Chapters 15, 16, 37-39

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? A). Dopamine B). Acetylcholine C). Cholinesterase D). Monoamine oxidase

Acetylcholine

What electrolyte change should you be on the look out for when you first start ACE inhibitors on your patient?

Hyperkalemia

What do the loop diuretics block?

The entire loop of Henle

What do potassium-sparing diuretics ultimately block to increase urine output?

They block aldosterone in the collecting ducts

A patient is prescribed chlorthalidone. What is the most important information the nurse will teach the patient? A). "Do not drink more than 10 ounces of fluid a day while on this medication." B). "Take this medication on an empty stomach." C). "Take this medication before bed each night." D). "Wear protective clothing and sunscreen while taking this medication."

"Wear protective clothing and sunscreen while taking this medication." Rationale: Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.

Which patient's urinary output would you call the physician about if they are on Lasix?

25 ml per hour for the last 4 hours

The patient's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? A). It is in the high (elevated) range. B). It is in the low (decreased) range. C). It is within normal range. D). It is in the low-average range.

It is in the high (elevated) range

A nurse is caring for a patient receiving acetazolamide. Which assessment finding will require immediate nursing intervention? A). A decrease in bicarbonate level B). An increase in urinary output C). A decrease in arterial pH D). An increase in PaO2

A decrease in arterial pH Rationale: Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.

The nurse is administering atenolol to a patient. Which concurrent drugs does the nurse expect to most likely cause an interaction? (SELECT ALL THAT APPLY). A). Ginseng supplement B). A nonsteroidal antinflammatory drug, such as aspirin C). Atropine, an anticholinergic D). Haloperidol E). Methyldopa

A nonsteroidal antinflammatory drug, such as aspirin Atropine, an anticholinergic

What is a priority nursing diagnosis for a patient 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

Alteration in cardiac output related to effects on the sympathetic nervous system Rationale: Circulation is always a priority over fatigue, pain, and knowledge deficit.

The patient is receiving digoxin for treatment of HF. Which finding would suggest to the nurse that the HF is improving? A). Pale and cool extremities B). Absence of peripheral edema C). Urine output of 60ml every 4 hours D). Complaints of increasing dyspnea

Absence of peripheral edema

A patient is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action? A). Monitor urinary output. B). Insert a large-bore IV catheter. C). Attach patient to telemetry monitor. D). Administer ordered anticholinergic medication.

Administer ordered anticholinergic medication. Rationale: An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.

A patient's serum digoxin level is noted to be 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.

Administer ordered dose of digoxin Rationale: Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.

What is an angiotension receptor blocker actually blocking?

Angiotension II

When angiotension I goes to the lungs through the blood stream, what is the enzyme called? A). Antidiuretic hormone B). Angiotension II C). Renin D). Angiotension converting enzyme

Angiotension converting enzyme

If the patient is experiences a consistent dry cough, which medication class can we switch to?

Angiotension receptor blockers (ARBs)

The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administration? A). Urine output B). Apical pulse C). Potassium level D). Serum level of medication

Apical pulse

Your patient has been put on Lasix. What food and why would you tell them to increase?

Bananas or other potassium containing foods due to potential for hyopkalemia

Why is an increased potassium level something to watch for when starting an ACE inhibitor?

Because blocking the ACE increases the K+ reabsorption as well, which increases the serum potassium level

Why doesn't an ARB cause a dry cough (like ACE inhibitors do)?

Because it's not blocking the ACE that's located in the lungs, it's blocking the next step (Angiotension II) of the Renin Angiotension Aldosterone system

Why is a dry cough a common side effect of ACE inhibitors?

Because the ACE is located in the lungs, which increases the bradykinins in the lungs (which is an inflammatory agent)

An African American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African American patients? A). Diuretics B). Calcium channel blockers C). Beta blockers and angiotensin-converting enzymes inhibitors D). Alpha blockers

Beta blockers and angiotensin-converting enzymes inhibitors

The beta blocker acebutolol is prescribed for dysrhythmias. What is the primary purpose of the drug? A). Increase beta1 and beta2 receptors in cardiac tissues B). Increase the flow of oxygen to cardiac tissues C). Block beta1 -adrenergic receptors in cardiac tissues D). Block beta2 -adrenergic receptors in cardiac tissues

Block beta1 -adrenergic receptors in cardiac tissues

Before and after the first dose, what's a good thing to assess on your patient?

Blood pressure

A nurse is monitoring a patient receiving atropine. Which finding requires nursing action? A). Heart rate of 60 beats/min B). Nasal congestion C). Blood pressure of 90/40 mm Hg D). Dilated pupils

Blood pressure of 90/40 mm Hg Rationale: Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.

The nurse teaches the patient receiving atropine to expect which side effect? A). Diarrhea B). Bradycardia C). Blurred vision D). Frequent urination

Blurred vision

A patient is prescribed metoprolol to treat hypertension. It is important for the nurse to monitor the patient for which condition? (SELECT ALL THAT APPLY). A). Bradycardia B). Hypotension C). Ankle edema D). Decreased respirations E). Increased respirations

Bradycardia Hypotension

Nadolol is prescribed for a patient. The nurse realizes that this drug is a beta-adrenergic blocker and that this drug classification is contraindicated for patients with which condition? A). Hypothyroidism B). Angina pectoris C). Bronchial asthma D). Liver dysfunction

Bronchial asthma

How do ARBs increase the water excretion and therefore decrease the circulating blood volume (which ultimately decrease blood pressure and cardiac workload)?

By decreasing ADH secretion from the pituitary gland

The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is ordered a nonselective beta blocker. What is the nurse's primary intervention? A). Assess the heart rate before administration. B). Maintain the patient on intake and output. C). Make sure the patient is on telemetry monitoring. D). Call the health care provider to request a different medication.

Call the health care provider to request a different medication. Rationale: Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The patient could receive a selective beta blocker instead. The nurse should make the health care provider aware of the patient's history of respiratory disease.

A nurse is caring for a patient 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 patient for other symptoms of upper respiratory infection. C). Instruct the patient to take antitussive medication until the symptoms subside. D). Tell the patient that the cough will subside in a few days.

Call the health care provider to switch the medication. Rationale: Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.

The nurse is monitoring a patient 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

Chest pain Rationale: The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.

Captopril has been ordered for a patient. The nurse should teach the patient that the most commonly occurring side effect of an angiotensin-converting enzyme drug is which of the following? A). nausea and vomitting B). dizziness and headaches C). upset stomach D). Constant, irritating cough

Constant, irritating cough

ACE inhibitors

Decrease Na+ and water reabsorption

A patient is prescribed a beta blocker. Beta blockers are as effective as antianginals because they do what? A). Increase oxygen to the systemic circulation B). Maintain heart rate and blood pressure C). Decrease heart rate and decreased myocardial contractility. D). Decrease heart rate and increase myocardial contractility.

Decrease heart rate and decreased myocardial contractility.

The nurse monitors a patient prescribed dicyclomine for which therapeutic effect? A). Decrease in GI motility B). Decrease in urinary frequency C). Increase in heart rate D). Increase in blood pressure

Decrease in GI motility Rationale: Dicyclomine is an antispasmodic cholinergic blocker used to decrease GI motility in patients with functional GI disorders such as irritable bowel syndrome.

A patient 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 patient's lung sounds. B). Decrease the intravenous nitroglycerin by 10 mcg/min. C). Stop the nitroglycerin infusion for 1 h and then restart. D). Continue the infusion and recheck the patient's vital signs in 15 min.

Decrease the intravenous nitroglycerin by 10 mcg/min. Rationale: Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion.

The nurse notes that the patient is receiving hydrochlorothiazide for hypertension. Which additional medication in the patient's drug regimen would cause concern on the part of the nurse? A). Maalox B). Digoxin C). Nitroglycerine D). Albuterol

Digoxin Rationale: Of the numerous thiazide drug interactions with hydrochlorothiazide, the most serious occurs with digoxin. Thiazides can cause hypokalemia, which enhances the action of digoxin, and digitalis toxicity can occur.

Which 2 meds can cause a toxicity effect with diuretics?

Digoxin and lithium

A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient's BP might be which drug? A). Diuretic B). Alpha blocker C). Angiotensin-converting enzyme inhibitor D). Alpha/beta blocker

Diuretic

A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient? A). Blood pressure measurement B). BUN and creatinine C). ECG and palpitations D). Lung sounds

ECG and palpitations Rationale: Ibutilide is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm and to watch for palpitations.

Which agent would the nurse expect to be ordered to facilitate the diagnosis of myasthenia gravis? A). Ambenonium chloride B). Edrophonium chloride C). Neostigmine methylsulfate D). Physostigmine salicylate

Edrophonium chloride Rationale: Edrophonium is the drug of choice to assist in the diagnosis of myasthenia gravis.

A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, 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 h.

Evaluate digoxin levels. Rationale: Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient's digoxin levels.

Calcium channel blockers will increase the effectiveness of IV calcium. True or false?

False

The main mechanism of action for loop diuetics is they block the re-absorption of sodium, water, magnesium, and chloride. True or false?

False - prevents the re-absorption of sodium, water, and chloride.

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? 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

Fasting blood glucose level of 140 mg/dL Rationale: Hydrochlorothiazide can cause hyperglycemia. Normal calcium level is approximately 8.8-10.3 mg/dL; normal sodium level is 135-147 mEq/L; normal chloride level is 95-107 mEq/L, and normal fasting blood glucose should be 60-110 mg/dL.

Which loop diuretic do many physicians use to treat HTN?

Furosemide (Lasix)

Which juice should you tell your patient to avoid when taking calcium channel blockers because it infers with their efficacy?

Grapefruit juice

A patient takes an initial dose of a nitrate. Which symptom(s) will the nurse expect to occur? A). Nausea and vomitting B). Headaches C). Stomach cramps D). Irregular pulse rate

Headaches

Like ACE inhibitors, ARBs are very effective in treating

Heart failure

A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? A). Hypokalemia B). Dysrhythmias C). Hypotension D). Increased intracranial pressure

Hypotension Rationale: Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.

Which is a priority nursing diagnosis for a patient receiving an anticholinergic (parasympatholytic) medication? A). Impaired gas exchange related to thickened respiratory secretions B). Knowledge deficit related to pharmacologic regimen C). Risk for injury related to excessive CNS stimulation D). Urinary retention related to loss of bladder tone

Impaired gas exchange related to thickened respiratory secretions Rationale: Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

Which finding would indicate to the nurse that a medication has activated alpha1 receptors? A). Increase in blood pressure B). Pupillary constriction C). Bradycardia D). Increased saliva production

Increase in blood pressure

A patient is given epinephrine, an adrenergic agonist (sympathomimetic). The nurse should monitor the patient for which condition? A). Decreased pulse B). Pupil constriction C). Bronchial constriction D). Increased blood pressure

Increased blood pressure

The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect? A). Increased gastrointestinal (GI) motility B). Mydriasis C). Urinary retention D). Vasoconstriction

Increased gastrointestinal (GI) motility Rationale: Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.

The nurse realizes that the beta1 receptor stimulation is differentiated from beta2 stimulation in that stimulation of beta1 receptors leads to which conditions? A). Increased bronchodilation B). Decreased uterine contractility C). Increased myocardial contractility D). Decreased blood flow to skeletal muscles

Increased myocardial contractility

The nurse is administering bethanechol, a cholinergic agonist, and should know that the expected cholinergic effects include which of the following? A). Increased heart rate B). Decreased peristalsis C). Decreased salivation D). Increased pupil constriction

Increased pupil constriction

A patient is taking a potassium-depleting diuretic and digoxin. The nurse expects that a low K level (hypokalemia) could have what effect on digoxin? A). Increases serum digoxin sensitivity level B). Decreases serum digoxin sensitivity level C). No effect on serum digoxin sensitivity level D). Causes a low-average serum digoxin sensitivity level

Increases serum digoxin sensitivity level

When you block the ACE, a decrease in vasoconstriction results, therefore making

It easier for the heart to pump blood because the blood pressure has been decreased

When you block the ACE, what happens to the potassium level?

It goes up

Please list the diuretics from strongest to weakest.

Loop, thiazide, Potassium-sparing

Which assessment finding will alert the nurse to suspect early digitalis toxicity? A). Loss of appetite with slight bradycardia B). Blood pressure of 90/60 mm Hg C). Heart rate of 110 beats/min D). Confusion and diarrhea

Loss of appetite with slight bradycardia Rationale: Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.

A patient with acute pulmonary edema is receiving furosemide. What assessment finding indicates to the nurse that the intervention is working? A).Potassium level decreased from 4.5-3.5 mEq/L B). Improvement in mental status C). Lungs clear to auscultation D). Output 30 mL/h

Lungs clear to auscultation Rationale: Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.

Which adverse reaction will the nurse monitor for in a patient taking bethanechol for treatment of urinary retention? A). Constipation B). Hypertension C). Muscle weakness D). Tachycardia

Muscle weakness Rationale: Adverse reactions to bethanechol include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness.

Which is the only calcium channel blocker that crosses the blood brain barrier and will prevent vasospasms in the brain?

Nimodopine

The patient taking methyldopa has elevated liver function tests. What is the nurse's best action? A). Document the finding and continue care. B). Notify the health care provider. C). Immediately stop the medication. D). Change the patient's diet.

Notify the health care provider. Rationale: This drug should not be used in patients with impaired liver function. The nurse should notify the health care provider so that the patient can be tapered off the medication. The nurse should not immediately stop this medication, as the patient could have a hypertensive crisis. The patient's diet is not the cause of elevated liver enzymes and should not make a difference with therapy.

The nurse will monitor the patient taking albuterol for which of the conditions? (SELECT ALL THAT APPLY.) A). Palpitations B). Hypertension C). Hypoglycemia D). Bronchospasm E). Uterine contractions

Palpitations Hypertension Bronchospasm

When benztropine is ordered for a patient, the nurse acknowledges that this drug is an effective treatment for which condition? A). Parkinsonism B). Paralytic ileus C). Motion sickness D). Urinary retention

Parkinsonism

Which patient who has recently started lasix would you be most concerned about?

Patient with ringing in ears

Which is the highest priority nursing intervention for a patient who is starting on metoprolol? A). Peripheral pulses B). Respiratory rate C). Urinary retention D). Lung sounds

Peripheral pulses Rationale: Decreased cardiac output puts the patient at highest risk. This will be evident by the assessment of peripheral pulses.

Which diuretic is the weakest? Loop, Potassium sparing, or Thiazide

Potassium sparing

Which diuretic excretes sodium and water, and re-absorbs potassium?

Potassium-sparing diuretics

A patient has HF, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide? A). A decrease in level of consciousness occurs, and the patient sleeps more. B). Respiratory rate decreases from 28/min to 20/min and the depth increases C). Increased congestion is heard in breath sounds, and the patient complains of shortness of breath D). Urine output is 50ml/4h and intake is 200 ml

Respiratory rate decreases from 28/min to 20/min and the depth increases

Where are calcium channels?

SA Node, AV node, cardiac myocytes, and vascular smooth muscle

What do thiazide diuretics ultimately block to increase urine output?

Sodium chloride cotransporter

The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication? A). Docusate sodium B). Furosemide C). Morphine sulfate D). Spironolactone

Spironolactone Rationale: ACE inhibitors 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 and should not be administered with an ACE inhibitor.

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? A). Apply a cold pad to the site. B). Pull the IV immediately. C). Elevate the patient's extremity. D). Stop the infusion.

Stop the infusion. Rationale: The nurse's first action is to stop the infusion, followed by infusing phentolamine into the area to counteract vasoconstrictive effects of the dopamine.

The health care provider is planning to discontinue a patient's beta blocker. Which instruction will the nurse give the patient 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 anitanginal drug D). Half the beta blocker dose should be taken for the next several weeks

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

When calcium enters the cell, what does it cause?

The contraction of those muscles or electrical activity

The nurse administered donepezil to a patient. Which finding indicates that the medication is therapeutic? A). The patient is relaxed. B). The patient has increased cognition. C). The patient is awake. D). The patient has urinated.

The patient has increased cognition. Rationale: Donepezil is used to treat Alzheimer disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

The nurse is caring for a patient who is prescribed propranolol. Which assessment finding will reveal if the medication is having a therapeutic effect? A). The patient's lung sounds are clear. B). The patient is in sinus rhythm. C). The patient has strong peripheral pulses. D). The patient's blood pressure is 130/75 mm Hg.

The patient's blood pressure is 130/75 mm Hg. Rationale: Propranolol is nonselective—it blocks both beta

What is the best information for the nurse to provide to the patient who is receiving spironolactone 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.

This combination promotes diuresis but decreases the risk of hypokalemia. Rationale: Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient.

For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose? A). To decrease serum potassium level B). To increase serum potassium level C). To decrease glucose level D). To increase glucose level

To increase serum potassium level

All calcium channel blockers that end with -dipine (examples: Amlodpine, Nicardipene, etc.) work only on the vessels. They will decrease the blood pressure, but will not decrease the heart rate. True or false?

True

Diltiazem and Verapamil will work both on the heart and vessels (and therefore will also decrease the heart rate). True or false?

True

Which assessment most assists the nurse in determining if bethanechol has had a therapeutic effect? A). Neurologic assessment B). Muscular assessment C). Urinary assessment D). Gastric assessment

Urinary assessment Rationale: This medication increases the tone of the detrusor muscle and causes the patient to void.

A patient is receiving bethanechol. The nurse realizes that the action of this drug is to treat which condition? A). Glaucoma B). Urinary retention C). Delayed gastric emptying D). Gastroesophageal reflux disease

Urinary retention

When the sympathetic activity is increased by the presence of angiotension converting enzyme, what is the effect on the body? A). Decreased level of consciousness B). Decreased blood volume C). Vasodilation, decreased blood pressure D). Vasoconstriction, increased blood pressure

Vasoconstriction, increased blood pressure

By blocking calcium from entering the cell (which is why they are called calcium channel blockers) and preventing muscular contraction and slow electrical impulses, what response will we see in the patient?

Vasodilatation and lower blood pressure, decreased heart rate

The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? A). Weak peripheral pulses and decreased heart rate. B). Increased peripheral pulses and increased heart rate C). Stable blood pressure and increased cardiac output. D). Heart rate of 95 beats per minute and strong peripheral pulses.

Weak peripheral pulses and decreased heart rate. Rationale: Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.

A patient is prescribed losartan. The nurse teaches the patient that an angiotension II-receptor blocker acts by doing what? A). inhibiting angiotensin-converting enzyme B). blocking angiotensin II from angiotensin I receptors C). preventing the release of angiotensin I D). Promoting the release of aldosterone

blocking angiotensin II from angiotensin I receptors

During an admission assessment, a patient states that she takes amlodpine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of a calcium channel blocker? (SELECT ALL THAT APPLY) A). insomnia B). dizziness C). headache D). angioedema E). ankle edema F). hacking cough

dizziness, headache, ankle edema

A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? A). "Apply the patch to a non-hairy 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."

"Apply the patch to a non-hairy area of the upper torso or arm." Rationale: A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

Which statement made by the patient 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."

"I can take up to five tablets at 3-minute intervals for chest pain if necessary." Rationale: Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.

Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? A). "I will take up to five doses every 3 min 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."

"I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness." Rationale: Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 min apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.

What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? A). "I will check my blood pressure daily and take my medication when it is over 140/90." B). "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." C). "I will change my position slowly to prevent feeling dizzy." D). "I will not mow my lawn until I see how this medication makes me feel."

"I will check my blood pressure daily and take my medication when it is over 140/90." Rationale: Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates that he will take rest periods and change positions slowly to avoid orthostatic hypotension, he is demonstrating compliance with the treatment regimen.

The nurse is preparing to discharge a patient who is receiving acebutolol HCl. Which instruction will the nurse include in the medication teaching plan for this patient? A). "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." B). "If you become dizzy, do not take your medication for 2 days and then restart on the third day." C). "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." D). "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." Rationale: Acebutolol HCl, a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before acebutolol is administered to a patient with bradycardia (heart rate less than 60 beats/min).

The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A). "You can protect it from heat by placing the bottle in an ice chest." B). "It's best to keep it in its original container away from heat and light." C). "You can put a few tablets in a resealable bag and carry in your pocket." D). "It's best to lock them in the glove compartment to keep them away from heat and light."

"It's best to keep it in its original container away from heat and light." Rationale: Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.

A patient is ordered furosemide to be given via intravenous push. Which interventions will 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 the electrocardiogram continuously. F). Insert an arterial line for continuous blood pressure monitoring.

- Administer at a rate no faster than 20 mg/min. - Assess lung sounds before and after administration. - Assess blood pressure before and after administration. - Maintain accurate intake and output record. Rationale: Furosemide can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor the electrocardiogram because the medication is not cardiotoxic.

A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (SELECT ALL THAT APPLY) A). Have the patient sit or lie down when taking a nitroglycerin sublingual tablet. B). Teach the patient who has taken a tablet to call 911 in 5 mins if chest pain persists. C). Apply the nitroglycerin 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 the patient against ingesting alcohol while taking nitroglycerin.

- Have the patient sit or lie down when taking a nitroglycerin sublingual tablet. - Teach the patient who has taken a tablet to call 911 in 5 mins if chest pain persists. - Warn the patient against ingesting alcohol while taking nitroglycerin.

The patient is caring for the patient receiving nitroprusside. Which interventions should be included in the nurse's plan of care? (SELECT ALL THAT APPLY) A). Monitor for thiocyanate levels. B). Protect fluid bag from light. C). Provide continuous blood pressure monitoring. D). Monitor potassium levels. E). Assess chest pain level

- Monitor for thiocyanate levels. - Protect fluid bag from light. - Provide continuous blood pressure monitoring. Rationale: Nitroprusside is used for hypertensive emergencies as well as emergency management for heart failure. The drug can be administered over 24 h but decomposes in light, so the container must be wrapped in opaque material, such as aluminum foil. Discard drug if red, green, or blue. Measure cyanide and thiocyanate levels. May cause confusion, hypotension, bradycardia, tachycardia, dizziness, headache, palpitations, ataxia, seizures, cyanide or thiocyanate toxicity, and methemoglobinemia.

A patient's BP is 130/84. The health care provider plans to suggest nonpharmacologic methods to lower BP. Which should the nurse include in the teaching? (SELECT ALL THAT APPLY) A). Stress-reduction techniques B). An exercise program C). Salt restriction D). Smoking cessation E). A diet with increased protein

- Stress-reduction techniques - An exercise program - Salt restriction - Smoking cessation

A patient comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously? A). 0.3 mg B). 0.5 mg C). 1.25 mg D). 2 mg

0.5 mg Rationale: The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

Which patient would the nurse need to assess first if the patient is receiving mannitol? A). A 67-year-old patient with type 1 diabetes mellitus B). A 21-year-old patient with a head injury C). A 47-year-old patient with anuria D). A 55-year-old patient receiving cisplatin to treat ovarian cancer

A 47-year-old patient with anuria Rationale: Mannitol is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.

In which patient(s) would the nurse question the use of bethanechol? (SELECT ALL THAT APPLY). A). A patient with urinary retention B). A patient with asthma C). A patient with peptic ulcer disease D). A patient with bradycardia E). A patient with an enlarged prostate

A patient with asthma A patient with bradycardia A patient with peptic ulcer disease A patient with an enlarged prostate Rationale: The principal use of bethanechol is to promote urination by stimulating the muscarinic cholinergic receptors in the detrusor muscle to contract the bladder and produce urine output. Mild to severe side effects of most muscarinic agonists, such as bethanechol, include hypotension, bradycardia, blurred vision, excessive salivation, increased gastric acid secretion, abdominal cramps, diarrhea, bronchoconstriction, and, in some cases, cardiac dysrhythmias. This group of agents should be prescribed cautiously for patients with low blood pressure and low heart rates. Muscarinic agonists are contraindicated for patients with intestinal or urinary tract obstruction, severe bradycardia, or active asthma.

Dicyclomine is an anticholinergic, which the nurse realizes is given to treat which condition? A). Mydriasis B). Constipation C). Urinary retention D). Irritable bowel syndrome

Irritable bowel syndrome

Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A). Absence of chest pain B). Decreased swelling in the ankles and feet C). Patient denies dizziness. D). Patient states that she feels stronger.

Absence of chest pain Rationale: 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 as afterload is decreased.

The nurse is assessing a patient who is taking furosemide. The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? A). Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. B). Administer sodium polystyrene sulfonate. C). Administer 2 mEq potassium chloride per kilogram per day IV. D). Administer calcium acetate, two tablets three times per day.

Administer 2 mEq potassium chloride per kilogram per day IV.

The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide? (SELECT ALL THAT APPLY) A). Monitor patients for signs of hypoglycemia B). Administer ordered potassium supplements C). Assess blood pressure before administration D). Monitor serum potassium and uric acid levels E). Notify the health care provider if a patient has had obliguria for 24 hours.

Administer ordered potassium supplements Assess blood pressure before administration Monitor serum potassium and uric acid levels

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action? A). Ask the patient to lie down and rest. B). Assess the patient's dietary intake of sodium and fluid. C). Administer phentolamine. D). Administer nitroprusside.

Administer phentolamine. Rationale: Phentolamine is a potent alpha-blocking agent specifically effective for treatment of hypertension associated with pheochromocytoma. The patient's blood pressure is elevated owing to tumor secretion. If the patient lies down, the blood pressure will not necessarily decrease. Increased fluid and sodium is not the cause of hypertension in this condition. Nipride is not the recommended treatment for this condition.

Given each of the following actions, the nurse would recognize which action has the highest priority for a patient admitted with glaucoma? A). Teach the patient to wear glasses at all times. B). Administer pilocarpine as prescribed. C). Teach patient to avoid bending at the waist. D). Administer atropine as prescribed.

Administer pilocarpine as prescribed. Rationale: Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? (SELECT ALL THAT APPLY.) A). Angina pectoris B). Cardiogenic shock C). Chronic obstructive pulmonary disease (COPD) D). Congestive heart failure (CHF) E). Hypertension F). Sinus bradycardia

Angina pectoris Congestive heart failure (CHF) Hypertension Rationale: Beta blockers are effective in treating hypertension (secondary to negative inotropic effects) and angina pectoris (decreases cardiac workload when decreasing heart rate and contractility). Beta blockade has also been shown to reduce mortality in patients with CHF.

The nurse is assessing a patient for possible evidence of digitalis toxicity. Which of these is included in the signs and symptoms of digitalis toxicity? A). Apical pulse of 72 bpm with an irregular rate. B). Apical pulse of 90 bpm with an irregular rate. C). Apical pulse of 48 bpm with an irregular rate. D). Apical pulse of 100 bpm.

Apical pulse of 48 bpm with an irregular rate.

What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment? A). Use the fingers to spread the ointment evenly over a 3-inch area. B). Apply the ointment to a non-hairy part of the upper torso. C). Massage the ointment into the skin. D). Cover the application paper with ointment before use.

Apply the ointment to a non-hairy part of the upper torso. Rationale: Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.

What should the nurse do when a patient is taking furosemide? A). Instruct the patient to change positions quickly when getting out of bed B). Assess BP before administration C). Administer the drug @ bedtime for maximum effectivness D). Teach the patient to avoid fruits to prevent hyperkalemia

Assess BP before administration

Before the nurse administers isosorbide dinitrate, what is a priority nursing assessment? A). Assess serum electrolytes. B). Measure blood urea nitrogen and creatinine. C). Assess blood pressure. D). Monitor level of consciousness.

Assess blood pressure. Rationale: Isosorbide dinitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol. What is the nurse's primary intervention? A). Assess the patient's urinary output. B). Teach the change position slowly. C). Encourage increase in fluid intake. D). Assess for history of any respiratory disease.

Assess for history of any respiratory disease. Rationale: At therapeutic dosages, atenolol selectively blocks only the beta

What does the nurse know to be correct concerning the use of mannitol in patients? A). It decreases intracranial pressure B). It increases intraocular pressure C). It causes sodium and potassium retention D). It causes diuresis in several days

It decreases intracranial pressure

A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? A). Assess hourly blood pressure readings. B). Assess the patient's ECG and slow the infusion. C). Assess the patient's respiratory rate and measure ABGs. D). Assess the patient's I&O and decrease IV fluids.

Assess hourly blood pressure readings. Rationale: The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect.

What intervention will the nurse perform when monitoring a patient receiving triamterene? A). Assess urinary output every other day. B). Monitor for side effect of hypoglycemia. C). Assess potassium levels. D). Monitor for hypernatremia.

Assess potassium levels. Rationale: Triamterene is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.

A patient has been taking metoprolol and tells the home care nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's priority action? A). Refer the patient to the social worker. B). Call the drug company to ask for assistance. C). Assess the patient's blood pressure. D). Teach the patient that abrupt medication withdrawal may lead to a rebound hypertensive crisis.

Assess the patient's blood pressure. Rationale: Abrupt withdrawal of a beta blocker can cause rebound hypertension. The nurse should immediately check the patient's blood pressure and then proceed with teaching and calling the health care provider.

When a patient has a cholinergic overdose from excessive dosing of bethanechol, the nurse anticipates administration of which drug as the antidote? A). Atropine B). Tolerodine C). Benztropine D). Metoclopramide

Atropine

A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient? A). Assessment of blood glucose levels B). Auscultation of the lungs C). Orthostatic blood pressure assessment D). Teaching about potential tachycardia

Auscultation of the lungs Rationale: Noncardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and teaching about tachycardia will not be priorities.

A patient taking spironolactone has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? A). Potatoes B). Lima beans C). Chicken D). Strawberries

Chicken Rationale: Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.

When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? (SELECT ALL THAT APPLY). A). Continuous oxygen saturation B). Continuous blood pressure C). Hourly electrocardiograms D). Presence of chest pain E). Serum nitroglycerin levels F). Visual acuity

Continuous blood pressure Presence of chest pain Rationale: Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.

Which assessment indicates to the nurse a therapeutic effect of mannitol has been achieved? A). Decreased intracranial pressure B). Decreased potassium C). Increased urine osmolality D). Decreased serum osmolality

Decreased intracranial pressure Rationale: Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.

A patient taking prazosin has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action? A). Hold the medication. B). Call the health care provider to change to an alternative medication. C). Determine the patient's drug history with this medication. D). Weigh the patient.

Determine the patient's drug history with this medication. Rationale: The desired therapeutic effect of prazosin may not fully occur for 4 weeks. The nurse does not know how long the patient has been on this medication. There is no need to hold the medication. It is more important to determine the patient's history prior to weighing the patient or calling the health care provider, since symptoms may be the result of the medication not yet achieving the full therapeutic effect.

The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What is the correct information to teach this patient? A). Change the patch daily at the same time. B). Remove the patch before taking a shower or bath. C). Do not take other antihypertensive medications while on this patch. D). Get up slowly from a sitting to a standing position.

Get up slowly from a sitting to a standing position. Rationale: This medication can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.

The nurse knows that which diuretic is most frequently combined with antihypertensive drug? A). Chlorthalidone B). Hydrochlorothiazide C). Bendroflumethiazide D). A potassium-sparing diuretic

Hydrochlorothiazide

Which finding would indicate to the nurse that a medication has activated beta2 receptors? A). Uterine contractions B). Bronchiolar constriction C). Hyperglycemia D). Increased saliva production

Hyperglycemia

The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition? A). Hypokalemia B). Hyperkalemia C). Hypoglycemia D). Hypermagnesmia

Hyperkalemia

A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? A). Hypocalcemia B). Hypokalemia C). Hyperkalemia D). Hypermagnesemia

Hypokalemia

A patient who is taking epinephrine is also taking several other medications. The nurse should realize that there is a possible drug interaction with which drugs? (SELECT ALL THAT APPLY). A). Albuterol B). Metoprolol C). Propranol D). Digoxin E). Methylopa

Metoprolol Propranol Digoxin

A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? A). Administer digoxin via IV infusion with the milrinone. B). Administer furosemide (Lasix) via IV infusion after the milrinone. C). Monitor cardiac rhythm and blood pressure continuously. D). Maintain an infusion of lactated Ringer with milrinone infusion.

Monitor cardiac rhythm and blood pressure continuously. Rationale: 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 IV infusion. Lactated Ringer does not have to be administered with milrinone.

A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A). Blood pressure of 120/80 mm Hg B). Heart rate of 70 beats/min C). ECG without evidence of ST changes D). Patient stating that pain is 0 out of 10

Patient stating that pain is 0 out of 10 Rationale: The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.

The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? A). The patient who has been on beta blockers for 1 day B). The patient who is on a beta blocker and a thiazide diuretic C). The patient who has stopped taking a beta blocker due to cost D). The patient who is taking a beta blocker and Lasix (furosemide)

The patient who has stopped taking a beta blocker due to cost Rationale: Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension. The patient who has just been started on an antihypertensive drug and the patients who are on combinations of antihypertensive drugs will not be as high priorities for assessment since they seem to be complying with treatment. Abruptly discontinuing the drug indicates either a failure to understand the treatment or a noncompliance with the treatment.