-molecular weight heparin. This class of drug has fewer side effects, and is less likely to cause thrombocytopenia. Family and/or clients can be taught to give subcutaneous injections at home.

A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin? a. protamine sulfate b. vitamin K c. aminocaproic acid d. vitamin C

a. protamine sulfate

The client is using a H1 receptor antagonist. Which of the following statements indicates the client understands drug therapy? a. "I will use my bronchodilator if my wheezing increases." b. "I will report fever, blurred vision, or eye pain." c. "This is the only drug I will need to treat my asthma attacks." d. "I will use this drug only when I feel an attack coming on."

b. "I will report fever, blurred vision, or eye pain."

The client is receiving theophylline (Theo-Dur) for treatment of asthma. Nursing intervention is required if the client makes which of the following statements? a. "I will check my heart rate each day." b. "I will take my medicine with my coffee each morning." c. "I will notify my doctor if my vision changes." d. "I will use my inhaler if I am wheezing."

b. "I will take my medicine with my coffee each morning." Rationale: The methylxanthines comprise a group of bronchodilators chemically related to caffeine. Because of the drugs' chemical similarities, clients should avoid foods and beverages containing caffeine when taking these drugs.

The client is receiving an antitussive with codeine for treatment of a cough. Nursing intervention is required if the client makes which of the following statements? a. "I will avoid driving." b. "I will take my medicine with red wine, to help me sleep." c. "I will notify my doctor if my breathing changes." d. "I will keep this medication away from my children."

b. "I will take my medicine with red wine, to help me sleep."

A client is started on warfarin (Coumadin) therapy while still receiving intravenous heparin. The client questions the nurse about the risk for bleeding. How should the nurse respond? a. "Your concern is valid. I will call the doctor to discontinue the heparin." b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." c. "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." d. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."

b. "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic."

What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) and furosemide (Lasix) therapy? a. "Moderate doses of two different diuretics are more effective than a large dose of one." b. "This combination promotes diuresis but decreases the risk of hypokalemia." c. "This combination prevents dehydration and hypovolemia." d. "Using two drugs increases the osmolality of plasma and the glomerular filtration rate."

b. "This combination promotes diuresis but decreases the risk of hypokalemia."

A client has been admitted through the emergency department and requires emergency surgery. The client has been receiving heparin. What nursing intervention is essential? a. Teach the client about the phenytoin. b. Administer protamine sulfate. c. Assess the INR before surgery. d. Administer vitamin K.

b. Administer protamine sulfate.

A client who has been taking warfarin (Coumadin) is admitted with coffee-ground emesis. What is the nurse's primary action? a. Administer vitamin E. b. Administer vitamin K. c. Administer protamine sulfate. d. Administer calcium gluconate.

b. Administer vitamin K.

A client is ordered furosemide (Lasix) to be given via intravenous push. What interventions should the nurse perform? (Select all that apply.) a. Administer at a rate no faster than 20 mg/min. b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record. e. Monitor ECG continuously. f. Insert an arterial line for continuous blood pressure monitoring.

b. Assess lung sounds before and after administration. c. Assess blood pressure before and after administration. d. Maintain accurate intake and output record.

A client receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? a. Assess the client's lung sounds. b. Decrease the intravenous nitroglycerin by 10 mcg/min. c. Stop the nitroglycerin infusion for 1 hour, and then restart. d. Recheck the client's vital signs in 15 minutes but continue the infusion.

b. Decrease the intravenous nitroglycerin by 10 mcg/min.

The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by: a. Increasing preload. b. Decreasing afterload. c. Positive chronotropic effect. d. Positive inotropic effect.

b. Decreasing after load. Rationale: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand, and reduces frequency of anginal pain.

What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina? a. Discontinue drug if heart rate <60. b. Do not discontinue drug abruptly. c. Exercise heart rate should be 110-120. d. Monitor for hyperglycemia.

b. Do not discontinue drug abruptly. Rationale: Beta blocker treatment should never be abruptly discontinued. With abrupt cessation, a rebound excitation occurs, and adrenergic receptors are stimulated. This can exacerbate angina, increase heart rate, and cause myocardial infarction. Clients often tolerate heart rates as low as 50. The beta blocker might blunt the compensatory increase in heart rate with exercise. Hypoglycemia can occur.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide (HydroDIURIL)? a. Sodium level of 140 mEq/L b. Fasting blood glucose level of 140 mg/dL c. Calcium level of 9 mg/dL d. Chloride level of 100 mEq/L

b. Fasting blood glucose level of 140 mg/dL

When a client first takes a nitrate, the nurse expects which symptom that often occurs? a. Nausea and vomiting b. Headaches c. Stomach cramps d. Irregular pulse rate

b. Headaches

The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug? a. Heart rate 110 beats per minute b. Heart rate 58 beats per minute c. Urinary output 40 mL/hr d. Blood pressure 90/50 mm Hg

b. Heart rate 58 beats per minute

A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The appropriate nursing intervention is to: a. Hold the digoxin, and give HCTZ as ordered. b. Hold the digoxin and HCTZ. c. Document the findings; the lab results are within normal limits. d. Administer both drugs as ordered.

b. Hold the digoxin and HCTZ. Rationale: Thiazide diuretics increase serum digitalis levels by promoting potassium loss, which increases the risk of digoxin toxicity. A digitalis level above 2.0 ng is toxic.

The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition? a. Hypokalemia b. Hyperkalemia c. Hypoglycemia d. Hypermagnesemia

b. Hyperkalemia

A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur? a. Hypocalcemia b. Hypokalemia c. Hyperkalemia d. Hypermagnesemia

b. Hypokalemia

The nurse developing a teaching plan for a client receiving thiazide diuretics should include the following. a. Teaching client to take apical pulse. b. Including citrus fruits, melons, and vegetables in diet. c. Decreasing potassium rich food in diet. d. Teaching client to check blood pressure t.i.d.

b. Including citrus fruits, melons, and vegetables in diet. Rationale: Thiazide diuretics are potassium wasting and levels should be closely monitored. Encouraging foods rich in potassium could help maintain potassium levels. Taking an apical pulse is indicated before administering cardiac glycosides and beta blockers. It would not be necessary to check blood pressure TID unless client was experiencing hypotension.

The client is using intranasal sympathomimetics for treatment of nasal congestion. The nurse teaches that the use of this drug: a. Reduces mucus production. b. Is limited to 3-5 days for nasal congestion. c. Liquefies mucus. d. Reduces cough.

b. Is limited to 3-5 days for nasal congestion.

The nurse recognizes that the mechanism for action of beta-adrenergic blockers in the treatment of angina is: a. Positive chronotropic effect. b. Negative inotropic effect. c. Positive inotropic effect. d. Antidysrhythmia.

b. Negative inotropic effect. Rationale: Beta blockers decrease the workload of the heart by slowing heart rate (negative chronotropic effect) and reducing contractility (negative inotropic effect).

Warfarin (Coumadin) is prescribed to treat clotting following a surgery. Which of the following findings requires immediate nursing intervention? a. INR of 3.0 b. Positive Homans' sign c. Tylenol (acetaminophen) prescribed for headache d. Urinary output 1,000 ml/day

b. Positive Homans' sign Rationale: Changes in peripheral pulses, paresthesias, positive Homans' sign, and prominence of superficial veins indicate clotting occurring in peripheral arterial or venous vasculature. International Normalized Ratio is used to indicate therapeutic range, and 2.0 is indicative that therapy is adequate.

The client is using a beta-adrenergic agonist for treatment of asthma. The nurse teaches that the action of this drug is: a. Reducing mucus production. b. Relaxing smooth muscle, causing bronchodilation. c. Liquefying mucus. d. Reducing cough.

b. Relaxing smooth muscle, causing bronchodilation.

A client is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this client? a. Assessment of blood glucose levels b. Respiratory assessment c. Orthostatic blood pressure assessment d. Teaching about potential tachycardia

b. Respiratory assessment

The nurse reviews lab studies of a client receiving digoxin (Lanoxin). Intervention by the nurse is required if the results include a a. Serum digoxin level of 1.2 ng/dl. b. Serum potassium level of 3.0 mEq/L. c. Hemoglobin 14.4 g/dL. d. Serum sodium level of 140 mEq/L.

b. Serum potassium level of 3.0 mEq/L. Rationale: Normal serum potassium level is 3.5-5.0 mEq/L. Hypokalemia may predispose the client to digitalis toxicity. The other lab values are WNL.

The client is prescribed a beta-blocker as adjunct therapy to treatment of heart failure. The nurse recognizes that beta blockers act by a. Increasing contractility and cardiac output. b. Slowing the heart and decreasing afterload. c. Decreasing peripheral resistance. d. Decreasing preload.

b. Slowing the heart and decreasing after load. Rationale: Beta-blockers improve symptoms of HF by slowing heart rate and decreasing blood pressure. The decreased afterload causes decreased workload on the heart.

A client who is taking warfarin (Coumadin) requests an aspirin for headache relief. What is the nurse's best response? a. Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 minutes. b. Teach the client of potential drug interactions with anticoagulants. c. Explain to the client that ASA is contraindicated and administer ibuprofen as ordered. d. Explain that the headache is an expected side effect and will subside shortly.

b. Teach the client of potential drug interactions with anticoagulants.

The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker? a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed. b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down. c. The beta blocker dose should be maintained while taking another antianginal drug. d. Half the beta blocker dose should be taken for the next several weeks.

b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.

The nurse reviews a client's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 5.9 mEq/L. What is the nurse's primary intervention? a. To administer atropine b. To administer digoxin immune FAB c. To administer epinephrine d. To administer Kayexalate

b. To administer digoxin immune FAB

The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? a. chlorthalidone b. hydrochlorothiazide c. bendroflumethiazide d. potassium-sparing diuretic

b. hydrochlorothiazide

A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? a. enoxaparin sodium (Lovenox) b. warfarin (Coumadin) c. bivalirudin (Angiomax) d. lepirudin (Refludan)

b. warfarin (Coumadin)

The client receiving heparin therapy asks how the "blood thinner" works. The best response by the nurse would be: a. "Heparin makes the blood less viscous." b. "Heparin dissolves the clot." c. "Heparin does not thin the blood, but prevents platelets from clotting" d. "Heparin decreases the number of platelets, so that blood clots slower."

c. "Heparin does not thin the blood, but prevents platelets from clotting" Rationale: Anticoagulants do not change the viscosity of the blood. Instead, anticoagulants exert a negative charge on the surface of the platelets, so that clumping or aggregation of cells is inhibited.

A client is receiving warfarin (Coumadin) for a chronic condition. Which client statement requires immediate action by the nurse? a. "I will avoid contact sports." b. "I will take my medication in the early evening each day." c. "I will increase dark-green, leafy vegetables in my diet." d. "I will contact my health care provider if I develop excessive bruising."

c. "I will increase dark-green, leafy vegetables in my diet."

The client is prescribed digoxin (Lanoxin) for treatment of HR. Which of the following statements by the client indicates the need for further teaching by the nurse? a. "I may notice my heart rate decrease." b. "I may feel tired during early treatment." c. "This drug will help my heart muscle pump less." d. "I should not get short of breath anymore."

c. "This drug will help my heart muscle pump less." Rationale: The ability to increase the strength of contractions is a characteristic of cardiac glycosides. It may result in a decrease in pulse. Initially the client may experience some fatigue. Symptoms of CHF, such as dyspnea, should improve.

Nursing intervention for a client on an expectorant includes: a. Assessing liver function tests. b. Assessing of cardiac dysrhythmias. c. Assessing for signs of increased sputum production. d. Monitoring blood glucose for hypoglycemia.

c. Assessing for signs of increased sputum production.

The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day.

c. Bleeding may increase when taken with aspirin.

The client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow-up. Which of the following objective data should the nurse consider when determining the effectiveness of the drug therapy? a. Absence of edema in lower extremities b. Weight loss of six pounds in the past month c. Blood pressure log notes blood pressure 120/70-134/88 since discharge. d. Frequency of voiding of at least six times per day

c. Blood pressure log notes blood pressure 120/70-134/88 since discharge. Rationale: Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the best measure of the drug's effectiveness for hypertension.

The nurse determines that treatment of a client with a beta-adrenergic blocker for myocardial infarction has been effective when: a. Tachycardia occurs. b. Blood pressure is 90/50. c. Decreased dysrhythmias occur. d. Decreased urinary output occurs.

c. Decreased dysrhythmias occur. Rationale: Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. Tachycardia would not be desired with an MI. A low BP alone would not indicate effective treatment of the MI.

The client's serum digoxin level is 2.2ng/dl and the heart rate is 120 and irregular. The nurse expects to administer which of the following drugs? a. Potassium 40 mEq added to I.V. fluids b. Digoxin 0.5mg bolus I.V. c. Digoxin immune Fab (Digibind) d. Furosemide (Lasix) 60 mg I.V.

c. Digoxin immune Fab (Digibind) Rationale: Digibind binds and removes digoxin from the body and prevents toxic effects of digoxin overdose. A serum level of 2.2 is elevated and client is exhibiting signs of digoxin toxicity. The question does not indicate potassium level is low. Giving additional digoxin would exacerbate the toxicity. Giving Lasix may reduce potassium levels and contribute to increased toxicity.

A client taking spironolactone (Aldactone) has been taught about the therapy. Which menu selection indicates that the client understands teaching related to this medication? a. Apricots b. Bananas c. Fish d. Strawberries

c. Fish

What would cause the same client's electrolyte imbalance? a. High dose of digoxin b. Digoxin taken daily c. Hydrochlorothiazide d. Low dose of hydrochlorothiaizde

c. Hydrochlorothiazide

A calcium channel blocker has been ordered for a client. Which condition in the client's history is a contraindication to this medication? a. Hypokalemia b. Dysrhythmias c. Hypotension d. Increased intracranial pressure

c. Hypotension

A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug? a. Thiazide diuretic b. Osmotic diuretic c. Loop diuretic d. Potassium-sparing diuretic

c. Loop diuretic

A client with acute pulmonary edema receives furosemide (Lasix). What assessment finding indicates that the intervention is working? a. Potassium level decreased from 4.5 to 3.5 mEq/L. b. Crackles auscultated in the bases. c. Lungs clear. d. Output 30 mL/hr.

c. Lungs clear.

A client is being started on lisinopril (Zestril). Nursing interventions during initial therapy with this medication must include a. Monitoring EKG. b. Monitoring intake and output. c. Monitoring blood pressure. d. Monitoring serum levels.

c. Monitoring blood pressure. Rationale: Lisinopril is an ACE Inhibitor, which can cause severe hypotension with initial doses. The nurse should monitor the client closely for several hours.

Alteplase (Activase) is prescribed for a client with an acute myocardial infarction. Priority nursing action includes: a. Monitoring APTT. b. Monitoring PT, INR. c. Monitoring level of consciousness (LOC). d. Monitoring injection sites.

c. Monitoring level of consciousness (LOC). Rationale: Thrombolytics will dissolve any clots they encounter. Cerebral hemorrhage is a major concern, so the nurse must assess the level of consciousness and neurological status.

A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: a. Dilating peripheral blood vessels. b. Removing serum potassium. c. Reducing sympathetic outflow. d. Constricting blood vessels.

c. Reducing sympathetic outflow. Rationale: Diuretics decrease blood volume, which in turn decreases the workload of the heart and reduces blood pressure. They do not dilate blood vessels. Some diuretics promote potassium loss, but this does not reduce the blood pressure. Central-acting antihypertensives work by blocking sympathetic outflow.

A nurse admits a client diagnosed with pneumonia. The client has a history of chronic renal insufficiency, and the health care provider orders furosemide (Lasix) 40 mg twice a day. What is most important to include in the teaching plan for this client? a. That the medication will have to be monitored very carefully owing to the client's diagnosis of pneumonia. b. The fact that Lasix has been proven to decrease symptoms with pneumonia. c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency. d. That the medication will need to be given at a higher than normal dose owing to the client's medical problems.

c. The fact that Lasix has shown efficacy in treating persons with renal insufficiency.

A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery? a. Anticoagulant agent b. Antiplatelet agent c. Thrombolytic agent d. Low-molecular-weight heparin (LMWH)

c. Thrombolytic agent

Which of the following is the most important baseline value prior to initiation of diuretic therapy? a. Glucose level b. Amino acids c. Water d. Sodium bicarbonate

c. Water Rationale: Although many baseline values are important, blood pressure (sitting and supine) can indicate excessive diuresis, which can result in dehydration and hypovolemia.

Which statement made by the client demonstrates a need for further instruction regarding the use of nitroglycerin? a. "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." b. "I should keep my nitroglycerin in a cool, dry place." c. "I should change positions slowly to avoid getting dizzy." d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

d. "I can take up to five tablets at 3-minute intervals for chest pain if necessary."

Which statement indicates to the nurse that the client understands sublingual nitroglycerin medication instructions? a. "I will take up to five doses every 3 minutes for chest pain." b. "I can chew the tablet for the quickest effect." c. "I will keep the tablets locked in a safe place until I need them." d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

d. "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."

The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? a. "I will double my dose if I forget to take it the day before." b. "I should keep taking ibuprofen for my arthritis." c. "I should decrease the dose if I start bruising easily." d. "I should use a soft toothbrush for dental hygiene."

d. "I should use a soft toothbrush for dental hygiene."

What statement is the most important for the nurse to include in the teaching plan for a client who has started on a transdermal nitroglycerin patch? a. "This medication works faster than sublingual nitroglycerin works." b. "This medication is the strongest of any nitroglycerin preparation available." c. "This medication should be used only when you are experiencing chest pain." d. "This medication will work for 24 hours and you will need to change the patch daily."

d. "This medication will work for 24 hours and you will need to change the patch daily."

The nurse is monitoring a client during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? a. Blood pressure 110/90 mm Hg b. Flushing c. Headache d. Chest pain

d. Chest pain

A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? a. Blood pressure 120/80 mm Hg b. Heart rate 70 beats per minute c. ECG without evidence of ST changes d. Client stating that pain is 0 out of 10

d. Client stating that pain is 0 out of 10

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? a. Dilating just the coronary arteries b. Decreasing the blood pressure c. Increasing contractility of the heart d. Dilating arteries and veins

d. Dilating arteries and veins Rationale: Organic nitrates relax both arterial and venous smooth muscle. This in turn decreases myocardial oxygen demand by decreasing heart rate, decreasing preload, decreasing contractility, and decreasing afterload. The blood pressure might decrease secondary to venous vasodilation, but this is not the primary way in which angina is relieved.

The nurse completes a physical assessment on the client receiving heparin therapy for DVT. The client complains of severe lumbar pain. The appropriate action by the nurse is to: a. Reposition the client to promote comfort. b. Document the finding, and report it to the next shift. c. Administer pain medication. d. Evaluate further; this could indicate a complication of drug therapy.

d. Evaluate further; this could indicate a complication of drug therapy. Rationale: A major side effect of heparin is bleeding. Lumbar pain and unilateral abdominal wall bulges or swelling could indicate retroperitoneal hemorrhage.

Lisinopril (Prinivil) is part of the treatment regimen for a client with HF. The nurse monitors the client for which electrolyte imbalance of this drug ? a. Hyponatremia. b. Hypernatremia. c. Hypokalemia. d. Hyperkalemia.

d. Hyperkalemia. Rationale: ACE inhibitors block aldosterone secretion, which results in sodium loss and potassium retention. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium sparing diuretics.

The nurse recognizes the action of beta blockers for treatment of dysrhythmias is: a. Positive inotropic effect. b. Negative inotropic effect. c. Positive chronotropic effect. d. Negative chronotropic effect.

d. Negative chronotropic effect. Rationale: Beta blockers slow the heart rate (negative chronotropic effect) and decrease conduction velocity through the AV node.

Client teaching for clients on long-term therapy with beta-adrenergic agonists for treatment of asthma should include: a. Discontinuing the drug if the heart rate increases. b. Monitoring intake and output. c. Reducing the dosage of the drug if insomnia occurs. d. Notifying the physician if the drug no longer seems effective.

d. Notifying the physician if the drug no longer seems effective.

A nurse teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels? a. Hemoglobin and hematocrit b. Blood urea nitrogen (BUN) c. Arterial blood gases d. Serum glucose (sugar)

d. Serum glucose (sugar)

The nurse is reviewing a medication history on a client taking an ACE inhibitor. The nurse plans to contact the health care provider if the client is also taking which medication? a. docusate sodium (Colace) b. furosemide (Lasix) c. morphine sulfate d. spironolactone (Aldactone)

d. spironolactone (Aldactone)