Drugs Exam 2: PrepU Questions

To maximize absorption of digoxin, the nurse would instruct the patient to take the drug

-On an empty stomach -Is absorbed best on empty stomach

Nesiritide is a human B-type natriuretic peptide

-True

The client is prescribed warfarin. His INR is 5.2. At what level is this dose?

-elevated -Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeutic PT value is approximately 1.5 times the control, or 18 seconds.

A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?

-orally

Heparin is the anticoagulant of choice during lactation.

Although some adverse fetal affects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation.

Antidote for warfarin

Vitamin K

A client experiencing a ventricular dysrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client?

- 1 to 4 mg/min -A continuous infusion of lidocaine IV after a bolus is 1 to 4 mg/minute. The administration of 0.25 to 0.75 mg/minute would be too small of a dosage. The administration of 10 to 20 or 6 to 8 mg/minute would be too large.

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?

- 5 minutes - Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects.

A client who is taking digoxin would withhold the drug if his pulse rate was

- 56 beats/minute -If a client's pulse rate is less than 60 beats/minute, the drug should be withheld and the pulse retaken in 1 hour. If the pulse is still below 60 beats/minute, the dose is held and the prescriber should be notified.

The nurse would instruct a client receiving acebutolol about which adverse effect?

- Bronchospasm -Bronchospasm is a possible adverse effect of acebutolol, a class II antiarrhythmic. Other effects include hypotension, decreased libido, and decreased exercise tolerance.

Which is the result of positive inotropic activity?

- Increased cardiac output

Which would be considered a therapeutic effect of digoxin?

- Increased force of contraction -Digoxin increases the force of myocardial contraction, increases cardiac output and renal perfusion, and slows the heart rate.

Which factor would necessitate a reduction in the dosage of disopyramide?

- Renal impairment -As a general rule, dosage of several antidysrhythmic drugs, including disopyramide, should be reduced in clients with significant impairment of renal function to avoid toxicity.

A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?

- Renal impairment -Disopyramide is excreted in the kidneys and the liver in almost equal proportions. The dose must be reduced in renal insufficiency based on creatinine clearance. The dose does not need to be reduced in immobility, hypertension, or chronic diarrhea.

A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client?

- Respiratory assessment -Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.

A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client?

- The dose should be decreased in this client. -The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The client should be taught to limit sodium intake in the diet. The client's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function.

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

- aPTT -Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.

Which medications are Class II antiarrhythmics? (Select all that apply.)

- acebutolol (sectral), propranolol (inderal)

A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor?

- blood glucose levels -The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels.

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as

- calcium channel blockers. - Class IV antiarrhythmics include calcium channel blockers. Beta blockers are class II antiarrhythmics. Cardiac glycosides, such as digoxin may be used as an antiarrhythmic, but are not classified as class I, II, III, or IV. Vasodilators are not used as antiarrhythmics

A client is being treated for heart failure. Which is most indicative of improved health status?

- decreased pitting edema -The absence of pitting edema, decreased size of ankles and abdominal girth, and decreased weight improves circulation and increases renal blood flow. The diminished fluid volume is indicative of an improved blood supply to the body tissues. Increased skin turgor indicates that the client is well hydrated and does not have fluid volume excess. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status

The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:

- does not have peptic ulcer disease -Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.

A client asks the nurse what dose of acetylsalicylic acid is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?

-30 mg -A single dose of 300 to 600 mg or multiple doses of 30 mg inhibit cyclooxygenase in circulating platelets almost completely. The dose of 100 mg is too small. The doses of 625 mg and 1000 mg are too large

A male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity?

-4.0 nanograms per milliliter -Therapeutic serum levels of digoxin are 0.5 to 2 nanograms per milliliter; toxic serum levels are above 2.0

The primary health care provider prescribes sotalol (Betapace) 80 mg BID orally. The drug is available in 40 mg tablets. The nurse will administer how many tablets in 24 hours?

-80mg X 2 (BID) = 160 mg total daily dose 160 mg / 40 mg = 4 tablets in 24 hours

A nurse is preparing an in-service presentation about arrhythmias. As part of the presentation, the nurse is planning to include factors that contribute to arrhythmias. Which would the nurse include? (Select all that apply.)

-Accumulation of waste products, Electrolyte imbalances, Structural damage to conduction pathways, Drug effects -Electrolyte disturbances, decreases in the oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products can trigger arrhythmias

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney

-Acebutolol -The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and the kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and on the beta-adrenergic receptors of the heart and the kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and the kidney.

After teaching group of students about antiarrhythmic agents, the instructor determines that the teaching was successful when the students identify which of the following as examples of class III antiarrhythmics? Select all that apply.

-Aminodarone, dofetilide, sotalol, ibutilide

When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?

-Atropine -Atropine should be administered to patients who develop bradycardia. Bradycardia may be seen in digitalis toxicity. Inamrinone and milrinone are miscellaneous inotropics used in heart failure. Cholestyramine is used to lower blood cholesterol levels. Inamrinone, milrinone, and cholestyramine are not used in the treatment of bradycardia.

Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.

-Block the stimulation of the adrenergic receptors -Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization

When describing the action of low-molecular weight heparins, which would the nurse include? (Select all that apply.)

-Blockage of factor Xa, Blockage of factor IIa -Low molecular weight heparins block factor Xa. Low molecular weight heparins block factor IIa. Heparin blocks the formation of thrombin from prothrombin. Warfarin decreases the production of vitamin K clotting factors. Thrombolytic agents activate the natural anticlotting system and stimulate the conversion of plasminogen to plasmin

Which are examples of low-molecular-weight heparins (LMWHs)? (Select all that apply.)

-Dalteparin (Fragmin), Enoxaparin (Lovenox), Tinzaparin (Innohep)

A client is admitted to the emergency department with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV?

-Determine if the client has had a reaction to local anesthesia. -Lidocaine is contraindicated in clients allergic to local anesthetic agents. It is important to determine if the client has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the client's ability to swallow. However, swallowing can be impaired after administration and should be assessed. It is not necessary to do a nutritional assessment at this time.

A client is being treated for hypokalemia. The client's current medications include Inderal, digoxin, and Coumadin. The client reports nausea, abdominal discomfort, and visual changes. Which problem would the nurse suspect?

-Digitalis toxicity -Individuals with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated. Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes

A male client is diagnosed with heart failure. The physician orders a loading dose of digoxin. Loading doses are necessary for what reason?

-Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading

The nurse is assessing the client for left-sided heart failure. Which symptom would the nurse identify as left-sided failure? (Select all that apply.)

-Dyspnea, Tachycardia, Cough -Left-sided heart failure symptoms include a cough, tachycardia, and dyspnea. Right-sided heart failure symptoms include hepatic engorgement, peripheral edema, and neck vein distention.

The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs?

-Ginseng -Patients taking digoxin should avoid licorice, ginseng, or hawthorn because concomitant use of those products can increase drug effects or cause toxicity. In general, patients taking any medication should discuss all herbal remedies with a health care provider to assess for potential interactions

A 65-year-old client presents to the physician's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition?

-Heart failure -Cardinal manifestations of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers?

-III -The class III antidysrhythmics are primarily potassium channel blockers. Class I drugs are sodium channel blockers; class II drugs are beta-adrenergic blockers; and class IV drugs are calcium channel blockers.

An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms?

-Inadequate cardiac output -Symptoms presenting suggest a cardiac condition. A diseased heart may not be able to maintain an adequate cardiac output with heart rates below 60 bpm above 120 bpm.

Which would a nurse include when teaching a client about right-sided heart failure? (Select all that apply.)

-Increased jugular venous pressure, Hepatomegaly, Pitting edema of the legs -Right-sided heart failure is manifested by increased JVP, hepatomegaly, pitting peripheral edema, and increased urination. Dyspnea is associated with left-sided heart failure

A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?

-Intravenous -Esmolol is only available for IV administration

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema?

-Measurement of intake and output -Measurement of intake and output is a nursing intervention related to the edema in the patient receiving cardiotonic drugs. Auscultation of the lungs, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the patient.

The nurse is administering intravenous amiodarone to a patient in the emergency department. Which task would the nurse need to prioritize?

-Monitoring the patient's blood pressure -Amiodarone has vasodilating effects and decreases systemic vascular resistance. Monitoring the patient's blood pressure for signs of hypotension should be a priority.

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take?

-Notify the health care provider -Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the provider. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages.

Which would a nurse expect to assess if a client is experiencing right-sided heart failure?

-Peripheral edema -Peripheral edema would be noted in clients with right-sided heart failure. Wheezing, hemoptysis, and dyspnea would suggest left-sided heart failure.

Which phase of the cardiac muscle action potential is affected by class I antiarrhythmics?

-Phase 0 -Class I antiarrhythmics stabilize the cell membrane by binding to sodium channels, depressing phase 0 of the action potential

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?

-Positive inotropic -A positive inotropic effect improves the contractility and pumping ability of the heart. -In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a client with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a client with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.

A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor?

-Potassium levels -Although it is important to monitor the client's ECG, it is more important to closely monitor potassium levels when the client is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The client's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered?

-Premature ventricular contraction -The patient can be safely administered an anti-arrhythmic drug if the patient has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of anti-arrhythmic drugs.

Which is true in regards to the drug propranolol (Inderal)? (Select all that apply.)

-Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney, Propranolol reduces the release of renin, Propranolol has membrane stabilizing effects -Propranolol (Inderal) is a class II anti-arrhythmic that acts by blocking beta-adrenergic receptors of the heart and kidney, reducing the influence of the sympathetic nervous system on theses areas, decreasing the excitability of the heart and the release of renin. Propranolol also has membrane stabilizing effects

A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?

-Protamine sulfate -If a client who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.

A nurse is required to monitor a client for right ventricular dysfunction. Which is one of the most common symptoms associated with right ventricular dysfunction?

-Swelling of the hands -One of the most common symptoms associated with right ventricular dysfunction is peripheral edema, a problems characterized by swollen feet and hands. The other symptoms of right ventricular dysfunction are nocturia, anorexia, weight gain, and weakness. Dyspnea, orthopnea, and hacking cough are the symptoms associated with left ventricular dysfunction, and not right ventricular dysfunction

A patient with CHF has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?

-Take drug regularly without skipping a dose -the nurse should instruct the patient to take the drug regularly without skipping a dose. The patient should consult the provider before discontinuing the drug. Taking the drug with high fiber meals will decrease the absorption of the drug. The patient should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as it alters the plasma digoxin levels

A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a client who has just been admitted. What is the most likely goal of this intervention?

-To convert the client's atrial fibrillation to normal sinus rhythm -Dofetilide is used to convert clients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias.

Vasodilators used to treat heart failure include nitrates and ACE inhibitors.

-True -Drug therapies used to treat heart failure include vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, which decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function

The teaching plan for a client taking amiodarone should include which instruction?

-Use a reliable form of birth control while taking this medication. -Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy.

A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to

-avoid grapefruit and grapefruit juice. -The patient should be instructed to avoid grapefruit and grapefruit juice because they may increase the verapamil level. The patient should also abstain from using alcohol and aspirin while taking this medication. Encouraging the patient to increase her fluid intake and include fresh fruit and fiber in her diet can help prevent constipation. Taking the medication with meals would not enhance its effect.

The health care provider orders quinidine for a client who is receiving a common treatment for atrial fibrillation. The nurse would monitor this client for

-digoxin toxicity -Quinidine interacts with digoxin (classically prescribed for atrial fibrillation , possibly leading to increased digoxin levels and digoxin toxicity. The effects of digoxin, not quinidine, are increased. Bleeding may occur if class I antiarrhythmics are given with oral anticoagulants such as warfarin. Renal dysfunction is unrelated to the use of both drugs

Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia?

-diltiazem -Calcium channel blockers obstruct the movement of calcium into conductive and contractile myocardial cells by inhibiting the influx of calcium through its channels, causing a slower conduction through the SA and AV nodes. Diltiazem is administered intravenously to treat acute supraventricular tachycardia. Bethanechol is used to treat neurogenic bladder. Chlorambucil is an antineoplastic agent used to treat chronic lymphocytic leukemia. Midazolam hydrochloride is administered to reduce anxiety.

A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?

-elevated glucose -The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol.

Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of

-hypersensitivity to beta blockers -Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.

A client has questions about the new medication prescribed for cardiac rhythm after having cardioversion performed. The nurse explains how the sodium channel blocker decreases the likelihood of dysrhythmias by:

-prolonging the refractory period. -Sodium channel blockers slow conduction velocity, prolonging refractoriness and decreasing automaticity of sodium-dependent tissue.

A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's:

-pulse is 52 beats per minute. -It is important for the nurse to monitor the pulse for a full minute before administering the medication. If the client's heart beat is lower than 60 beats per minute, the nurse will withhold the medication. Weight, respiratory rate, and blood pressure are not criteria for withholding the drug.

What is given to treat a massive digoxin overdose?

Digoxin immune Fab (Digibind)

Milrinone (Primacor) is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?

Intravenously