Pharm 103 Unit 1

A patient arrives in the ED with reports of chest pain. The patient states that she cannot be admitted in the hospital because she has a 3-month-old baby at home. What follow-up question(s) should the nurse ask this patient before administering nitroglycerin? Select all that apply. -"How is your baby's cardiac health?" -"Did your angina symptoms occur after giving birth?" "Are you breastfeeding your child?" -"Is it possible you might be pregnant again?" -"How many children do you have?"

-"Are you breastfeeding your child?" Nitroglycerin should be used with caution in women who are breastfeeding. -"Is it possible you might be pregnant again?" Nitroglycerin should be given to pregnant women only if it is clearly needed.

A 30-year-old woman taking warfarin has a hematocrit of 22. Which questions would be important for the nurse to ask? Select all that apply. -"Do you have tar-colored stools?" -"How heavy is your menstrual bleeding?" -"Do you experience headaches frequently?" -"Are you eating a lot of aged cheeses and meats?" -"Are you taking any over-the-counter medications?"

-"Do you have tar-colored stools?" -"How heavy is your menstrual bleeding?" -"Are you taking any over-the-counter medications?"

A patient asks if it is safe to take heparin while pregnant. How should the nurse respond? -"Heparin will dissolve the blood clot, and it is safe to use this during pregnancy." -"Heparin can be administered safely during pregnancy because it does not cross the placenta." -"Warfarin is a better choice, and I will speak with the health care provider about this." -"Heparin is safe because it will ensure you and the fetus do not develop further blood clots."

-"Heparin can be administered safely during pregnancy because it does not cross the placenta."

A patient is overheard telling a family member, "I am receiving heparin intravenously to dissolve the blood clot in my lung." What would be an appropriate response to this patient's statement? -"Heparin will help dissolve your current blood clot." -"You are taking warfarin, not heparin, to dissolve your blood clot." -"Heparin does not dissolve clots but prevents new clots from forming." -"You are receiving heparin subcutaneously, not intravenously, for your lung blood clot."

-"Heparin does not dissolve clots but prevents new clots from forming."

The nurse is providing discharge teaching to a patient who will be taking a class I antiarrhythmic medication at home. Which patient statement requires intervention by the nurse? -"I need to change positions slowly after taking my medication." -"It is necessary to weigh myself daily at the same time." -"I need to take my medication strictly as prescribed." -"I can skip my medication when I feel worse and take it when I feel better."

-"I can skip my medication when I feel worse and take it when I feel better." This statement made by the patient shows a lack of understanding about medication compliance. Instruct the patient to call the health care provider if the medication was missed, or if the patient starts to feel worse.

The nurse is educating the patient on the side effects of metoprolol. Which response by the patient indicates teaching was successful? -"When I have a cold, it's okay to take cold medicine." -"I will be careful when I go from a lying to sitting position." -"If I miss a dose I should wait until tomorrow to take the next one." -"I should expect to be very tired when taking this medication."

-"I will be careful when I go from a lying to sitting position."

Which statement would indicate that a patient needs more discharge teaching related to warfarin? Select all that apply. -"I'll increase my intake of green leafy vegetables." -"This medication will break up blood clots I have in my legs." -"I'll take this medication whenever I don't take my baby aspirin." -"I'll look for blood in my urine and stool and notify my health care provider if I see this." -"I'll notify my health care provider if I'm considering taking a new over-the-counter vitamin."

-"I'll increase my intake of green leafy vegetables." -"This medication will break up blood clots I have in my legs." -"I'll take this medication whenever I don't take my baby aspirin."

The nurse knows patient teaching regarding metoprolol has been successful when Mr. Butler makes which statement? -"I'll take my new medication every day at the same time." -"I can still have my glass of wine before dinner every day." -"If this new medication makes me sick to my stomach, I'll just stop taking it." -"I'll take my propranolol when I take my antacid; that is a good way for me to remember my new medicine."

-"I'll take my new medication every day at the same time."

The patient is discharged with sublingual nitroglycerin tablets. What instruction does the nurse tell the patient about storing these medications? Select all that apply. -"Arrange these tablets in a pill box at home for easy access." -"Keep the tablets in their original airtight glass containers." -"Always put a few loose pills in your purse or pocket in case you have angina symptoms and are not at home." -"Keep the glass containers of nitroglycerin away from children because they have screw-cap tops for easy access." -"Keep the nitroglycerin tablets in the refrigerator."

-"Keep the tablets in their original airtight glass containers." Nitroglycerin SL must be kept in their original glass containers as they decompose when exposed to heat and light. -"Keep the glass containers of nitroglycerin away from children because they have screw-cap tops for easy access." The glass containers of nitroglycerin do not have childproof tops.

Given Ms. Adams' concerns about her diuretic, what should the nurse recommend to her regarding taking her medicine? -"Take your diuretic at 8 am." -"Take your diuretic at 9 pm." -"Don't eat foods that have potassium." -"Learn to like bananas."

-"Take your diuretic at 8 am." Taking the diuretic in the morning will help Ms. Adams with her fear of bedwetting. The effects will be decreased by bedtime, making nocturia less likely.

The nurse is giving discharge teaching regarding warfarin to a Chinese patient. The patient uses coining (rubbing a coin vigorously along the back) to help decrease fever. Which teaching will be especially important for this patient? -"It is okay to use coining as long as you do it only once a week." -"You should not use coining because it may increase your INR levels." -"You can continue coining daily and taking aspirin until the fever is gone." -"Warfarin causes an increased risk for bruising; coining can lead to bruising and would not be advised."

-"Warfarin causes an increased risk for bruising; coining can lead to bruising and would not be advised."

What is the target blood pressure for this patient? (62 yo male hx dm and HTN) -140/90 mm Hg -130/80 mm Hg -125/80 mm Hg -120/70 mm Hg

-130/80 mm Hg

A patient taking diltiazem is complaining of dizziness. What should the assessment of this patient include? Select all that apply. -Brain imaging -A chest x-ray -A 12-lead ECG -The patient's blood pressure -The patient's food and drug history -The patient history regarding postural changes

-A 12-lead ECG -The patient's blood pressure -The patient's food and drug history -The patient history regarding postural changes

The clinic patient is taking extended-release nitroglycerin for angina symptoms. When doing a social history, the patient states he drinks 2 shots of bourbon nightly to help with sleeping. Which patient education is essential for this patient? Select all that apply. -Alcohol intake is not advised when taking nitroglycerin. -Instruct the patient to limit his alcohol intake to one shot of bourbon nightly. -Alcohol intake may contribute to liver disease, where the drug is metabolized. -Alcohol intake is not contraindicated, but one has to be careful of the hypotensive and lightheadedness side effects of nitroglycerin. -Teach the patient that only wine and beer, not hard alcohol, should be consumed when taking nitroglycerin.

-Alcohol intake is not advised when taking nitroglycerin. Alcohol intake may contribute to hypotension and lightheadedness side effects of nitroglycerin. -Alcohol intake may contribute to liver disease, where the drug is metabolized. Nitroglycerin is metabolized by the liver and nitroglycerin is also used with caution in those with liver disease.

Which statements are true about class III antidysrhythmic drugs? Select all that apply. -Drugs in this class shorten the cardiac QT interval. -The drugs in this class may be used interchangeably. -All of these drugs delay repolarization of fast potentials. -One of the drugs in this class is also a beta-adrenergic blocking agent. -Class III drugs are used in emergency treatment of ventricular dysrhythmias.

-All of these drugs delay repolarization of fast potentials. -One of the drugs in this class is also a beta-adrenergic blocking agent. -Class III drugs are used in emergency treatment of ventricular dysrhythmias.

For which patient would warfarin be contraindicated? -An alcoholic patient with liver disease -A patient on hemodialysis at high risk for thrombosis -A patient 24 hours post-operative for total knee replacement -A patient with new onset atrial fibrillation who has a mechanical heart valve

-An alcoholic patient with liver disease

A patient is receiving a continuous heparin infusion. What is the appropriate aPTT response? -An increase in INR 1.5-2.5 times above baseline. -A decrease of 1.5-2.5 times below baseline aPTT. -An increase of 1.5-2.5 times above baseline aPTT. -No response. This is not the lab value monitored for continuous heparin infusion.

-An increase of 1.5-2.5 times above baseline aPTT.

A pre-administration assessment by the nursing staff is essential to identify which condition(s) that are contraindicated for nitroglycerin administration? Select all that apply. -Anemia -Orthostatic hypotension -Transient ischemic attack -Increased intracranial pressure -Cardiomyopathy

-Anemia -Increased intracranial pressure -Cardiomyopathy

Which are common adverse reactions related to calcium channel blockers? Select all that apply. -Nausea -Skin rash -Ankle edema -Constipation -Facial flushing

-Ankle edema is related to the vasodilatory effect of calcium channel blockers on the microcirculation. -Constipation is a common adverse effect of the calcium channel blocker, verapamil. -Facial flushing is related to the vasodilatory effect of calcium channel blockers.

What facts are emphasized regarding statins when teaching about medication compliance? Select all that apply. -When antihyperlipidemic therapy is withdrawn, cholesterol levels remain at current level. -Antihyperlipidemic therapy is a lifetime commitment. -Statin drugs should not be discontinued abruptly. -Antihyperlipidemic therapy is generally continued for about a year. -Serum liver enzyme levels should be monitored according to practitioner orders.

-Antihyperlipidemic therapy is a lifetime commitment. -Statin drugs should not be discontinued abruptly. -Serum liver enzyme levels should be monitored according to practitioner orders.

Which teaching is important for a patient taking warfarin? Select all that apply. -Avoid smoking. -Avoid exercise. -Wear support hose. -Avoid herbal products. -Take the warfarin dose at any time.

-Avoid smoking. -Wear support hose. -Avoid herbal products.

Which effects of centrally-acting alpha2 agonists decrease blood pressure? Select all that apply. -Bradycardia -Decreased cardiac output -Atrial fibrillation -Ventricular fibrillation -Vasodilation

-Bradycardia -Decreased cardiac output -Vasodilation

How does nitroglycerin promote vasodilation? Select all that apply. -By relaxing cardiac muscle -By exciting cardiac muscle -By relaxing vascular smooth muscle -By exciting vascular smooth muscle -By dilating vascular smooth muscle -By contracting vascular smooth muscle

-By relaxing vascular smooth muscle Nitroglycerin promotes vasodilation by relaxing vascular smooth muscle. -By dilating vascular smooth muscle Nitroglycerin promotes vasodilation by dilating vascular smooth muscle.

Ms. Jones reports episodes of joint and muscle pain to the nurse. What would the nurse's priority action be? -Call the health care provider and request an order for an antinuclear antibody (ANA) panel. -Call the health care provider for an order of pain medication. -Rate the pain and continue to assess. -Call the health care provider and request an order for an X-ray.

-Call the health care provider and request an order for an antinuclear antibody (ANA) panel.

An 80-year-old patient arrives to the ED with new onset of mental status changes and is no longer oriented to place or time. The medication record notes the patient is prescribed a nitroglycerin transdermal patch and a calcium channel blocker for angina and hypertension. What are priority nursing assessments for this patient? Select all that apply. -Check a blood glucose level to note if the patient is hypoglycemic. -Reorient patient to person, place, and time now and as needed. -Check vital signs and monitor for hypotension. -Check the skin for any nitroglycerin patches. -Obtain urine for a urinalysis.

-Check a blood glucose level to note if the patient is hypoglycemic. Low blood sugar can cause confusion, so this should be assessed. -Check vital signs and monitor for hypotension. Nitroglycerin given with an antihypertensive can cause significant hypotension. This is a priority intervention. -Check the skin for any nitroglycerin patches. Nitroglycerin can cause confusion, and confirming whether the patient has applied the nitroglycerin patch is a priority intervention. Also, a patient with confusion may have forgotten to remove a previous nitroglycerin patch.

Prior to administering lidocaine to a patient in the cardiac care unit, which action should the nurse take to reduce the patient's risk for adverse drug reactions? Select All that apply. -Complete a social history for the patient -Complete a medication profile for the patient -Request a blood test to determine serum medication level -Monitor the patient's cardiac rhythm -Monitor the patient's vital signs

-Complete a medication profile for the patient -Monitor the patient's cardiac rhythm -Monitor the patient's cardiac rhythm

During the patient interview, the nurse finds that the patient taking warfarin eats a salad for lunch every day. What is a concern for this patient? -Increase in GI upset -Allergic reaction to warfarin -Increase in warfarin's action -Decrease in warfarin's effectiveness

-Decrease in warfarin's effectiveness

By which mechanism does metoprolol work? -Increasing the speed of conduction through the atrioventricular node -Decreasing the speed of conduction through the atrioventricular node -Increasing the speed of conduction through the sinoatrial node -Decreasing the speed of conduction through the sinoatrial node

-Decreasing the speed of conduction through the atrioventricular node

Match the effects on action potential with the corresponding subclasses for class I antidysrhythmic drugs. -Delayed relayed repolarization -Accelerated repolarization -No effect on Repolarization

-Delayed relayed repolarization, Class 1B -Accelerated repolarization, Class 1C -No effect on Repolarization, Class 1A

Which class III antidysrhythmic medication is given with food to improve absorption? -Ibutilide -Dofetilide -Amiodarone -Dronedarone

-Dronedarone

What adverse reactions of amlodipine could Ms. Jones experience? Select all that apply. -Flushing -Headache -Constipation -Heart failure -Peripheral edema -Reflex tachycardia

-Flushing -HA -Peripherial Edema -Reflex Tachycardia

Which should be avoided by patients who are taking dronedarone? Select all that apply. -Grapefruit juice -Ibuprofen -Amoxicillin -Ketoconazole -Clarithromycin

-Grapefruit juice Grapefruit juice is a strong inhibitor of hepatic CYP3A4, and can make dronedarone accumulate to dangerous levels; concurrent use is contraindicated. -Ketoconazole Ketoconazole is a strong inhibitor of hepatic CYP3A4 and can make dronedarone accumulate to dangerous levels; concurrent use is contraindicated. -Clarithromycin Clarithromycin is a strong inhibitor of hepatic CYP3A4 and can make dronedarone accumulate to dangerous levels; concurrent use is contraindicated.

Which patient response alerts the nurse to an adverse effect of metoprolol? select all that apply. -I seem to get very tired very easily -My urine is dark and foul smelling -I feel dizzy when I stand up too quickly -I have been feeling very anxious lately. - I am getting short of breath going up a flight of stairs.

-I seem to get very tired very easily -I feel dizzy when I stand up too quickly - I am getting short of breath going up a flight of stairs.

Which reflex mechanisms cause an increase in cardiac oxygen demand and can exacerbate chest pain in a patient on minoxidil treatment? Select all that apply. -increase HR -decreased HR -increased contractility -decreased contractility -constant HR

-Increase heart rate An increase in heart rate leads to an increased cardiac oxygen demand. -Increased myocardial contractility Increased myocardial contractility leads to an increased cardiac oxygen demand.

A patient taking warfarin is profusely bleeding. The patient received vitamin K 2 hours ago but continues to bleed. Which prescription should the nurse anticipate? -Infusion of heparin -Administration of aspirin -Infusion of fresh frozen plasma -Administration of protamine sulfate

-Infusion of fresh frozen plasma

The nurse asks the patient to tell her how to administer SL nitroglycerin when experiencing angina symptoms. The patient states, "I take the medication every 5 minutes until the pain is gone." How does the nurse respond to this information? Select all that apply. -Instruct the patient to take one tablet sublingual at the onset of angina pain and repeat every 5 minutes for a total of 6 tablets if the pain is not resolved. -Instruct the patient to take one tablet sublingual at the onset of angina pain and repeat every 5 minutes for a total of 3 tablets if the pain is not resolved. -Instruct the patient that if the pain is not resolved after taking nitroglycerin as recommended, it is necessary to drive to the ED for further treatment. -Instruct the patient that if there is no relief of angina symptoms after taking the recommended dose, contact the health care provider and arrange transportation to the ED right away. -Instruct the patient to take one tablet sublingual at the onset of angina pain and double the dose until the pain is resolved.

-Instruct the patient to take one tablet sublingual at the onset of angina pain and repeat every 5 minutes for a total of 3 tablets if the pain is not resolved. This is the recommended administration of SL nitroglycerin. -Instruct the patient that if there is no relief of angina symptoms after taking the recommended dose, contact the health care provider and arrange transportation to the ED right away. If no relief of angina symptoms after 3 doses occurs, it is necessary to arrange for transportation to the ED or call 911.

A patient is admitted to the emergency department with a blood pressure of 222/110 mm Hg. Why would the nurse anticipate intravenous beta blocker administration? -Intravenous forms of beta blockers have immediate effects. -Administering a beta blocker intravenously prolongs the action of the drug. -There are fewer adverse systemic effects when giving intravenous beta blockers. -Intravenous beta blockers have a slower peak time than other forms of these medications.

-Intravenous forms of beta blockers have immediate effects.

Which finding requires further teaching? -Ms. Jones reports eating grapefruit for breakfast each morning on her new diet. -Ms. Jones states she swallows her capsules whole with a full glass of water each morning. -The patient reports she regularly checks her blood pressure at the pharmacy. -The patient reports she has decreased the intake of fat in her diet.

-Ms. Jones reports eating grapefruit for breakfast each morning on her new diet.

A hospitalized patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. What is the nurse's priority action? -Anticipating what supplies are needed for the 0900 lumbar puncture -Notifying the health care provider that the patient is receiving heparin -Ensuring that the patient understand and has signed a consent for the procedure -Giving the 0900 dose at 0830 to ensure that the patient receives heparin before the lumbar procedure

-Notifying the health care provider that the patient is receiving heparin

Why should patients inform their dentist if they are taking an anticoagulant? -Patients are at increased risk for bleeding -Dentists cannot work on pts taking anticoagulants -The dentist should know about every medical condition. -Anticoagulants may influence the anesthetic the dentist may use.

-Patients are at increased risk for bleeding

For which patients is warfarin contraindicated? Select all that apply. -Patients on hemodialysis -Patients who are pregnant -Patients with vitamin K deficiency -Patients scheduled for brain surgery -Patients with a mechanical heart valve

-Patients who are pregnant -Patients with vitamin K deficiency -Patients scheduled for brain surgery

When a patient is taking warfarin, which manifestation could indicate bleeding? -Petechiae on arms -Clay-colored stools -Elevated blood pressure -Pain and burning with urination

-Petechiae on arms

A patient who has been admitted for a hypertensive crisis and adjustment of prescribed hydralazine. What is the nursing priority for this patient? -Orient the patient to the unit. -Place a fall risk armband on the patient. -Place an order for appropriate diet. -Have consent signed for treatment.

-Place a fall risk armband on the patient.

What effect of amiodarone puts a patient at risk for torsades des pointes? -Prolongation of QT interval -Dilation of coronary blood vessels -Reduction in SA node automaticity -Dilation of peripheral blood vessels

-Prolongation of QT interval

Which may result from abrupt withdrawal of a calcium channel blocker? -Rebound hypertension -Worsening heart failure -Hypotension -Headache -Worsening tissue ischemia

-Rebound HTN -Worsening Tissue Ischemia

Which instruction should the nurse include when teaching a patient about taking oral amiodarone? Select all that apply. -Take the drug with food -Take the drug with grapefruit juice -Use sunscreen while taking this drug -Report skin color changes to the provider -Expect some weight loss while taking this drug

-Take the drug with food -Use sunscreen while taking this drug -Report skin color changes to the provider

What adjustments in drug dosing need to be made when a patient is treated with both verapamil and digoxin? -The dose of digoxin should be increased. -The digoxin must be discontinued. -The verapamil should be administered at one-half the standard starting dose. -The dose of digoxin should be decreased.

-The dose of digoxin should be decreased. Verapamil increases digoxin plasma levels by 60%. In order to avoid toxicity, the dosage of digoxin should be decreased.

Which teaching is essential when a patient is prescribed sublingual nitroglycerin? -Swallow the tablet whole. -Crush the tablet before swallowing. -Allow up to 30 minutes for medication to take effect. -The tablet is placed under the tongue and allowed to dissolve.

-The tablet is placed under the tongue and allowed to dissolve.

A patient has been on a nitroprusside infusion for 6 days and starts talking about the color of the sky while pointing to the ceiling. The nurse suspects that the patient has which kind of toxicity? -Cyanide poisoning -Cardiac Toxicity -Thiocyanate Toxicity -Neurotoxicity

-Thiocyanate Toxicity

What is the duration of action for amiodarone? -3 weeks -12 hours -8 to 16 hours -Up to 5 months

-Up to 5 months

Which discharge teaching is appropriate to give to a patient who has been prescribed warfarin? Select all that apply. -The medication may cause dizziness. -There are no dietary restrictions while taking warfarin. -Use a soft toothbrush when taking this medication. -Wear a medical alert ID that states you are taking warfarin. -Notify the health care provider for excessive bruising, abdominal pain, or tar-colored stools.

-Use a soft toothbrush when taking this medication. -Wear a medical alert ID that states you are taking warfarin. -Notify the health care provider for excessive bruising, abdominal pain, or tar-colored stools.

Which teaching is appropriate for a patient taking warfarin? Select all that apply. -Use an electric razor. -Use a soft-bristled toothbrush. -Notify your dentist you are taking warfarin. -Use over-the-counter supplements as needed. -Take aspirin whenever you need for a headache.

-Use an electric razor. -Use a soft-bristled toothbrush. -Notify your dentist you are taking warfarin.

The nurse reports which assessment finding(s) as contributing to a cardioprotective effect in a patient receiving beta blockers? -increased HR -delayed AV node conduction -increased myocardial contractility -increased myocardial automaticity.

-delayed AV node conduction

Which discharge instruction should be given to a patient who is prescribed metoprolol? -urine may turn orange -skin breakdown may last 45 days -measure HR before the dose -immune system will be compromised while on this med.

-measure HR before the dose

A patient with an abnormal cardiac rhythm is taking a class IB drug, and is on continuous ECG monitoring. Which medication effect will the nurse anticipate seeing on the ECG? -Delayed repolarization -Accelerated repolarization -Increased Action Potential velocity -Supression of SA node automaticity.

.Accelerated Repolorization Class IB drugs block sodium channels to increase repolarization.

What is the usual dosage of enoxaparin for a patient with unstable angina? -1 mg/kg daily -30 mg/kg bolus -40 mg once-daily -1 mg/kg every 12 hours

1 mg/kg every 12 hours

After metoprolol is administered intravenously, how soon will a therapeutic effect occur? - 1 minute - 30 mins - 1 hour - 2 hours

1 minute

When administering oral diltiazem to a patient, the nurse would expect to note a therapeutic response in what time frame? -1-2 minutes -15-20 minutes -1-3 hours -4-6 hours

1-3 hours The onset of action for oral diltiazem is 30-60 minutes, with peak plasma concentration occurring in 1-3 hours. This would be the expected time frame to note a therapeutic effect.

A patient is started on a continuous infusion of heparin at 0900. What time should an aPTT be checked? -1000-1200 -1300-1500 -1700-1900 -2100-2300

1300-1500 The time to check aPTT after the initial infusion is started is 4-6 hours.

The reduction of LDL cholesterol may be seen as early as _________ weeks after the initiation of statin drugs.

2

A patient taking propranolol complains of heartburn and requests to take an antacid. The nurse tells the patient to take the antacid at what time in relation to the propranolol? -1 hour before drug -2 hours before drug -4 hours before drug -6 hours before drug

2 hours before drug When an antacid is administered, it must be given either 2 hours before or 2 hours after the propranolol to avoid interference with drug absorption.

What is the half-life of propranolol? 1-2 hours 2-3 hours 3-6 hours 5-6 hours

3-6 hours

What percentage of propranolol reaches circulation after the medication is metabolized? -10 -20 -30 -40

30

What is the usual dosage for enoxaparin when used to prevent DVT after hip or knee replacement surgery? -40 mg Q day -30 mg/kg by IV bolus -30 mg Q 12 hrs -1 mg/kg Q12 hrs

30 mg every 12 hours 30 mg every 12 hours is the usual dose of enoxaparin for prevention of DVT after hip or knee replacement surgery.

Which is an appropriate adult PO dosage of quinidine gluconate? -200 mg q8h -224 mg q8h -300 mg q8h -324 mg q8H

324 mg Q8H

What is the time frame for the onset of effects of oral hydralazine? -45 mins -2 hours -6 hours -10 mins

45 minutes Oral hydralazine is readily absorbed and effects begin within 45 minutes.

How long should the nitrate-free period be for a patient prescribed nitroglycerin topical ointment? -1-2 hours -3-5 hours -6-8 hours -10-12 hours

6-8 hours The nitrate-free period for a patient prescribed nitroglycerin topical ointment should be 6-8 hours.

A patient has accidentally received an extra dose of valsartan. Due to the half-life of the drug, how long does the nurse closely monitor the blood pressure? -1-2 hours -3-4 hours -4-5 hours -6-9 hours

6-9 hours The half-life of valsartan is 6-9 hours; during this period of time the nurse would closely monitor the blood pressure and status of the patient.

The nurse would withhold medication for which quinidine plasma level? -1.2 mcg/mL -2.4 mcg/mL -4.2 mcg/mL -7 mcg/ml

7 mcg/ml The nurse would need to withhold the medication as the plasma level is elevated (therapeutic level for quinidine ranges from 2 to 6 mcg/mL).

What is the duration of action of clonidine? -2 hours -4 hours -6 hours -8 hours

8 hours

What percentage of the drug metoprolol IV is excreted in the urine within 24 hours? -10 -25 -50 -85

85%

t which times should the nurse instruct the patient to take furosemide prescribed two times daily? -8:00 am and 2:00 pm -2:00 pm and 8:00 pm -3:00 pm and 9:00 pm -11:00 am and 11:00 pm

8:00 am and 2:00 pm Taking furosemide early in the day is recommended to promote sleep at night when the effect of the medication is diminished.

Mr. Lowe does not respond very well to the lisinopril. What does the nurse anticipate the health care provider will prescribe in addition to the lisinopril? -A diuretic -A beta blocker -A potassium supplement -An additional ACE inhibitor

A diuretic African Americans and some older adults may not reach BP goals with ACE inhibitor therapy alone, and may require the addition of a diuretic.

Which information is important for the nurse to include when teaching Ms. Adams about her loop diuretic? -A loop diuretic causes high blood potassium levels. -Get a child proof cap for the diuretic. -Herbal supplements will not affect the diuretic. -A loop diuretic will increase urinary frequency.

A loop diuretic will increase urinary frequency. A loop diuretic will, indeed, increase urine volume and urinary frequency. That is how the medicine works to reduce edema and to decrease blood pressure.

Upon discharge from the hospital, a patient is ordered to take a calcium channel blocker in a sustained-release form. What teaching should be included for this patient? Select all that apply. -Take the medication with food or milk. -A wax matrix may be visible in your stool. -Do not split or crush or chew a sustained-release formulation. -Fluid intake should be limited to no more than 1200 ml per day. -Monitor your heart rate and blood pressure and report a slow heart rate and low blood pressure to your health care provider.

A wax matrix may be visible in your stool. Some sustained-release calcium channel blockers are composed of a wax matrix. This matrix is eliminated in feces. Do not split or crush or chew a sustained-release formulation. Once split, crushed or chewed, the mechanism controlling the drug release is no longer functional and the calcium channel blocker will act like an immediate release product. Monitor your heart rate and blood pressure and report a slow heart rate and low blood pressure to your health care provider. Adverse effects of calcium channel blockers include hypotension and bradycardia.

What is the most common reason for stopping ACE inhibitor therapy and changing the drug to an ARB? -ARBs are cheaper. -ARBs are given intravenously. -ARBs have a lower risk of cough. -ARBs are more effective at treating hypertension.

ARBs have a lower risk of cough. Patients taking ARBs are at a lower risk for developing a cough. The side effect of coughing is the most common reason patients stop ACE inhibitor therapy.

Which medicine should the nurse teach the patient not to use while on enoxaparin? Select all that apply. -Aspirin -NSAIDs -Beta blockers -Acetaminophen -Protamine sulfate

ASA NSAIDS

Which metabolic process determines how long a drug is present in the blood? -Catabolism -Acetylation -Lipogenesis -Glycogenesis

Acetylation

A patient is receiving intravenous furosemide. What medical condition might the nurse anticipate the patient reporting during an admission health history? Acute heart failure Liver cirrhosis Peripheral edema Primary hypertension

Acute heart failure IV furosemide is usually indicated in emergency conditions requiring diuresis and control of blood pressure.

Angiotensin II can cause vasoconstriction indirectly by acting on which of the following? Select all that apply. -Lungs -Adrenal medulla -Skeletal muscles -Sympathetic neurons -Central nervous system

Adrenal medulla Angiotensin II can cause vasoconstriction indirectly by acting on the adrenal medulla to promote epinephrine release. Sympathetic neurons Angiotensin II can cause vasoconstriction indirectly by acting on sympathetic neurons to promote norepinephrine release. Central nervous system Angiotensin II can cause vasoconstriction indirectly by acting on the central nervous system to increase sympathetic outflow to blood vessels.

Warfarin binds with which molecule in the body? -Keratin -Ferritin -Albumin -Platelets

Albumin

During patient teaching for Class 1 antidysrhythmic drugs, what will the nurse tell the patient to avoid? Select all that apply. -Alcohol -Caffeine -Exercise -Grapefruit Juice -Prolonged hot baths

Alcohol Caffeine Grapefruit Juice Prolonged hot baths

Verapamil is used to treat which conditions? Edema Angina Acute hypertension Cardiac dysrhythmias Long-term high blood pressure

Angina Cardiac Dysrhythmias Long Term HTN

Which side effect of ARBs could be potentially life-threatening? -Coughing -Angioedema -Pedal edema -Decreased urine output

Angioedema Angioedema is a life-threatening event, and patients taking ARBs need to be aware of the symptoms of angioedema and the need for emergency care if it should occur.

ACE inhibitors block the body's production of which hormone? -Adrenaline -Angiotensin II -Antidiuretic hormone -Glucagon

Angiotensin II Angiotensin II is responsible for vasoconstriction, which causes a rise in blood pressure. ACE inhibitors block the production of angiotensin II.

A nurse is providing discharge teaching to a patient being treated with sodium channel blockers. How should the nurse respond to the patient's concerns about taking the correct amount of medication? -"A liver function test will be done to determine the effect of the medication." -"Your complete blood count will be measured periodically." -"An electrolyte panel will be done to detect abnormalities." -"Blood draws will be taken periodically to measure for drug levels."

"Blood draws will be taken periodically to measure for drug levels." Drugs levels in the blood are determined by peak and trough.

Which teaching should the nurse to provide to Ms. Jones? Select all that apply. -"Change positions slowly." -"If you miss a dose, double your next dose." -"Stop taking the medication if you experience side effects." -"Inform all health care providers that you are taking metoprolol." -"Notify your health care provider if dizziness becomes excessive."

"Change positions slowly." The patient should go from a lying to standing position slowly because dizziness can occur with beta blockers. "Inform all health care providers that you are taking metoprolol." Patients who are taking beta blockers need to inform their health care providers of this because beta blockers can affect medical test and may need to be held prior to surgical procedures. "Notify your health care provider if dizziness becomes excessive." Patients should notify their health care provider if dizziness or fatigue becomes excessive.

A patient who is taking diltiazem asks the nurse, "Why do I need to weigh myself daily?" How should the nurse respond? -"Diltiazem can worsen heart failure, and weight gain is an indicator of worsening heart failure." -"Increased appetite is a common adverse drug effect associated with diltiazem use." -"Diltiazem can worsen heart failure, and weight loss is an indicator of worsening heart failure." -"Weight loss is a sign of anorexia, which is an adverse drug effect associated with diltiazem use."

"Diltiazem can worsen heart failure, and weight gain is an indicator of worsening heart failure." Diltiazem can exacerbate cardiac dysfunction in a patient with heart failure. Weight gain is indicative of worsening heart failure.

The nurse is preparing to administer an ACE inhibitor to a female of child-bearing age. What is the priority instruction the nurse should include when teaching this patient? -"Take your blood pressure on a regular basis." -"Take only as directed by your health care provider." -"Report any nausea and vomiting to your health care provider." -"Do not take ACE inhibitors if you are pregnant or contemplating becoming pregnant."

"Do not take ACE inhibitors if you are pregnant or contemplating becoming pregnant." The patient is of child-bearing age and should be warned that ACE inhibitors can cause harm to the fetus and reduce blood flow to the placenta.

Which statements are most appropriate when teaching about the management of calcium channel blockers' side effects? -"Limit your intake of alcohol and tobacco." -"Drink up to eight glasses of water to avoid constipation." -"Take your pulse daily and hold the medication if your heart rate is above 80 bpm." -"Take your blood pressure daily and hold the medication if it is above 140/80."

"Drink up to eight glasses of water to avoid constipation." Constipation is a common side effect of verapamil. Encourage fluid intake of up to eight glasses per day as appropriate.

A patient who began taking furosemide 24 hours ago complains of increased frequency of urination. How should the nurse respond to the patient? -"Increased frequency of urination is a side effect of this medication, and there is not much we can do about it." -"Frequency of urination will decrease 6-8 hours after you take this medication. You should take it in the morning." -"It is okay to skip a dose of your medication occasionally if frequent urination is bothering you." -"I can provide a bedpan or urinal to prevent frequent visits to the bathroom."

"Frequency of urination will decrease 6-8 hours after you take this medication. You should take it in the morning." Scheduling diuretic medication during the day time promotes sleep at night by preventing nocturia.

What is the initial intervention for a patient taking an anticoagulant who cuts him- or herself? -Apply a tourniquet above the cut. -Stop the anticoagulant immediately. -Call 911 and discuss the situation with the operator. -Apply direct pressure with a clean cloth to the cut for 5-10 minutes.

Apply direct pressure with a clean cloth to the cut for 5-10 minutes. Applying pressure to the wound should be performed initially for a patient on an anticoagulant who cuts him- or herself.

Hydralazine acts on which vessels? -Veins -Arteries -Venules -Arteroles

Arterioles

The physician has written an order for rosuvastatin to be initiated in a patient prior to discharge. The nurse would question the order in which patient? -Caucasian Male -Asian Female -African American Male -Elderly Caucasian Female

Asian Female

A student nurse asks her instructor, "Can you help me understand the difference between furosemide and thiazide diuretics?" How should the instructor respond? -"Furosemide can cause hypokalemia. A thiazide diuretic does not cause hypokalemia." -"Neither furosemide nor thiazide place a patient at risk for dehydration." -"Eating bananas is only indicated for patients taking furosemide. Patients on a thiazide diuretic do not benefit from potassium rich foods." -"Furosemide should not be added to another loop diuretic. A thiazide diuretic can be added to a loop diuretic."

"Furosemide should not be added to another loop diuretic. A thiazide diuretic can be added to a loop diuretic." Furosemide administered in combination with another loop diuretic would be too potent. A thiazide may be added to a loop diuretic to potentiate diuresis.

A nurse is teaching a woman of childbearing age about ARBs. Which statement verbalized by the woman would indicate understanding of the medication? -"This medication will not hurt a fetus." -"This medication can be taken with alcohol." -"I will call my health care provider if I become pregnant." -"This medication is used to treat pregnancy-induced hypertension."

"I will call my health care provider if I become pregnant." Calling the health care provider and letting him or her know about the pregnancy would demonstrate understanding of the medication. ARBs should not be taken by pregnant women in their second or third trimester.

The nurse is teaching a patient about side effects of spironolactone. Which statement by the patient indicates teaching has been effective? -"I will use topical medication if I get a rash." -"I will continue using a salt substitute on my eggs every morning." -"I will stop taking this medication if I experience side effects." -"I will do my gardening in the evening after the sun has gone down."

"I will do my gardening in the evening after the sun has gone down." Photosensitivity is a side effect of potassium-sparing diuretics, including spironolactone. The patient should avoid directly sunlight when taking spironolactone.

Hydrochlorothiazide has been prescribed for a patient who is pre-diabetic. The nurse knows that patient teaching has been successful when the patient makes which statement? -"I will have my blood sugar checked periodically." -"I can take herbal supplements with this medication." -"I will stop eating fresh fruit because it has too much sugar." -"I don't need to check my blood sugar while taking this medication."

"I will have my blood sugar checked periodically." Because large doses of hydrochlorothiazide increase serum glucose levels, a patients who are pre-diabetic should have their blood pressure checked regularly.

A patient is being discharged with a prescription for metoprolol. The nurse knows that the patient has understood discharge teaching when the patient makes which statement? -"I will take a decongestant if I get a cold." -"I can continue to drink my daily glass of wine." -"I will not drive until I know how this medication affects me." -"If I miss a dose of my medication, I will double the next dose."

"I will not drive until I know how this medication affects me." Patients should avoid tasks that require motor skills and alertness until their response to metoprolol is established.

The nurse is educating a patient on the side effects of propranolol. Which response by the patient indicates that teaching was successful? -"I will take my medication every day as directed." -"I will call the health care provider if my heart rate is 82." -"Feeling depressed is a normal side effect of my medication." -"I will take an antacid at the same time I take this medication to prevent an upset stomach."

"I will take my medication every day as directed." Propranolol should not be discontinued without notifying the health care provider first.

The nurse knows that the patient has understood the teaching about furosemide when the patient makes which statement? -"I will lower myself slowly into bed." -"I will weigh myself daily on the same scale." -"I will take this medication an hour before eating breakfast." -"I don't need to use sunscreen while I am taking this medication."

"I will weigh myself daily on the same scale." Patients should keep a log of daily weights and report any significant change in weight to their health care provider.

A patient has been taking metoprolol IR for 6 weeks. The nurse notes a heart rate of 72 beats per minute and a blood pressure of 126/74 mm Hg. The patient reports occasional dizziness, insomnia, and fatigue. What should the nurse recommend to this patient? -"You should stop the drug immediately." -"It is important to discuss these symptoms with the health care provider." -"You should go to an emergency department for evaluation." -"These symptoms are common, harmless side effects."

"It is important to discuss these symptoms with the health care provider." These are side effects of this drug and the patient should be instructed to discuss them with the health care provider.

A patient who is taking Losartan reports feeling lightheaded after standing up. What would be an appropriate explanation from the nurse? -"Losartan can decrease the stabilization of the inner ear." -"Losartan can increase urination, which can make you dehydrated." -"Losartan dilates the blood vessels, which can cause less blood to flow to the brain." -"Losartan can increase the amount of renin in the kidneys, increasing blood flow to the kidneys."

"Losartan dilates the blood vessels, which can cause less blood to flow to the brain." Losartan dilates the blood vessels. Less blood is immediately available to go to the brain because it pools in the lower blood vessels.

A patient who has asthma uses albuterol several times each week and asks the nurse if metoprolol IR can be used to treat hypertension. What should the nurse tell this patient? -"Metoprolol decreases the effects of albuterol." -"If you use the albuterol only as needed, there will not be a problem." -"If you do not take the medications at the same time, there are no adverse effects." -"Albuterol will increase the effects of metoprolol, causing severe hypotension."

"Metoprolol decreases the effects of albuterol." Beta blockers can cause bronchoconstriction, which counters the effects of albuterol. Patients with asthma should not take beta blockers unless necessary.

An African American patient has been prescribed metoprolol and a diuretic. The patient asks the nurse, "Why do I have to take two blood pressure medications?" How should the nurse respond? -"The diuretic will help reduce the side effects of metoprolol." -"I think your health care provider made a mistake in prescribing both medications." -"Diuretics are always prescribed with metoprolol to increase the effectiveness of therapy." -"Metoprolol is less effective in African Americans. The diuretic will increase the effectiveness of your medication."

"Metoprolol is less effective in African Americans. The diuretic will increase the effectiveness of your medication." Monotherapy with a beta blocker is less effective in controlling hypertension in African American patients. The addition of a diuretic can increase the effectiveness of therapy.

A patient is newly diagnosed with hypertension and asks for a minoxidil prescription. The patient states, "It was the only medication that helped my dad's hypertension." Which statement by the nurse is the most appropriate? -"Since genetic factors play a role in high blood pressure, minoxidil may be the only medication that works for you." -"Maximum vasodilation for minoxidil is 1 hour; you would need a medication that does not work as fast." -"Minoxidil is only indicated for patients with severe hypertension who have not responded to previous treatment." -"Minoxidil is primarily used for promoting hair growth; your dad likely was not using it to treat hypertension."

"Minoxidil is only indicated for patients with severe hypertension who have not responded to previous treatment." Because of the serious side effects, minoxidil is only used in patients with severe hypertension who have not responded to previous treatment.

A patient is to receive oral metoprolol IR to treat hypertension and asks the nurse why the health care provider has ordered liver function tests. How should the nurse respond? -"The drug may not be effective if your liver function is abnormal." -"Patients with poor liver function may experience toxic effects from this drug." -"This drug may damage the liver, so your health care provider needs to monitor liver function." -"If your liver is not functioning well, the medication may not be absorbed properly."

"Patients with poor liver function may experience toxic effects from this drug." Metoprolol and propranolol are both eliminated primarily by hepatic metabolism, so adequate liver function must be established to prevent toxicity.

The nurse is providing discharge education on a patient in the telemetry unit who has just been prescribed a statin drug. The patient asks the nurse when he can expect to be taken off the medication. How does the nurse respond? -"You will be on the drug for at least two weeks." -"Your provider may discontinue the medication in four to six weeks." -"Reduction of cholesterol will be a lifelong treatment." -"Cholesterol medications are generally discontinued in a few months."

"Reduction of cholesterol will be a lifelong treatment." If statin therapy is stopped, serum cholesterol will return to pretreatment levels. Therefore, treatment should continue lifelong.

The nurse is providing discharge teaching for a patient taking a calcium channel blocker. What should the nurse include in patient teaching to decrease the risk of lightheadedness? -"Remain in a supine position for 1 hour after taking your medication." -"Do not engage in physical activity for 2 hours after taking your medication." -"Split the dose of the calcium channel blocker over 4 hours." -"Rise slowly from a sitting or lying position."

"Rise slowly from a sitting or lying position." Lightheadedness is an adverse drug effect of calcium channel blockers. The postural hypotension that causes the lightheadedness result from arterial vasodilatation effect of calcium channel blockers.

A patient asks the nurse why ACE inhibitor medications are only administered twice a day. What is the nurse's best response? -"That is how the health care provider wrote the order." -"ACE inhibitors are too expensive to administer more frequently." -"The half-life of the drug makes it effective when administered twice a day." -"ACE inhibitors are only taken twice a day because they cannot be taken with food."

"The half-life of the drug makes it effective when administered twice a day." ACE inhibitors are administered twice a day because the length of their half-life means that this administration schedule is effective.

Which statement by the nurse is correct regarding sublingual nitroglycerin? -"Sublingual nitroglycerin effects can last for 1 hour." -"It is okay to take alcohol with this medication." -"The sublingual tablets need to be kept in the original airtight glass container." -"If the pain remains after you take the nitroglycerin, you should just try lying down."

"The sublingual tablets need to be kept in the original airtight glass container." Sublingual tablets should be kept in airtight, glass containers; this protect the tablets from exposure to light and moisture, which can reduce the potency of the tablets.

A patient just started taking lisinopril and is reporting that food tastes bland. What is the nurse's best response? -"I will ask the health care provider to change your medication." -"Stop taking the medication and we will address this at your next visit." -"I will order a nutrition consult to determine the cause of this problem." -"The taste of food may be diminished during the first month of drug therapy."

"The taste of food may be diminished during the first month of drug therapy." Lisinopril may cause a change in the taste of food.

A 30-year-old female who is taking a beta blocker asks why she cannot take this drug if she is considering pregnancy. What should the nurse tell this patient? -"The drug will affect your ability to become pregnant." -"There is scientific evidence of risks to the fetus with this drug." -"Being pregnant will alter the effectiveness of the medication." -"Taking this drug while pregnant increases the risk of bradycardia."

"There is scientific evidence of risks to the fetus with this drug." Beta blockers readily cross the placental barrier, which has known risks to the fetus.

A patient reports prolonged adverse effects several weeks after the provider has discontinued amiodarone. What will the nurse tell the patient? -"The adverse effects of amiodarone are usually permanent." -"This is expected because this drug has an especially long duration of action." -"You should increase your fluid intake so your kidneys can excrete the drug." -"Your provider will order tests to determine whether your liver is functioning properly."

"This is expected because this drug has an especially long duration of action." Amiodarone has an elimination half-life of 15-100 days and a duration of action up to 150 days, so drug effects may be present up to 5 months after the drug is withdrawn.

A patient asks the nurse why lidocaine can't be given orally. What is the most appropriate response by the nurse? -"You are asking me why this medication has to be given IV?" -"I will discuss your concern with the doctor during rounds." -"This medication can only be taken IV to be effective." -"The IV route is meant to make the medication work faster."

"This medication can only be taken IV to be effective." Lidocaine would be inactivated on its first pass through the liver if it were given orally.

The nurse asks a patient taking an ARB, "When do you take this blood pressure medication?" Which response(s) would indicate the patient needs more education regarding this medication? Select all that apply. -"Which one is for my blood pressure?" -"I take it roughly the same time each day." -"I always have to take it with food or it won't work." -"I take it only when my blood pressure is over 180/80." -"I will immediately call 911 or my health care provider if my face begins to swell."

"Which one is for my blood pressure?" Education is a priority when a patient is unsure of which medication is used for blood pressure. "I always have to take it with food or it won't work." The patient's statement is incorrect. ARBs can be taken with or without food. "I take it only when my blood pressure is over 180/80." ARBs should be taken as prescribed daily, not only when blood pressure reaches a certain number.

A patient was just started on an ACE inhibitor for hypertension. Which orders for monitoring the patient would the nurse expect to receive from the health care provider? Select all that apply. -Assess renal function. -Assess urinary output. -Assess blood pressure. -Assess potassium levels. -Obtain orthostatic vital signs.

Assess renal function. Assessing renal function is important because ACE inhibitors are excreted from the body through the kidneys. Assess urinary output. Assessing urinary output allows the health care provider to assess blood pressure and kidney function. Assess blood pressure. The health care provider can evaluate the efficacy of the drug by ordering the monitoring of blood pressure. Assess potassium levels. Potassium levels must be assessed due to the risk of hyperkalemia, a condition in which potassium rises to life-threatening levels.

On assessment the nurse finds that a patient's face is very red and swollen. The nurse notes that the patient took valsartan for the first time 2 hours ago. What is the priority nursing intervention? -Prepare to intubate the patient. -Apply a cream to lessen the redness. -Administer the normal dose of epinephrine. -Assess that the airway is patent and get help.

Assess that the airway is patent and get help. The priority nursing intervention is to assess the airway and prepare for a possible intubation.

Which comorbid conditions are causes for concern for patients who may need to take a beta blocker medication? Select all that apply. -Asthma -AV block -Diabetes -Hypertension -Benign prostatic hypertrophy (BPH)

Asthma Beta blockers can cause bronchoconstriction, so patients who have underlying disorders, such as asthma, should not take these drugs. AV block Because beta blockers slow the heart rate, patients with AV block should not take these drugs. Diabetes Beta blockers can impede early recognition of insulin-induced hypoglycemia and can block glycogenolysis, so patients with diabetes should not take these drugs.

A patient asks the nurse what diltiazem is prescribed for. The nurse responds that diltiazem is indicated for treatment of which dysrhythmia? Select all that apply. -Atrial flutter -Atrial fibrillation -Ventricular tachycardia -Supraventricular tachycardia -Multi-focal premature ventricular contractions

Atrial flutter Diltiazem can slow ventricular rate in patients with atrial flutter. Atrial fibrillation Diltiazem can slow ventricular rate in patients with atrial fibrillation. Supraventricular tachycardia Diltiazem can terminate supraventricular tachycardia caused by an atrioventricular (AV) nodal reentrant circuit.

What is important to teach Ms. Wang about nutrition while she is taking warfarin? -Avoid broccoli. -Eat a lot of grapes. -Avoid eating pasta. -Drink a lot of green tea.

Avoid Broccoli

An airline pilot was recently prescribed clonidine for high blood pressure. What teaching can the nurse provide to this patient regarding CNS adverse side effects? -They occur only in the older adult. -Drowsiness and sedation are rare. -Sedative effects wear off two hours after intake. -Avoid activities that require concentration.

Avoid activities that require concentration. Activities that require concentration should be avoided due to CNS responses (drowsiness and sedation) that are common, but become less intense with continued drug use.

A continuous infusion of nitroprusside has been stopped. Which effect will this being stopped have on a patient's blood pressure? -BP will increasse -BP will decrease -BP will remain the same -BP will fluctuate

BP will increase

Which foods should the nurse recommend to minimize the effect of potassium losses caused by diuretic medication? -Bread -Cheese -Bananas -Lettuce

Bananas Bananas are excellent sources of potassium.

A provider has ordered long-acting diltiazem for a patient with angina pectoris. In order to monitor the effectiveness of diltiazem the nurse should complete which assessments? -Baseline vital signs -Baseline electrocardiogram -Baseline pulmonary function tests -Baseline data on frequency and severity of angina attacks

Baseline data on frequency and severity of angina attacks Baseline data on frequency and severity of angina attacks should be assessed on a patient started on diltiazem, as a decrease in the frequency and severity of angina attacks will indicate drug effectiveness.

A provider has ordered long-acting diltiazem for a patient with angina pectoris. In order to monitor the effectiveness of diltiazem the nurse should complete which assessments? -Baseline vital signs -Baseline electrocardiogram -Baseline pulmonary function tests -Baseline data on frequency and severity of angina attacks attacks will indicate drug effectiveness.

Baseline data on frequency and severity of angina attacks Baseline data on frequency and severity of angina attacks should be assessed on a patient started on diltiazem, as a decrease in the frequency and severity of angina attacks will indicate drug effectiviness.

Which medication is commonly prescribed with a vasodilator to minimize reflex tachycardia? -Diuretic -Calcium Channel Blocker -Beta Blocker -Alpha Blocker

Beta Blocker

A patient who has hypertension also has a history of asthma, and asks why a beta blocker is not prescribed to treat the hypertension. How should the nurse respond? -Administering beta blockers increases the risk of toxicity of asthma medications. -Many asthma drugs reduce the therapeutic effects of beta blocker medications. -Beta blocker medications can cause bronchospasm, which can trigger an asthma attack. -Asthma medications act to potentiate the effects of beta blockers, increasing the risk for toxicity.

Beta blocker medications can cause bronchospasm, which can trigger an asthma attack. Nonselective beta blockers have effects on beta1 and beta2 receptors and can cause bronchospasm, so are contraindicated in patients who have asthma. Cardio selectivity of beta1 blockers does not confer absolute protection from bronchoconstriction, so these drugs are not recommended.

Which side effects should the patient taking ACE inhibitors report to the health care provider? Select all that apply. Itching Bleeding Extremity pain Nagging cough Swelling of the face, neck, and tongue

Bleeding Any bleeding should be reported to the health care provider, as it is a potentially dangerous side effect. Nagging cough A nagging cough is considered a serious side effect and indicates that the patient's medication needs to be changed to a different drug class. Swelling of the face, neck, and tongue Swelling of the face, neck, and tongue is symptomatic of angioedema, a life-threatening adverse effect that requires immediate treatment.

The nurse is completing medication teaching for a patient with a new medication order for lisinopril. What side effects should the patient report to the health care provider? Select all that apply. -Itching -Bleeding -Nagging cough -Persistent dizziness -Swelling of the face, lips, or throat

Bleeding Any bleeding should be reported to the health care provider, as it is a potentially dangerous side effect. Nagging cough Nagging cough is a major side effect that requires health care provider attention. Persistent dizziness Persistent dizziness can result from blood pressure being too low. Swelling of the face, lips, or throat Swelling of the face, lips, or throat could indicate angioedema, which is life-threatening and requires immediate attention.

loop diuretics

Block sodium and chloride reabsorption in the loop of Henle

Thiazide diuretics

Block sodium and water reabsorption in the distal tubule

Potassium Sparing Diuretics

Block sodium-potassium exchange in the collecting tubules

What would the nurse assess for when caring for a 74-year old patient receiving clonidine? -Potassium levels -Urinary frequency -Blood pressure -Rebound hypertension

Blood pressure Clonidine has a high risk of adverse CNS effects in the older adult. Blood pressure and heart rate should be monitored.

What vital sign is most important for the nurse monitor prior to giving a dose of losartan? -Heart rate -Temperature -Blood pressure -Respiratory rate

Blood pressure Losartan is an ARB used to treat hypertension. Knowing the baseline blood pressure prior to giving the medication is very important.

What is a priority nursing intervention when caring for a patient who has a clonidine epidural in place for pain control? -Lung auscultation -Blood pressure monitoring -Perfusion assessment -Urinary output assessment

Blood pressure monitoring Clonidine is used for pain control, but it can severely affect blood pressure. Blood pressure monitoring is a priority.

Which nursing assessment indicates an undesired effect of the beta blockade? Select all that apply. -Bradycardia -Bronchoconstriction -Reduced cardiac output -Reduced renin release in the kidneys -Decreased peripheral vascular resistance

Bradycardia Significant lowering of the heart rate can cause the undesired effect of sinus bradycardia. Bronchoconstriction Non-selective beta blockers have effects on beta2 receptors, causing bronchial constriction. This is considered an adverse effect and does not help to lower blood pressure.

Which items does the nurse teach the patient to avoid when teaching dietary counseling to the patient taking enoxaparin? Select all that apply. -Broccoli -Alcohol -legumes -milk products -grapefruit juice -leafy green vegetables

Broccoli Alcohol Legumes Green Leafy Vegetables

The nurse assesses the patient who is taking enoxaparin. Which signs and symptoms should prompt the nurse to take further action? Select all that apply. -bruising -diarrhea -petechiae -hematuria -brown stool

Bruising Petechiae Hematuria

How do thiazide diuretics lower blood pressure? -By acting on arterioles -By blocking beta1 receptors -By blocking alpha1 receptors -By relaxing venous smooth muscle

By acting on arterioles Thiazide diuretics cause vasodilation by acting directly on arterioles, which lowers blood pressure.

How does verapamil reduce the amount of oxygen required by the myocardium in a patient with angina pectoris? -By venodilation -By increasing coronary blood flow and decreasing after load -By increasing myocardial contractility -By slowing electrical conduction through the atrioventricular node

By increasing coronary blood flow and decreasing after load Verapamil causes vasodilation of the arterial vascular bed, thus reducing after load and decreasing myocardial wall tension. As a consequence, myocardial oxygen demand decreases.

How do antianginal drugs increase blood flow to the heart? Select all that apply. -By increasing oxygen supply to the myocardium. -By correcting cardiac arrhythmias. -By reducing plaque in the coronary arteries. -By increasing oxygen demand of the myocardium. -By decreasing oxygen demand of the myocardium.

By increasing oxygen supply to the myocardium. Antianginal drugs increase blood flow to the heart by increasing the supply of oxygen to the myocardium. By decreasing oxygen demand of the myocardium. Antianginal drugs increase blood flow to the heart by decreasing the oxygen demand of the myocardium.

How do ACE inhibitors lower blood pressure? -By decreasing potassium in the body. -By causing the body to excrete extra fluid. -By lowering the peripheral vascular resistance. -By decreasing pain, which lowers blood pressure.

By lowering the peripheral vascular resistance. ACE inhibitors decrease vascular resistance, causing blood vessels to relax and widen. This allows blood to flow through the vessels more easily, which reduces blood pressure.

A patient who only speaks Spanish is being discharged home on an anticoagulant. How can the nurse best ensure the patient understands discharge instructions? -By giving the patient written instructions -By teaching the patient and using their family member as the interpreter -By providing discharge teaching instructions in the patient's preferred language -By speaking to the patient slowly in English and enunciating the discharge instructions

By providing discharge teaching instructions in the patient's preferred language

Which baseline data will the nurse assess before administering enoxaparin? Select all that apply. -liver enzymes -platelet count -bleeding risk -CBC -INR

CBC Platelet count Bleeding risk

How do calcium channel blockers inhibit the transport of calcium in the heart? -Calcium channel blockers inhibit calcium influx into vascular smooth muscle only. -Calcium channel blockers inhibit calcium transport into the ventricular tissues of the heart. -Calcium channel blockers inhibit the influx of calcium into cardiac muscle by allowing the controlled delivery of calcium into cardiac cells. -Calcium channel blockers are calcium ion channel antagonists, which prevent calcium from entering cells of the heart and blood vessel walls.

Calcium channel blockers are calcium ion channel antagonists, which prevent calcium from entering cells of the heart and blood vessel walls. Calcium channel blockers are calcium ion channel antagonists and inhibit the influx of calcium ions through voltage-dependent calcium channels in the cell membrane of myocardial cells.

How do calcium channel blockers affect vascular smooth muscle? -Calcium channel blockers constrict vascular smooth muscle. -Calcium channel blockers dilate vascular smooth muscle. -Calcium channel blockers enhance vascular smooth muscle proliferation. -Calcium channels blockers dilate the vascular smooth muscle of veins.

Calcium channel blockers dilate vascular smooth muscle. Calcium channel blockers vasodilate peripheral arterioles and arteries and arterioles of the heart.

What should patients taking thiazide diuretics do when they "feel worse" or are uncomfortable with their medication? -Call the prescriber to report discomfort. -Hold the medication until they feel better. -Discontinue the medication and request change of medication. -Skip taking the current dose and resume medication with the next dose.

Call the prescriber to report discomfort. Patients are recommended to report drug-related discomfort to the prescriber for appropriate follow-up action.

Which patient assessment(s) may indicate that a class III antidysrhythmic drug is effective? Select all that apply. -Dyspnea -Orthostatic hypotension -Jugular vein distension -Capillary refill <3 seconds -Urine output >1200 mL/24 hours

Capillary refill <3 seconds indicates adequate perfusion, indicating that an antidysrhythmic drug is effective. Urine output >1200 mL/24 hours A urine output of more than 1200 mL/day indicates adequate perfusion, indicating that an antidysrhythmic drug is effective.

A patient started taking a new ACE inhibitor 4 weeks ago. The patient now has a nagging dry cough. What action does the nurse anticipate from the health care provider? -Scheduling a follow-up visit with the patient -Making no changes to the prescribed medication -Changing the patient to a different ACE inhibitor medication -Changing the patient to a different class of blood pressure medication

Changing the patient to a different class of blood pressure medication A nagging dry cough is a serious side effect of ACE inhibitors. The health care provider should change the patient's medication to a different class of blood pressure medication.

Mr. Allen is going to be discharged with oral verapamil. What should the nurse teach him about this medication? Select all that apply. -Take verapamil on an empty stomach. -Check his pulse before taking verapamil. -Constipation is a common side effect of verapamil. -Verapamil may cause hypertension and tachycardia. -Do not drink grapefruit juice while taking verapamil.

Check his pulse before taking verapamil. It is important for patients taking calcium channel blockers to know how and when to check their pulse. They should be taught to report a heart rate of less than 60 to their prescriber. Constipation is a common side effect of verapamil. Encourage fluid intake of up to eight glasses per day as appropriate. Do not drink grapefruit juice while taking verapamil. Grapefruit juice can inhibit the metabolism of verapamil and should be avoided.

A nurse obtains a blood pressure of 210/110 on a patient complaining of a headache. Previous blood pressure readings ranged from 140-170/65-85. Which of the following actions would be appropriate? -Notify the cardiac arrest team due to the extreme hypertension in this patient. -Check the patient's chart for any missed medication doses and notify the health care provider. -Try to decrease the stimulation in the room and use verbal techniques to calm the patient. -Document the vital signs and notify the health care provider on rounds of the blood pressure change.

Check the patient's chart for any missed medication doses and notify the health care provider. This patient is very hypertensive and is having clinical signs (headache) of hypertension. The nurse needs to contact the health care provider and, if possible, check for any medication errors that could be responsible for this hypertension.

What teaching can the nurse provide to a patient who is receiving clonidine and reporting xerostomia? -Take the medication with food. -Take the medication on an empty stomach. -Chew gum to help with discomfort. -Contact the health care provider to change medications.

Chew gum to help with discomfort. Xerostomia is a common side effect in patients who take clonidine and usually diminishes in the first 2 to 4 weeks. Chewing gum or hard candy can help with the discomfort.

A patient asks how long it takes for cholesterol levels to decrease using a statin. How does the nurse respond? Select all that apply. -Cholesterol reduction takes four to six weeks. -Cholesterol reduction will not likely occur. -Cholesterol reductions are significant within 2 weeks. -Maximal reduction is seen within 4 to 6 weeks. -Maximal reduction is seen within 4 to 6 months.

Cholesterol reductions are significant within 2 weeks. Maximal reduction is seen within 4 to 6 weeks.

How should a nurse respond to a patient on clonidine who is concerned about a quick drop in blood pressure when standing up from a sitting position? -"Stand up slowly and blood pressure should not be affected." -"Clonidine does not affect your blood pressure when you stand up." -"Clonidine causes your blood pressure to drop when you stand up." -"Sit as much as you can to keep your blood pressure down."

Clonidine does not affect your blood pressure when you stand up." Hypotensive effects of clonidine are not posture dependent. Therefore, orthostatic hypotension is not seen in patients on clonidine therapy.

A patient is taking clonidine 0.1 mg twice a day and questions if the medication is safe during pregnancy. What is the best response by the nurse? -Clonidine is safe after the first trimester. -Clonidine is not recommended for pregnant women. -Transdermal clonidine is safe. -There are no concerns during pregnancy.

Clonidine is not recommended for pregnant women. Clonidine is potentially harmful to the fetus and should not be used during pregnancy.

Which actions will the nurse take before administering clonidine? Select all that apply. -Confirming that the patient is not pregnant -Teaching symptoms of drug interaction with insulin -Obtaining a baseline blood pressure -Obtaining a baseline glucose level -Obtaining a baseline temperature

Confirming that the patient is not pregnant Clonidine is contraindicated in women who are pregnant because of fetal harm. The nurse should confirm that the patient is not pregnant and educate the patient about the importance of contraceptive use. Obtaining a baseline blood pressure Obtaining a baseline blood pressure prior to initiation will provide information on how well the medication is working.

What are the most common side effects that the patient should be aware of when initiating statin drugs? Select all that apply. -constipation -muscle pain -peptic ulcer -flushing of skin -muscle tenderness

Constipation Peptic ulcer

Discussion of which common adverse effects of statin therapy would the nurse include in patient education? Select all that apply. -Constipation -Blurred vision -Dyspepsia -Long bone stress fractures -Vaginal and oral yeast infections

Constipation Blurred Vision Dyspepsia

A patient with hypertension and heart failure who is taking a beta blocker to reduce blood pressure reports an increase in constipation. What should the nurse recommend? -Using an over-the-counter laxative -Increasing fluid intake -Consuming high fiber foods -Decreasing the medication dose

Consuming high fiber foods

A patient's medication list shows that the patient is currently taking spironolactone. The health care provider orders an ACE inhibitor for blood pressure control for this patient. What is the nurse's next action? -Administer the spironolactone. -Contact the health care provider. -Ask the nurse aid to check the patient's vital signs every four hours. -Check the patient's potassium level prior to medication administration.

Contact the health care provider. The combination of spironolactone and an ACE inhibitor can cause hyperkalemia, so the health care provider should be notified.

The nurse receives an order to begin a maintenance dose of intravenous amiodarone to a patient. The pharmacy sends a bag containing 900 mg of amiodarone in 250 mL of D5W. What should the nurse do? -Administer the drug at a rate of 20 mg/min -Contact the pharmacy to dilute the drug in 500 mL of D5W -Administer the solution through a peripheral intravenous line -Ask the pharmacy to change the concentration to 150 mg in 100 mL

Contact the pharmacy to dilute the drug in 500 mL of D5W The maintenance dose of IV amiodarone should be diluted as 900 mg in 500 mL D5W (1.8 mg/mL)

The nurse is hanging a new bag of intravenous heparin and sees the dose is prescribed in milligrams. What is the nurse's next action? -Discuss the situation with the charge nurse. -Hang the new bag of heparin, per hospital policy. -Contact the prescriber for a change in prescription. -Convert milligrams to grams and hang the new bag, per hospital policy.

Contact the prescriber for a change in prescription. Heparin is always dosed in units. This is a medication error and needs to be corrected before the medication is administered to the patient.

A patient has been switched from an ACE inhibitor to an ARB. Which of the following side effects would be a common reason for this change in medication? -Cough -Sneezing -Increased dizziness -Increased blood pressure

Cough Cough is often associated with ACE inhibitors due to the increased bradykinin release with those drugs. ARBs do not increase bradykinin release.

Which factors increase the patient's risk of the development of myopathy? Select all that apply. -Increased BMI -DM -Low Dose Statin -Frailty -Low vitamin D

DM Frailty Low Vitamin D

Propranolol is contraindicated in a patient with which condition? Select all that apply. -DM -HF -Tachydysrhythmias -MI -Paroxysmal atrial tachycardia

DM HF

A patient requires diuretic therapy with minoxidil. Which actions should the nurse anticipate? Select all that apply. -weekly weights -daily weights -measuring output once a shift -measuring output with every void -starting dialysis

Daily Weights Measuring output with every void.

Which LMWHs are approved for use in the United States? Select all that apply. Warfarin Tinzaparin Dalteparin Enoxaparin Dabigatran

Dalteparin Enoxaparin

What effect do ARBs have on edema? -Increase edema -Decrease edema -No effect on edema -Shift edema to generalized edema

Decrease edema ARBs decrease the release of aldosterone, the sodium-retaining hormone. When the kidneys excrete sodium, water is also excreted, decreasing edema.

A patient is admitted with a history of essential hypertension. Shortly after a nitroprusside drip is started, the patient complains of a headache, palpitations, nausea and sweating. Which action should the nurse take? -Decrease the rate of infusion. -Do not change the rate of infusion. -Increase the rate of infusion. -Obtain thiocyanate level.

Decrease the rate of infusion.

Which action of a loop diuretic can potentially cause hypotension in patients taking this medication? -Tubular reabsorption of sodium and chloride -Water retention and potassium-sparing -Excess fluid loss and dehydration -Decreased blood volume and venous constriction

Decreased blood volume and venous constriction Loss of water and sodium reduces blood volume. Loop diuretics do not cause smooth muscle constriction.

What should the nurse assess in a patient who is taking verapamil and digoxin to determine if the patient is experiencing a drug interaction? -Decreased heart rate -Increased heart rate -Increased blood pressure -Decreased blood pressure

Decreased heart rate Decreased heart rate is a sign of AV block, which can be caused by the use of verapamil with digoxin.

Which is a pharmacologic effect of class IC antidysrhythmic drugs? -Decreases conduction in the bundle of His-Purkinje system -Significantly increases conduction in the atria -Increases the refractory period -Have potent anticholinergic effects

Decreases conduction in the bundle of His-Purkinje system

What is the mechanism of action of clonidine? -Increases peripheral vascular resistance and decreases cardiac output. -Decreases peripheral vascular resistance and decreases cardiac output. -Decreases peripheral vascular resistance and increases cardiac output. -Increases peripheral vascular resistance and increases cardiac output.

Decreases peripheral vascular resistance and decreases cardiac output. Centrally acting alpha2 adrenergic agonists decrease sympathetic activity, which decreases both cardiac output and peripheral vascular resistance to promote a decrease in blood pressure.

Beta blockers work by which mechanism? Select all that apply. - Increasing HR - Decreasing HR -Increasing myocardial contractility - Decreasing myocardial contractility -Increasing myocardial automaticity - Decreasing myocardial automaticity

Decreasing HR Decreasing myocardial contractility Decreasing myocardial automaticity.

The nurse reviews a patient's medication history, and notes that the patient is taking lovastatin and cholestyramine, and has an order for amiodarone. What should the nurse discuss with the provider? -Decreasing the lovastatin dose -Decreasing the amiodarone dose -Increasing the cholestyramine dose -Changing the lovastatin to simvastatin

Decreasing the lovastatin dose Amiodarone can increase levels of several drugs, including three statins. Dosages of these agents often require reduction.

The nurse prepares to administer enoxaparin to a patient who is post-operative total knee replacement. How should the nurse administer the medication? -Oral dosing -IV bolus -Deep Subcutaneous -IM injection

Deep subQ injection Enoxaparin is administered by deep subQ injection, usually in the abdomen.

Which information should be included in discharge teaching plan for a patient taking vasodilators? -Desired therapeutic response may take up to 3 months. -Desired therapeutic response should take 1 month. -Monthly lab tests are needed for a complete blood count. -Monthly lab tests are needed for hyperlipidemia and cholesterol.

Desired therapeutic response may take up to 3 months. After initiation of vasodilator therapy, a therapeutic response may take up to 3 months to achieve.

Which drug/herbal history of a patient will prompt the nurse to report a possible drug-drug interaction in a patient taking a thiazide diuretic? -Furosemide -Spironolactone -Digoxin -Propranolol

Digoxin Thiazide and loop diuretics cause hypokalemia, which enhances the action of digoxin. If digoxin is taken with thiazide and loop diuretics, this can result in digoxin toxicity.

Nifedipine and amlodipine belong to which group of calcium channel blockers? -Alpha blockers -Dihydropyridines -Nondihydropyridines -Adrenergic blockers

Dihydropyridines Nifedipine, amlodipine, and felodipine belong to the dihydropyridine group of calcium channel blockers.

Which statement(s) correctly explain why the nurse should closely monitor the liver status of an 80 year-old patient on diltiazem? -Diltiazem is nephrotoxic -Diltiazem is exclusively excreted by the kidneys. -Diltiazem administration is contraindicated in the elderly. -Diltiazem dose would need to be reduced in a patient with hepatic impairment.

Diltiazem dose would need to be reduced in a patient with hepatic impairment. Diltiazem is extensively metabolized by the liver. Hepatic impairment would lead to increased serum levels and potential toxicity.

A patient taking diltiazem and digoxin has elevated digoxin levels and missed her appointment to obtain lab draws. How should interactions between the two drugs be explained and the rationale for monitoring blood levels? -Digoxin may cause a significant increase in the serum concentration of diltiazem. -Diltiazem may cause a significant increase in the serum concentration of digoxin. -Digoxin may cause a significant decrease in the serum concentration of diltiazem. -Diltiazem may cause a significant decrease in the serum concentration of digoxin.

Diltiazem may cause a significant increase in the serum concentration of digoxin. When diltiazem and digoxin are taken together, your body may not process digoxin properly. The result of this interaction is an increase in the level of digoxin in the blood. Patients taking both diltiazem and digoxin will need dose adjustments and/or or special tests in order to safely take the medications together.

A patient has been in the hospital and taking nitroprusside for the past 5 days for elevated blood pressure. The patient is restless and is not able to answer common questions. What is the priority nursing action? -decrease medication -administer an antidiuretic -increase the medication -d/c the medication

Discontinue the medication. Discontinue the medication and notify the health care provider. Plasma thiocyanate levels should be monitored.

A patient with hypertension begins taking metoprolol IR and asks about nonpharmacological methods to help reduce blood pressure. What should the nurse tell the patient? -Making lifestyle changes will have little or no effect on hypertension. -Minimize exercise because this will elevate blood pressure. -Use biofeedback to help with relaxation and eliminate the need for drug therapy. -Discuss a lifestyle modification plan with the health care provider that includes diet and exercise recommendations.

Discuss a lifestyle modification plan with the health care provider that includes diet and exercise recommendations. Diet and exercise, along with other nonpharmacologic methods can enhance the effects of antihypertensive medications. The patient should discuss these with the health care provider.

Prior to administering dronedarone, the nurse reviews the patient's medical record. The patient's electrocardiogram shows a PR interval of 250 msecs, a QT interval of 450 msecs, and a heart rate of 78 beats per minute. The nurse notes that the patient is taking carbamazepine for diabetic neuropathy. Based on this data, what should the nurse do prior to giving the medication? -Request an order to increase the carbamazepine dose -Give the drug and monitor the patient's heart rate closely -Discuss possible drug interactions with the patient's provider -Hold the drug and notify the provider of the electrocardiogram results

Discuss possible drug interactions with the patient's provider Carbamazepine is a strong inducer of CYP3A4 and can reduce dronedarone levels by as much as 80%. The nurse should contact the provider to discuss this drug interaction.

A patient has been admitted with newly-diagnosed hypertension. To prevent a hypotensive interaction, the health care provider should avoid ordering the first dose of an ACE inhibitor with which type of medication? -Antihistamine -Diuretic -Stool softener -Topical analgesic

Diuretic Diuretics can cause an unsafe drop in blood pressure when combined with ACE inhibitors.

Which medication can have adverse effects if given with clonidine? -Aspirin -Diuretics -Acetaminophen -Simvastatin

Diuretics Diuretics should not be given with clonidine because of increased hypotensive effects.

Which adverse reaction of Class 1 antidysrhythmic drugs must the nurse teach the patient to report immediately to their health care provider? -Dizziness -Nausea and vomiting -Headache -Fatigue

Dizziness

Which side effects associated with beta blocker use should the patient report to the health care provider? Select all that apply. -Nausea -Tinnitus -Vomiting -Dizziness -Muscle Cramps

Dizziness Vomiting Nausea

What teaching does the nurse need to include for Ms. Abbott, who is being discharged home on clonidine? Select all that apply. -Do not eat grapefruit while on clonidine because it interferes with the absorption of the medication. -Do not discontinue clonidine suddenly as it may cause rebound hypertension. -Avoid hazardous activities until the effects of the medication are known. -Take the medication with food. The medication can cause dry mouth.

Do not discontinue clonidine suddenly as it may cause rebound hypertension. Because Ms. Abbott has a history of noncompliance, the nurse must stress the importance of taking medications as prescribed and not abruptly stopping the clonidine due to the risk of rebound hypertension. Avoid hazardous activities until the effects of the medication are known. Clonidine can cause drowsiness, so patients should avoid hazardous activities until they know how the medication affects them. The medication can cause dry mouth. Clonidine can cause xerostomia, or dry mouth.

What are the priority teaching measures for the patient on verapamil? Select all that apply. -Keep a three-month supply of verapamil on hand at all times. -Do not drink grapefruit juice while you are on verapamil. -Monitor blood pressure and heart rate regularly. -Swallow the extended-release verapamil tablets and capsules whole. -If you miss a dose of verapamil, take the missed dose with your next dose. -Seek immediate medical attention for confusion, profound dizziness, severe hypotension, and/or slowed heart rate.

Do not drink grapefruit juice while you are on verapamil. Grapefruit juice can increase blood levels of verapamil and lead to toxicity. Monitor blood pressure and heart rate regularly. Bradycardia and severe hypotension are adverse drug effects associated with the use of verapamil. Swallow the extended-release verapamil tablets and capsules whole. Chewing an extended-release verapamil tablet or capsule may cause the verapamil to act like an immediate release product. Seek immediate medical attention for confusion, profound dizziness, severe hypotension, and/or slowed heart rate. Confusion, profound dizziness, severe hypotension and slowed heart rate are signs and symptoms consistent with verapamil toxicity.

Which teaching point would be most important for a patient to understand prior to leaving with a new prescription for an ARB? -Continue taking this medication if you become pregnant. -Do not take your medication if your blood pressure is lower than 90/50. -Do not take your medication if your blood pressure is higher than 180/80. -The goal of this medication is to keep your blood pressure lower than 80/50.

Do not take your medication if your blood pressure is lower than 90/50. If a patient's blood pressure is lower than 90/50, the ARB should not be taken and the health care provider should be notified.

A health care provider routinely orders verapamil 360 mg per day in divided doses for the prevention of paroxysmal supraventricular tachycardia. Why would the nurse question this order for a patient with a history of liver cirrhosis? -Verapamil is routinely administered as a once daily dose. -The dose of 360 mg is not a standard daily dosage of verapamil. -Verapamil is not indicated for the prevention of paroxysmal supraventricular tachycardia. -Doses of verapamil must be substantially reduced in patients with hepatic impairment.

Doses of verapamil must be substantially reduced in patients with hepatic impairment. Because verapamil is eliminated by the liver, doses must be reduced substantially in patients with hepatic impairment.

A patient taking warfarin states that she is having trouble falling asleep at night. Which advice would be contraindicated for this patient? -Drink a cup of warm milk at bedtime. -Drink hot water with honey before bedtime. -Drink a cup of chamomile tea before bedtime. -Try gentle yoga or meditation 2 hours before bedtime.

Drink a cup of chamomile tea before bedtime. Chamomile can affect the INR.

Why do most calcium channel blockers have low and variable oral bioavailability? -Due to rapid excretion from the kidneys. -Due to extensive first-pass metabolism in the liver. -Because of degradation of the drugs in the intestine. -Because of the action of enzymes in the gastrointestinal lumen.

Due to extensive first-pass metabolism in the liver. Following oral administration, calcium channel blockers undergo extensive metabolism on the first pass through the liver, resulting in a reduced amount of medication reaching the systemic circulation.

Which symptoms should patients taking calcium channel blockers be instructed to report to their health care provider? Select all that apply. -Edema -Headache -Facial flushing -Shortness of breath -Pronounced dizziness

Edema The patient should be taught about signs of edema and instructed to notify the prescriber if swelling occurs. Shortness of breath Shortness of breath (dyspnea) may be a symptom of heart failure. Pronounced dizziness Pronounced dizziness may be related to hypotension and/or bradycardia.

Beta blockers work by blocking the action of which catecholamine(s)? Select all that apply. -Serotonin -Histamine -Dopamine -Epi -Nore Epi

Epi Nore Epi

A patient is being discharged home with a prescription for minoxidil for hypertension. Which priority information should the nurse inform the patient about? -administration times -diet -Excessive hair growth -exercise

Excessive hair growth Excessive hair growth can occur in patients who have been taking minoxidil for more than 4 weeks; this is a priority teaching concept.

A patient with a history of sedentary lifestyle, cigarette smoking and frequent meals of "fast food" has initiated cholesterol-lowering therapy. Which lifestyle modifications would the nurse encourage to enhance the effectiveness of the treatment plan? Select all that apply. -Exercise -Maintain current diet -Smoking cessation -Reduce saturated fats -Reduce cholesterol in diet

Exerecise Smoking Cessation Reduce Saturated Fats Reduce Cholesterol

A patient who is taking enoxaparin informs the nurse that she takes fish oil for her heart. Which teaching should the nurse provide this patient? -Fish oil does not interact with enoxaparin. -Fish oil increases the effectiveness of enoxaparin. -Fish oil decreases the effectiveness of enoxaparin. -Take fish oil with milk to decrease the interaction.

Fish oil decreases the effectiveness of enoxaparin. The patient taking enoxaparin should avoid fish oil because it may decrease the effectiveness of enoxaparin.

The nurse should teach a patient taking enoxaparin that which herbs and supplements may interact with enoxaparin and should be avoided? Select all that apply. -Iron -Ginger -Ginseng -Vitamin E -EPO

Ginger Ginseng EPO

The patient taking statin drugs should be instructed to avoid which food? -grapefruit -Bananas -chocolate -leafy greens

Grapefruit

The nurse should advise Mr. Walters to avoid taking amiodarone with which type of juice? -Orange -Cranberry -Pineapple -Grapefruit

Grapefruit Grapefruit juice has been shown to increase amiodarone levels and risk for toxicity.

Patients taking calcium channel blockers should be instructed to avoid which beverages? Select all that apply. -Milk -Orange juice -Grapefruit juice -Alcoholic beverages -Caffeinated beverages

Grapefruit juice can affect the action of many of the calcium channel blockers by inhibiting hepatic metabolism. Alcohol may interfere with the effects of calcium channel blockers and increases the adverse effects related to vasodilation. Caffeine can decrease the body's metabolism of calcium channel blockers.

Why must patients being treated with calcium channel blockers avoid consuming grapefruit juice? -Grapefruit juice can increase levels of select calcium channel blockers. -Grapefruit juice can decrease levels of select calcium channel blockers. -Grapefruit juice decreases the effectiveness of the calcium channel blockers. -Grapefruit juice has similar adverse effects as calcium channel blockers.

Grapefruit juice can increase levels of select calcium channel blockers. Grapefruit juice can inhibit the intestinal and hepatic metabolism of calcium channel blockers, and thus, raise their levels in the blood.

What enzyme is inhibited by the use of statin drugs? -hsCRP -HMG CoA -VLDL -Cholesterol

HMG CoA

Which nursing assessment would be of highest priority when administering a beta blocker? -HR -Daily weights -Respiratory rate -Intake and Output

HR

The nurse is collecting a medication list upon admission. Which medical history would the nurse expect to see in the patient's history if the patient is taking a statin drug? Select all that apply. -HTN -MI -Liver Disorder -Smoking Hx -Peptic ulcer

HTN MI Smoking Hx

Which adverse reaction to loop diuretic therapy requires immediate nursing intervention? -Dizziness -Thirst -Hearing loss -Weight gain

Hearing loss in patients taking loop diuretics indicates ototoxicity and must be immediately reported to the prescriber.

In addition to hypertension, which diagnoses do ACE inhibitors treat? Select all that apply. -Stroke -Heart failure -Diabetic nephropathy -Myocardial infarction (MI) -Diabetic ketoacidosis (DKA)

Heart failure ACE inhibitors are used to prevent adverse cardiovascular events. Diabetic nephropathy ACE inhibitors are used to prevent adverse cardiovascular events that can result from diabetic nephropathy. Myocardial infarction (MI) ACE inhibitors are used to prevent adverse cardiovascular events.

Which is priority when assessing for potential drug interactions for a patient taking both quinidine and digoxin? -Heart rate -Urine output -Lung sounds -Bowel sounds

Heart rate Quinidine can reduce digoxin metabolism by 50%, causing toxicity manifested by dysrhythmias.

The nurse is preparing to administer IV propranolol IR to a patient. The nurse assesses a heart rate of 58 beats per minute and a blood pressure of 110/70 mm Hg. The patient has a potassium level of 3.8 mEq/L and a serum glucose of 110 mg/dL. Which of these findings is most important for the nurse to report to the health care provider before giving this medication? -Heart rate -Glucose level -Blood pressure -Potassium level

Heart rate This patient has a low heart rate and the drug should be held, since AV heart block is a serious adverse effect.

What baseline assessment data will be needed for a patient with cardiac dysrhythmias before a beta blocker is prescribed? Select all that apply. -Heart rate -Electrocardiogram -Supine blood pressure -History of diabetes -History of bronchitis

Heart rate Vital signs, including heart rate, should be assessed for all patients before a beta blocker is prescribed. Electrocardiogram A baseline electrocardiogram should be obtained for patients with cardiac dysrhythmias. History of diabetes Because beta blockers should be used with caution in patients with diabetes, it is important to determine whether the patient has diabetes.

Why is heparin administered parenterally rather than orally? -Heparin is destroyed by gastric secretions. -One of heparin's adverse effects is oral lesions. -Heparin is poorly tolerated and causes nausea. -Heparin causes bleeding in the GI tract after oral administration.

Heparin is destroyed by gastric secretions.

A patient with a history of diabetes, a bleeding disorder, and hepatitis C has just been diagnosed with hypertension. Which part of the patient's history would put this patient at risk if clonidine is prescribed? -Diabetes -Hypertension -Hepatitis C -Bleeding disorder

Hepatitis C A patient with hepatitis C has elevated liver enzymes. Because clonidine is metabolized in the liver, its metabolism may be altered, thereby putting this patient at risk.

The nurse prepares to administer a beta blocker to a patient who exhibits signs of bradycardia. What is the nurse's next action? - Hold the med - Crush the med - Administer the med - Notify healthcare provider

Hold the med

The health care provider prescribes a maintenance dose of metoprolol 250 mg orally twice daily for hypertension. What should the nurse do when giving this medication? -Ask the health care provider if the dose should be 500 mg once daily. -Administer the metoprolol as prescribed. -Hold the medication and ask the health care provider about the dose. -Discuss whether the medication should be given intravenously.

Hold the medication and ask the health care provider about the dose. The maximum daily dose of metoprolol is 450 mg. This dose exceeds the maximum, and the nurse should check with the health care provider before administering the dose.

A patient with a history of liver failure has a new prescription for quinidine 5 mg. Which action by the nurse is most appropriate? -Administer the medication and observe for side effects -Review the patient's medication history for potential drug interactions -Review the side effects of the medication with the patient before administering it -Hold the medication and call the prescriber to report impaired hepatic function

Hold the medication and call the prescriber to report impaired hepatic function. Quinidine is eliminated by hepatic metabolism and the prescriber should be informed about hepatic impairment for possible dosage reduction.

The nurse confirms Mr. Allen's heart rate is 56. What action should the nurse take with regard to the administration of verapamil? -Administer the medication as ordered. -Administer half the ordered dose of verapamil. -Hold the medication and contact the prescriber. -Administer the medication and recheck the heart rate in 30 minutes.

Hold the medication and contact the prescriber. The nurse should notify the prescriber of the low heart rate because the medication dose may need to be adjusted.

The nurse is getting ready to administer an ARB to an older adult patient. The nurse takes the patient's blood pressure and it is 85/50 mm Hg. Which is the priority nursing intervention? -Give the medication -Retake the blood pressure every 5 minutes -Hold the medication until the next dose is due -Hold the medication and notify the health care provider

Hold the medication and notify the health care provider This patient's blood pressure is likely too low for administration of a normal dose of the ARB. The nurse should hold the medication and notify the health care provider.

What is the most significant adverse effect of spironolactone? -Hyperkalemia -Hypokalemia -Hypernatremia -Hyponatremia

Hyperkalemia Spironolactone has potassium-sparing effects and is contraindicated in patients with hyperkalemia. Hyperkalemia is a risk of this drug.

Prior to administering quinidine, the nurse would review the patient's history for which contraindications? Select all that apply. -Hypersensitivity -Thrombocytopenic purpura -Digoxin Atrioventricular block - A. Fib.

Hypersensitivity Thrombocytopenic Purpura AV block

A patient who is taking a thiazide diuretic has been admitted to the hospital. The nurse should notify the prescriber of which side effect? -Hyperuricemia -Hyperkalemia -Hypoglycemia -Hyperammonemia

Hyperuricemia Hyperuricemia is excess uric acid in the blood stream, and is a side effect of thiazide diuretics.

What side effect is more likely to occur with nifedipine? -Headache -Tachycardia -Hypotension -Dizziness

Hypotension Hypotension is more likely to occur with nifiedipine because it is the most potent calcium channel blocker.

The nurse is providing patient teaching for a patient taking diltiazem. Which adverse effect does the nurse teach the patient may occur when a diuretic is also prescribed? -Hypotension -Flushing -Hypokalemia -Peripheral edema

Hypotension Hypotension is adverse drug effect of diltiazem and of diuretics.

The nurse educates a patient about taking sustained-release metoprolol. Which response indicates that the patient requires further teaching? -I will chew the tablet -I will take it with food -I will take it with water -I will swallow the tablet whole

I will chew the tablet.

A patient with recurrent blood clots is taking warfarin at home. During an office visit, which lab work would indicate a high risk for thrombus formation? -INR of 5 -INR of 1.5 -aPTT of 70 -Platelets 200,000/microL

INR of 1.5 INR of 1.5 indicates the INR is sub-therapeutic and that the patient is at risk for thrombus.

Which form(s) of nitroglycerin have the most rapid onset of action? Select all that apply. PO IV Topical Sublingual Transdermal patch

IV Sublingual

Which class III antidysrhythmic medication will the nurse intravenously administer to a patient with atrial fibrillation? -Ibutilide -Dofetilide -Amiodarone -Dronedarone

Ibutilide Ibutilide terminates atrial fibrillation or atrial flutter of recent onset and is given as an infusion.

An oral dose of ibutilide is prescribed to a patient. Why should the nurse question this order? -Ibutilide is an IV medication. -Ibutilide is excreted by the liver. -Ibutilide has a slow onset of action. -Ibutilide has a short duration of action.

Ibutilide is an IV medication. Ibutilide is strictly an IV agent and is not given PO.

When administering amiodarone, when should the nurse hold the drug and notify the provider? -If the heart rate is 58 beats per minute -If the blood pressure is 180/98 mm Hg -If the capillary refill is greater than 5 seconds -If the patient is experiencing peripheral edema

If the heart rate is 58 beats per minute Amiodarone is contraindicated in patients with sinus bradycardia or heart block. The nurse should notify the provider of the patient's heart rate if it is less than 60 beats per minute.

A patient is taking an anticoagulant at home. In which situation should the health care provider be contacted immediately? -If the patient has dark, tarry stools -If the patient has a sore throat and nasal drainage -If a small bruise appears on the patient's knee after the patient bumps it on a table -If the patient has a cut from knife but is able to stop the bleeding after putting pressure on the cut

If the patient has dark, tarry stools Dark, tarry stool is a sign of bleeding when a patient is taking an anticoagulant.

A patient is admitted with an acute pulmonary embolism (PE). Heparin intravenous (IV) is prescribed. Why is the prescription for IV rather than subcutaneous heparin? -Better absorption -Ease of administration -Immediate onset off action -IV heparin will dissolve PE

Immediate onset of action

What effect do ARBs have on the excretion of sodium and water? -Increase excretion of sodium and water -Decrease excretion of sodium and water -Increase excretion of sodium and decrease excretion of water -Decrease excretion of sodium and increase excretion of water

Increase excretion of sodium and water ARBs decrease the release of aldosterone, thereby increasing the excretion of sodium and water.

What dietary modifications are put into place to reduce or alleviate gastrointestinal side effects of statin drugs? Select all that apply -increase fiber intake -take with grapefruit juice -take on empty stomach -crush tablets and take with pureed foods -increase intake of fluids.

Increase fiber and fluids.

What pharmacokinetic factor results in plasma levels of LMWH being highly predictable? -Shorter half lives -binds with antithrombin -increased bioavailability -inactivavtion of thrombin

Increased bioavailability Because of increased bioavailability of LMWH, plasma levels are highly predictable.

Which result is possible if a patient takes St. John's wort and heparin simultaneously? -Hemorrhage -Blood clotting -Increased bleeding -Myocardial infarction

Increased bleeding Many herbal products interact with anticoagulants and may increase bleeding.

The nurse is providing discharge education to a patient prescribed a statin drug. The nurse instructs the patient to take the medication in the evening for what purpose? -reduces drowsiness -increased drug effectiveness -reduces GI disturbances -increases medication compliance

Increases drug effectiviness

The nurse is administering an initial dose of propranolol IR to a patient. What is the priority intervention prior to administration? -Instituting fall precautions -Frequent glucometer checks -Hourly blood pressure monitoring -Counseling about sexual dysfunction

Instituting fall precautions The risk of orthostatic hypotension occurs early in dosing with beta blockers and can increase the risk of falls. The nurse should institute a fall risk precaution.

A patient is admitted to the emergency department with a blood pressure of 222/110 mm Hg. Why would the nurse anticipate intravenous beta blocker administration? Intravenous forms of beta blockers have immediate effects. Administering a beta blocker intravenously prolongs the action of the drug. There are fewer adverse systemic effects when giving intravenous beta blockers. Intravenous beta blockers have a slower peak time than other forms of these medications.

Intravenous forms of beta blockers have immediate effects. The onset of action of IV beta blockers is immediate, compared with 30 minutes when taken orally.

The nurse is preparing to administer intravenous propranolol IR to a patient. The nurse assesses a heart rate of 60 beats per minute and reports this finding to the health care provider before administering the drug. Why is this action important? -Patients who have lower heart rates may not respond as well to beta blocker medications. -Intravenous propranolol can rapidly decrease the heart rate and this patient already has bradycardia. -Beta blocker medications cause tachycardia, so the baseline heart rate should be reported. -A heart rate of 60 beats per minute indicates that the patient does not need antihypertensive therapy.

Intravenous propranolol can rapidly decrease the heart rate and this patient already has bradycardia. Beta blocker medications lower the heart rate and can cause cardiac blockade. The drug should be withheld if bradycardia is present.

Why is Low-Molecular-Weight Heparin (LMWH) easier to use than unfractionated heparin? Select all that apply -It has a shorter half-life. -It can be given using a fixed dosage. -It can be given as long-term therapy. -It can be given intravenously in the hospital. -It does not require activated partial thromboplastin time (aPTT) monitoring.

It can be given using a fixed dose. It does not require activated partial thromboplastin time (aPTT) monitoring.

A patient with asthma is prescribed a beta blocker. Why would the nurse question this order? - it can cause syncope - it can cause hypotension - it can cause bronchospasm - It can increase the pts anxiety during an asthma attack.

It can cause bronchospasm.

A patient diagnosed with hypertension is placed on amlodipine. Why did the patient's health care provider order amlodipine as a daily dose? -To enhance patient compliance. -As a cost-saving measure for the patient. -It has a long half-life. -So the peak effect of the drug would occur in 18 hours.

It has a long half-life. The half-life of amlodipine is 30-50 hours.

A patient with new-onset atrial fibrillation receives diltiazem intravenously. How does diltiazem temporarily slow the ventricular response to atrial fibrillation? -It slows the conduction of impulses through the AV node. -It decreases the excitability and contractility of the myocardium. -It slows the ventricular response to atrial fibrillation through vasodilation. -It enhances the influx of calcium ions into the calcium channels in cardiac conduction tissue.

It slows the conduction of impulses through the AV node. In atrial fibrillation and atrial flutter, diltiazem delays AV nodal conduction of impulses received from the atria; thereby, preventing the ventricles from beating as fast as the atria.

What discharge teaching information should the nurse provide to Ms. Jones? (taking metoprolol for HTN) -Take the medication with juice. -Keep a record of blood pressure measurements. -Measure blood pressure near the beginning of the dosing interval. -Altered sexual function is an expected side effect that does not need to be reported to the health care provider.

Keep a record of blood pressure measurements. The log record will help the patient report the effects of the medication to the health care provider and help the health care provider determine if the medication is effective.

The wife of a patient taking an ARB calls the nurse and identifies the patient as having severe angioedema. The patient and his wife are at home. What is the priority nursing intervention? -Keep the wife on the phone and contact 911 for emergency care for the patient. -Place the wife on hold so a health care provider can be contacted to talk with her. -Discuss the exact size of the patient's tongue and lips so it can be clearly documented. -Pull the patient's chart and review what new medications he is taking that could be causing this reaction.

Keep the wife on the phone and contact 911 for emergency care for the patient. Angioedema is a medical emergency. The patient could lose his airway due to the edema and needs to be in a hospital as soon as possible. The nurse should keep the wife on the line so he or she can advise heron how to open his airway and give rescue breaths if necessary.

What cholesterol level would a hypertensive patient with diabetes older than 40 years need to be prescribed a statin? -LDL 105 mg/dL -LDL 98 mg/dL -LDL 84 mg/dL -LDL 65 mg/dL

LDL 105 mg/dL

Which class I antidysrhythmic medication will the nurse anticipate giving parenterally to a patient with a ventricular arrhythmia because of the first-pass effect? -Phenytoin -Quinidine -Lidocaine -Adenosine

Lidocaine Lidocaine is usually administered IV to prevent first pass elimination by the liver.

ACE inhibitors can cause which drug(s) to accumulate to toxic levels? -Lithium -Metoprolol -NSAIDs -Valium

Lithium Lithium can accumulate to toxic levels if not monitored closely while the patient is concurrently taking ACE inhibitors.

The nurse is reviewing the medication list of a newly admitted patient, which includes a newly prescribed statin drug. Which diagnosis in the patient's medical history would cause the nurse to question this drug? -MI -DM -Liver Disorder -CAD

Liver Disorder

Why are LMWHs able to be given using a fixed dose without the need for routine lab monitoring? Select all that apply. -long half lives -ease of dosing -Long clearance by liver -Predictable plasma levels -Decreased bioavailability

Long half lives Predictable plasma levels

Why do loop diuretics have a greater diuresis effect than thiazides or potassium-sparing diuretics? -Loop diuretics act directly by blocking sodium-potassium exchange in the distal convoluted tubule. -Loop diuretics act early in the loop of Henle and block sodium chloride reabsorption. -Loop diuretics block greater amounts of sodium chloride reabsorption in the proximal convoluted tubule. -Loop diuretics promote the greatest reabsorption of sodium chloride in the loop of Henle.

Loop diuretics act early in the loop of Henle and block sodium chloride reabsorption.

Based on Mr. Robbin's medical history, which ARB would be a better option? (HTN and DM) -Losartan -Olmesartan -Telmisartan -Candesartan

Losartan Losartan is approved for use to help slow the progression of diabetic nephropathy in patients with type 2 diabetes, as well as to treat hypertension.

How does metoprolol act to lower blood pressure? Select all that apply. -Lowering heart rate -Reducing renin release -Dilating peripheral arteries -Decreasing cardiac contractility -Increasing bronchial constriction

Lowering HR Reducing Renin Release Decreasing cardiac contractility

Verapamil is contraindicated for a patient with sick sinus syndrome. Which statements most accurately describe a potential adverse effect of verapamil on the sinoatrial node of the heart? -May cause premature contraction of the atria -May interfere with sinus-node impulse generation -May increase the excitability of the sinoatrial node -May decrease velocity of conduction at the sinoatrial node

May interfere with sinus-node impulse generation Verapamil may interfere with sinus-node impulse generation and thus induce sinus arrest or sinoatrial block in a patient with sick sinus syndrome.

A patient is admitted with severe hypertension and profuse sweating, and admits to not taking the prescribed clonidine for 3 days. What is a priority teaching point prior to discharge? -Effects of hypertension -Ways to minimize sweating -Diet restrictions -Medication teaching

Medication teaching Medication teaching is important, especially when taking clonidine. Rebound hypertension can occur if clonidine is abruptly discontinued, which is what this patient is experiencing. It can be avoided by reducing the dosage slowly under the guidance of a health care provider.

The nurse should use caution when administering calcium channel blockers to patients with which condition? -Hypertension -Mild heart failure -Sick sinus syndrome -Atrial dysrhythmia

Mild heart failure Verapamil decreases left ventricular contractility, and thus may worsen heart failure.

A patient with a known drug abuse history is admitted to the hospital for pneumonia. The patient admits to periodically taking high doses of clonidine. What is a priority nursing intervention for this patient? -Monitor blood sugars for hyperglycemia. -Check daily labs for electrolyte imbalance. -Monitor for euphoria, sedation, and hallucinations. -Check daily weights for fluid retention.

Monitor for euphoria, sedation, and hallucinations. Those who abuse drugs often take high doses of clonidine to intensify the effects. Monitoring the patient for euphoria, sedation, and hallucinations would be a priority nursing intervention.

When discharging a patient on vasodilators, the nurse should teach which concept? -storing of medications -monitoring for edema -counting HR prior to taking medication -obtaining BP prior to taking medication

Monitoring for edema

When administering lisinopril to Mr. Lowe for the first time, what should the nurse be most concerned about? -Preventing hypoglycemia -Monitoring for marked hypotension -Teaching the patient about the ACE cough -Assessing the patient for signs of an infection

Monitoring for marked hypotension Patients with severe hypertension, history of recent diuretic use, or volume depletion may experience marked hypotension with the first dose of lisinopril.

What is a critical nursing assessment for a patient receiving a continuous heparin infusion? -Monitoring the patient's platelet count -Assessing for bruising or bleeding after a fall -Monitoring the aPTT and notifying the provider of the need to make changes -Monitoring the INR and notifying the provider of the need to make changes

Monitoring the aPTT and notifying the provider of the need to make changes This is the highest priority when monitoring a patient on a heparin infusion.

Which side effect should the patient taking a statin report to the nurse immediately? -muscle tenderness -fatigue -HA -Constipation

Muscle tenderness

Which nursing assessment information would warrant intravenous administration of metoprolol? -Angina -Hypertension -Migraine headache -Myocardial infarction

Myocardial infarction Intravenous administration of metoprolol is reserved for treatment of myocardial infarction.

A patient has been taking a statin medication for two weeks, and reports a new onset of lower leg pain. Which adverse effect of the medication is likely? -Myositis -DVT -Rhabdomyolysis -Restless Pain Syndrome

Myositis

A 52-year-old patient presents to the Emergency Department with a blood pressure of 230/118 mm Hg. The nurse anticipates which orders for a calcium channel blocker? -Nifedipine -Diltiazem -Verapamil -Amlodipine

Nifedipine Nifedipine IR is used in the inpatient setting to treat a hypertensive emergency.

Upon admission for angina symptoms the patient reports that he has been undergoing dialysis for the past 6 months. Why is this a concern for administering nitroglycerin? -Nitroglycerin should not be administered if there are potential electrolyte imbalances. -Nitroglycerin is excreted primarily in urine. -Dialysis patients typically have coronary artery disease, which is a contraindication for nitroglycerin. -The primary cause of renal disease is hypertension, which is a contraindication for nitroglycerin.

Nitroglycerin is excreted primarily in urine. Nitroglycerin is used with caution in patients with renal disease, and a dose adjustment might be needed.

Which medication produces both venous and arteriolar dilation? -lisinopril -nitroprusside -hydralazine -minoxidil

Nitroprusside

What information should be included in discharge teaching for a patient on amlodipine? Select all that apply. -Amlodipine must be taken with meals. -Notify the health care provider if your ankles swell. -Amlodipine should be taken twice a day. -Avoid drinking alcohol while taking amlodipine. -You need a follow-up appointment with your provider in three months. -Slowly rise from a sitting or lying position.

Notify the health care provider if your ankles swell. Peripheral edema is an adverse drug effect associated with the use of amlodipine that may need to be reduced with a diuretic. Avoid drinking alcohol while taking amlodipine. The vasodilatory effects of alcohol may exacerbate the vasodilatory effects of amlodipine and excessively lower a patient's blood pressure. Slowly rise from a sitting or lying position. Amlodipine may cause lightheadedness if the patient rises quickly from a sitting or lying position.

The nurse is caring for a patient with severe dysphagia after having a stroke who is on extended-release clonidine therapy for hypertension. What is a priority nursing intervention when administering clonidine to this patient? -Crush the medication and give with sips of water. -Administer the medication with food. -Notify the health care provider that they should consider another class of antihypertensive that can be given IV. -Notify the health care provider that a transdermal clonidine patch should be considered.

Notify the health care provider that a transdermal clonidine patch should be considered. Due to the patient's severe dysphagia, oral clonidine should not be administered because of the risk for aspiration. Clonidine should be administered via a transdermal patch.

A patient taking enoxaparin asks what he should do if he voids dark urine. What should the nurse teach the patient about this finding? -Stop the medication -Increase fluid intake -Decreased fluid intake -Notify healthcare provider

Notify the health care provider.

A patient who is taking oral amiodarone has an elevated serum amiodarone level. What should the nurse do initially to help evaluate this finding? -Obtain a diet and medication history -Tell the patient to stop taking the drug -Request an order for liver function tests -Assess the patient for jaundice and a rash

Obtain a diet and medication history Grapefruit juice and inhibitors of CYP3A4 and can increase amiodarone levels, causing toxicity. The nurse should perform a diet and medication history to determine whether these are factors related to the elevated serum amiodarone level.

Variant angina

Occurs during rest

What would a nurse administering an oral dose of clonidine expect in terms of its pharmacokinetics? -Poor absorption and slow distribution in the body. -Onset of action in 90-120 minutes. -Onset of action in 30-60 minutes. -Elimination half-life is 24 hours.

Onset of action in 30-60 minutes. The onset of action for clonidine is 30-60 minutes and is widely distributed in the body.

When administering the Lidocaine, the nurse monitors the patient with what knowledge? -Onset of action is rapid -Duration of action is prolonged -Therapeutic serum drug levels are 5-10 mcg/mL -Hepatic metabolism is slowed

Onset of action is rapid

What are the routes of administration for verapamil? Select all that apply. -Oral -Buccal -Vaginal -Intravenous -Intramuscular

Oral IV

How are statin drugs administered?

PO

Which ECG findings would be expected in patients receiving dronedarone? -Atrial fibrillation -Sinus tachycardia -PR and QT prolongation -Narrowing of the QRS complex

PR and QT prolongation Dronedarone causes PR and QT prolongation.

Which laboratory value should the nurse monitor related to warfarin therapy? -WBC -aPTT -Hct and Hbg -PT reported in INR

PT reported in INR

Which adverse effect must the nurse advise a patient to be aware of when taking quinidine? -Persistent Diarrhea -Paresthesias -Hypertension -Persistent coughing

Persistent Diarrhea

Education has been appropriately completed when the patient demonstrates injecting enoxaparin in which order? -Administer the medication. -Clean the site with alcohol. -Pinch the site. -Pick a site on the lateral side of the abdomen at least 2" from the umbilicus. -Remove the safety cap from the syringe.

Pick a site on the lateral side of the abdomen at least 2" from the umbilicus. Clean the site with alcohol. Remove the safety cap from the syringe. Pinch the site. Administer the medication.

A patient is receiving heparin infusions for several days after major surgery. In reviewing lab data, the nurse finds that the platelet count is 130,000/microL, when previously it had been 300,000/microL. What might this decrease in platelets signify? -Bleeding at the surgical site -Decrease in vitamin K activity -An expected response to heparin therapy -Possible heparin induced thrombocytopenia (HIT)

Possible heparin induced thrombocytopenia (HIT)

When taking ACE inhibitors, the patient should avoid foods high in which nutrient? -Calcium -Fat -Potassium -Sodium

Potassium

What baseline labs should the nurse anticipate for a patient starting captopril? Select all that apply. -Potassium -Serum protein -White blood cell count -Blood urea nitrogen (BUN) -International normalized ratio (INR)

Potassium ACE inhibitors can cause hyperkalemia, so potassium levels should be monitored. Serum protein Serum protein can be affected by decreased kidney function and should be monitored. White blood cell count Obtaining a baseline white blood cell count is important for future comparison because of the risk of neutropenia. Blood urea nitrogen (BUN) Captopril is excreted through the kidneys and can accumulate to dangerous levels if kidney function is impaired. BUN should be monitored as a measurement of kidney function.

An ICU patient is experiencing electrolyte imbalance. The nurse needs to know that aldosterone promotes the excretion of which electrolyte? -Calcium -Magnesium -Potassium -Sodium

Potassium Aldosterone promotes excretion of potassium.

A patient is taking an ARB for the treatment of hypertension. Which laboratory value should be most closely monitored for this patient? -Sodium -Potassium -Creatinine -Liver enzymes

Potassium Monitoring of serum potassium levels is necessary for all patients taking ARBs.

The nurse is reviewing the medication list of a patient taking an ARB for hypertension. Seeing which medication would prompt the nurse to assess recent laboratory values? -NSAID -Rifampin -ACE inhibitor -Potassium-sparing diuretic

Potassium-sparing diuretic A patient taking an ARB along with a potassium-sparing diuretic should be assessed for possible hyperkalemia. ARBs can promote hyperkalemia.

What would a nurse assess for prior to initiating clonidine for a 30-year-old female patient? -Gynecological disorders -Breast cancer -Pregnancy -Urinary tract infection (UTI)

Pregnancy Clonidine should not be used in pregnant women due to risk of fetal harm. Contraception should be discussed with women who will be prescribed clonidine.

A 30-year-old female patient is being treated for hypertension with valsartan. She also has a history of diabetes. What medical history is most important for the nurse to assess? -Cancer -Pregnancy -Cardiac history -Surgical history

Pregnancy Valsartan is contraindicated in the second and third trimesters of pregnancy. The nurse should assess for pregnancy in a young female patient on valsartan.

The nurse teaches a 29-year-old female patient that which test will need to be performed before she can start her clonidine medication? -ECG -Pregnancy test -Stress test -MRI

Pregnancy test A pregnancy test should be performed on women of childbearing age before starting clonidine therapy since clonidine is contraindicated in pregnancy.

ARBs are contraindicated for which patient? -Diabetic male -Pregnant female -Hispanic older adult -African-American male

Pregnant female ARBs are contraindicated in the second and third trimesters of pregnancy.

What is the primary use for subcutaneous heparin therapy? -Preventing thrombosis -Treating DVT -Managing Hepatitis -Treating MI

Preventing thrombosis

Which medication is classified as a nonselective beta blocker? -Atenolol -Acebutolol -Metoprolol -Propranolol

Propranolol

A patient with asthma takes albuterol on a regular basis and is prescribed propranolol. Why should the nurse question the health care provider about this order? - albuterol increases the therapeutic effect of propranolol -albuterol decreases the therapeutic effect of propranolol - Propranolol increases the therapeutic effect of albuterol -Propranolol decreases the therapeutic effect of albuterol.

Propranolol decreases the therapeutic effect of albuterol.

What is the antidote to heparin? -Vitamin K -Whole Blood -Protamine Sulfate -Packed red blood cells

Protamine Sulfate

Which medication can the nurse administer to reverse enoxaparin overdose? -Naloxone -Flumazenil -N-Acetylcysteine -Protamine sulfate

Protamine sulfate

Which drug is used to treat accidental overdose of enoxaparin and bloody stools? -Diuretics -Vitamin K -Protamine Sulfate -Activated Charcoal

Protamine sulfate Overdose with LMWHs can be treated with protamine sulfate.

A patient will begin receiving high-dose amiodarone to treat a cardiac dysrhythmia. Which pre-treatment test is most important to help monitor for serious adverse effects? -Vision screen -Renal function tests -Thyroid function tests -Pulmonary function test

Pulmonary function test Pulmonary toxicity is the greatest concern and carries a 10% chance of mortality in the 2% to 17% of patients who develop this complication. Patients who receive long-term, high-dose therapy are at highest risk. Baseline chest x-rays and pulmonary function tests should be obtained prior to beginning amiodarone.

What condition is the nurse concerned about when a patient taking high doses of amiodarone begins to exhibit symptoms of dyspnea and cough? -Pneumonia -Heart failure -Cardiotoxicity -Pulmonary toxicity

Pulmonary toxicity Lung damage is the greatest concern in the patient with symptoms of dyspnea and cough. Pulmonary toxicity carries a higher risk of mortality.

Which cardiac conduction system is most affected by class IB antidysrhythmic drugs? -AV node -SA node -Purkinje fibers -Bachman's bundle

Purkinje fibers

What frequency are statins prescribed? -Q AM -Q PM -BID -TID

Q PM

A nurse is reviewing home medications with a patient at the time of admission and learns the patient is taking 2 mg of clonidine twice a day. What is the priority nursing intervention? -Document the dosage. -Document the frequency. -Question the dosage. -Question the frequency.

Question the dosage. Question the patient and ask if he or she has the pill bottles to review. A 2-mg dose is higher than the usual maintenance dose.

The nurse is completing discharge teaching, which includes the direction, "Do not stop the ACE inhibitor abruptly." What should the nurse tell the patient to expect if the medication is stopped suddenly? -Pain -High blood sugar -Rebound hypertension -Weakness on the affected side

Rebound hypertension The patient's blood pressure can rebound and become very hypertensive if the medication is stopped abruptly.

The nurse would anticipate using flecainide for which dysrhythmia? -Recurrent ventricular tachycardia -Atrial fibrillation -First-degree heart block -Supraventricular tachycardia

Recurrent ventricular tachycardia Flecainide use is reserved for the most serious dysrhythmias, secondary to risk of sudden cardiac death. Recurrent ventricular tachycardia is a very serious dysrhythmia.

How will lidocaine help Mr. Jones with PVC? -Increases myocardial excitability. -Profoundly affects the AV node -Shifts ectopic beats to the atria -Reduces ectopic beats in the ventricles

Reduces ectopic beats in the ventricles

Blockade of calcium channels by verapamil and diltiazem include which effects on cardiac tissue? Select all that apply. -Reduction of myocardial contractility -Enhancement of myocardial contractility -Slowing of sinoatrial (SA) node automaticity -Delay of atrioventricular (AV) nodal conduction -Acceleration of atrioventricular (AV) nodal conduction

Reduction of myocardial contractility The blockade of cardiac calcium channels by verapamil and diltiazem decreases the excitability and contractility (negative inotrope) of the myocardium. Slowing of sinoatrial (SA) node automaticity The blockade of cardiac calcium channels by verapamil and diltiazem make atrial tissues more refractory to stimulation. Delay of atrioventricular (AV) nodal conduction The blockade of cardiac calcium channels by verapamil and diltiazem prolong conduction at the AV node.

Nifedipine and a beta blocker are ordered for a patient with newly diagnosed hypertension. The beta blocker was ordered to prevent which adverse effects commonly associated with nifedipine? -Hypotension -Reflex bradycardia -Reflex tachycardia -Decreased contractility

Reflex tachycardia is an adverse drug reaction of nifedipine.

ARBs help prevent which action? -Release of sodium -Release of bradykinin -Release of aldosterone -Absorption of aldosterone

Release of aldosterone ARBs block the angiotensin II receptors in the adrenals, decreasing the release of aldosterone.

What teaching should the nurse include for a patient receiving a transdermal clonidine patch? -Place the patch on the upper thigh. -Apply a new patch every 10 days. -Wear gloves when applying the patch. -Remove one patch before applying another.

Remove one patch before applying another. The first patch must be removed before the new patch is applied.

Prior to giving dofetilide, which laboratory values will the nurse review? -Liver function tests -Renal function tests -Arterial blood gases -Complete blood count

Renal function tests In patients with moderate renal impairment, the dosage of dofetilide must be reduced and should not be used in patients with severe renal impairment. Prior to administering the drug, renal function tests should be performed.

The nurse understands that class IA antidysrhythmic drugs work by which mechanism of action? - Delayed repolarization -Automaticity is increased -Repolarization is accelerated -Action Potential Velocity is decreased

Repolarization is delayed

A patient who has been taking amiodarone for 18 months calls the clinic to report noticing a blue-gray tinge to the skin on the face and neck. What should the nurse recommend? -Report this to the provider immediately -Avoid the use of skin moisturizers and lotions -Discuss liver function testing with the provider -Consume increased amounts of clear fluids each day

Report this to the provider immediately After a year of taking amiodarone, patients are susceptible to blue-gray discoloration of the skin with exposure to the sun. Patients should be counseled to report this symptom immediately.

Which side effects should the patient taking alpha2 adrenergic agonists report to the health care provider? Select all that apply. -Restlessness -Excitement -Insomnia -Mood swings -Vertigo

Restlessness Excitement Insomnia

Which interventions may decrease the adverse effects associated with calcium channel blocker therapy? -Restricting dietary fluids -Rising slowly from a sitting or lying position -Consuming adequate amounts of dietary fluid and fiber -Consulting the health care provider prior to taking over-the-counter medications, vitamins, or herbal remedies -Monitoring weight gain

Rising slowly from a sitting or lying position Rising slowly from a sitting or lying position may decrease the occurrence of lightheadedness and dizziness. Consuming adequate amounts of dietary fluid and fiber Consuming an adequate amount of dietary fluid and fiber may minimize constipation. Consulting the health care provider prior to taking over-the-counter medications, vitamins, or herbal remedies Some over-the-counter medications, vitamins, or herbal remedies may exacerbate the adverse drug reactions associated with calcium channel blockers.

Which patient history requires immediate nursing intervention prior to the administration of lidocaine? -Heart failure -Hypertension -SA intraventricular block -COPD

SA intraventricular block SA intraventricular block is a contraindication for lidocaine treatment and should be reported immediately to the prescriber.

A patient taking dofetilide reports having diarrhea. What should the nurse advise the patient to do? -Schedule an appointment with the provider -Stop taking the drug until the diarrhea is resolved -Wait a few days to see if this symptom will resolve -Obtain and take an over-the-counter antidiarrheal medication

Schedule an appointment with the provider Patients taking dofetilide should be encouraged to report any difficulty such as chest pain, nausea, or diarrhea to the provider immediately.

Which is appropriate treatment for calcium channel blocker overdose? -Secure patient's airway; administer fluids and norepinephrine; administer intravenous calcium -Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon -Administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium -Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium

Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium Securing the patient's airway is the priority intervention. Treatment of toxic effects may include: administering fluids and a vasoconstrictor to treat hypotension, atropine or glucagon to increase the heart rate, and intravenous calcium to counteract vasodilation and impaired contractility.

Which screenings would be most effective in determining the presence of adverse effects related to statin use? Select all that apply. -Serum liver enzymes -eye exam -blood lipid levels -chemistry panels -WBC

Serum liver enzymes Eye Exam Blood Lipid Levels

For which reasons would a nurse withhold a scheduled dose of diltiazem or verapamil? Select all that apply. -Angina -Atrial fibrillation -Severe hypotension -Essential hypertension -Third-degree AV block

Severe hypotension Administration of diltiazem and verapamil are contraindicated in hypotension (systolic pressure less than 90 mm Hg). Third-degree AV block Administration of diltiazem and verapamil are contraindicated in third-degree AV block.

A patient is administering subcutaneous heparin at home. Which teaching point is appropriate for this patient? -Shave with an electric razor. -Use a hard-bristled toothbrush. -Inject heparin in the same spot every day. -Dispose of used syringes in the regular garbage.

Shave with an electric razor. An electric razor should be used because there is less risk of the patient for cutting himself than when using a straight razor.

Calcium channel blockers are contraindicated for patients with which conditions? Select all that apply. -Angina -Bradycardia -Sick-sinus syndrome -Third-degree heart block -Supraventricular tachycardia

Sick-sinus syndrome The calcium channel blockers, verapamil and diltiazem, may contribute to the development of sick-sinus syndrome by decreasing automaticity at the SA node. Third-degree heart block The calcium channel blockers, verapamil and diltiazem, slow automaticity at the SA node and delay conduction at the AV node; thus worsening the AV dissociation related to third-degree heart block.

A patient with paroxysmal supraventricular tachycardia is to receive 5 mg of verapamil intravenously. How does the nurse administer the dose? -Slow injection -Rapid injection -Slow infusion over 24 hours -The drug is not given intravenously

Slow injection Verapamil injected intravenously should be administered slowly over a few minutes. The patient's vital signs and heart rhythm are closely monitored during and after administration.

What is the mechanism of action of amiodarone? -Speeds automaticity in the SA node -Slows AV conduction and AV refractoriness -Speeds AV conduction and AV refractoriness -Speeds automaticity of the His-Purkinje system

Slows AV conduction and AV refractoriness Amiodarone slows AV conduction and prolongs AV refractoriness.

Which electrolyte is important for the nurse to teach the patient taking hydralazine to monitor? -Magnesium -Sodium -Potassium -Calcium

Sodium

When reviewing the electrolyte panel results of a patient taking furosemide for treatment of hypertension, the nurse observes that the patient's potassium level is 3.2 mEq/L. Which diuretic should the nurse administer to the patient to counteract this effect of furosemide? -Furosemide -Spironolactone -Bumetanide -Hydrochlorothiazide

Spironolactone Spironolactone is a potassium-sparing diuretic primarily used to counteract potassium loss in patients taking loop or thiazide diuretics.

Why is it important to instruct patients taking loop diuretics to change positions slowly from lying to standing? -Loop diuretic therapy may cause drowsiness. -Standing abruptly from a lying position causes hypertension. -Standing quickly from a lying position can cause postural hypotension. -Loop diuretic therapy may cause hearing loss with abrupt position changes.

Standing quickly from a lying position can cause postural hypotension. Standing quickly from a lying position can cause postural hypotension which is associated with dizziness.

Which information should the nurse include in teaching for a patient prescribed hydralazine? -stop smoking -being in a strenuous exercise program -increased protein intake -use ibuprofen for pain

Stop smoking

A patient who has been taking sublingual nitroglycerin for angina relief is reporting a bitter taste. The patient is asking to take the medication orally. What should the nurse teach the patient about the differences between the two routes? -Oral nitroglycerin works as well as the sublingual formula, but also leaves a bitter taste in the mouth. -The nitroglycerin transdermal patch may be a good alternative for rapid relief of angina. -Sublingual nitroglycerin is absorbed more quickly than oral nitroglycerin. -Sublingual nitroglycerin is still the best option for angina relief because the onset of action is 10 minutes.

Sublingual nitroglycerin is absorbed more quickly than oral nitroglycerin. Sublingual nitroglycerin is quickly absorbed directly into the internal jugular vein and right atrium, whereas 40% to 50% of oral nitroglycerin is absorbed through the GI tract and inactivated by first-pass metabolism in the liver.

The nurse is assessing a patient recently diagnosed with atrial fibrillation who is currently taking quinidine. Which finding should the nurse immediately report to the patient's health care provider? -Sudden chest pain and dyspnea -Nausea and vomiting -Blood pressure of 148/84 -Weight loss of 2 lbs in four weeks

Sudden chest pain and dyspnea Chest pain and dyspnea are symptoms of pulmonary embolism, which is common in patients receiving treatment for atrial fibrillation.

What is the mechanism of action of ACE inhibitors? -Suppress the RAAS -Block beta1 receptors -Block alpha1 receptors -Relax vascular smooth muscle

Suppress the RAAS The mechanism of action of ACE inhibitors is suppression of the renin-angiotensin-aldosterone system (RAAS).

For which condition are the most common calcium channel blockers verapamil and diltiazem used? -Heart failure -Essential hypertension -Third-degree heart block -Supraventricular tachyarrhythmias

Supraventricular tachyarrhythmias Because of their effect on cardiac tissue, verapamil and diltiazem are the calcium channel blockers used for the treatment of supraventricular tachycardia, atrial fibrillation, and atrial flutter.

Calcium channel blockers are used to treat which cardiovascular condition? -Heart failure -Myocardial infarction -Third-degree heart block -Supraventricular tachycardia

Supraventricular tachycardia Calcium channel blockers are used to prevent, treat, or improve symptoms in high blood pressure, chest pain related to ischemia, and cardiac dysrhythmias.

Which side effects should be included in the discharge teaching for a patient on hydralazine? Select all that apply. -Tachycardia -Excess hair growth -HA -restlessness -fatigue

Tachycardia HA Fatigue

The nurse is administering captopril to the patient. What patient teaching is important with this medication? -Take on an empty stomach. -Take with food to prevent nausea. -Stop the medication if side effects occur. -Take only as directed by the health care provider.

Take on an empty stomach. Food decreases captopril absorption by 35%, so the medication should be taken on an empty stomach.

A patient who has recently been prescribed clonidine twice a day refuses to take the morning dose because the patient says it causes drowsiness. What is a priority nursing intervention for this patient? -Tell the patient to occasionally skip administering clonidine. -Explain to the patient that clonidine causes drowsiness. -Explain to the patient that he will have to add exercise to his routine to stay awake. -Tell the patient to administer the majority of the daily dose at bedtime.

Tell the patient to administer the majority of the daily dose at bedtime. CNS adverse effects include drowsiness. These effects may become less intense with continued use. Giving the majority of the daily dose at night can result in decreased drowsiness during the day.

A patient was started on hydralazine for essential hypertension. At a follow-up appointment, the patient reports occasionally feeling lightheaded and dizzy when standing up. How can the nurse advise the patient to mitigate these symptoms? -Rise more quickly when standing -Tell the pt to stand up slowly -Tell the pt to consume less alcohol -Tell the pt to get more exercise.

Tell the patient to stand up slowly. Orthostatic hypotension is a side effect of vasodilators. Encouraging the patient to stand up slowly can prevent feelings of lightheadedness and dizziness.

A 30-year-old woman will begin taking dronedarone to treat atrial fibrillation. What is important to teach this patient prior to administration of this drug? -To stop taking dronedarone immediately if she becomes pregnant -To avoid taking oral contraceptive pills while taking dronedarone -The importance of using effective contraception while taking dronedarone -To let her provider know if she becomes pregnant, so the dronedarone dose can be adjusted

The importance of using effective contraception while taking dronedarone Dronedarone is classified as FDA Pregnancy Risk Category X, meaning that it is a proven teratogen with risks to the developing fetus greater than any potential benefit. Women of childbearing age must use effective contraception while taking this drug.

A clinic patient reports new unexpected chest pain that usually occurs during rest. The patient is diagnosed with unstable angina. What is the first course of treatment? -The patient will be given oral nitroglycerin in the clinic. -The patient will be given sublingual nitroglycerin and taken to the ED. -The patient will be given IV nitroglycerin and sent home. -The patient will be given a transdermal nitroglycerin patch and remain in the clinic until it takes effect.

The patient will be given sublingual nitroglycerin and taken to the ED. The patient could be having an MI, which could result in death; therefore, sublingual nitroglycerin should be administered and the patient should be transported to the ED.

A patient with peripheral edema, secondary to malnutrition, has been ordered a calcium channel blocker for the treatment of hypertension. Why would a nurse question this order? -The pre-existing peripheral edema may worsen with the use of calcium channel blockers. -Calcium channel blockers decrease serum albumin levels. -Calcium channel blockers do not effectively treat hypertension. -A patient who is malnourished will not be able to effectively metabolize calcium channel blockers.

The pre-existing peripheral edema may worsen with the use of calcium channel blockers. A common adverse drug effect of calcium channel blockers is peripheral edema. The peripheral edema is believed to occur secondary to arteriolar dilatation, causing intracapillary hypertension and fluid extravasation.

What is the mechanism of action for centrally acting alpha2 adrenergic agonists to produce vasodilation? -The stimulation of alpha2 receptors on the presynaptic nerve terminals increases the synthesis of norepinephrine release, resulting in vasodilation. -The drug acts within the terminals of the sympathetic neurons to minimize the release of norepinephrine. -The stimulation of alpha2 receptors on the presynaptic nerve terminals decreases the synthesis of norepinephrine release, resulting in vasodilation. -The stimulation of alpha1 and alpha2 receptors on the presynaptic nerve terminals result in vasodilation.

The stimulation of alpha2 receptors on the presynaptic nerve terminals decreases the synthesis of norepinephrine release, resulting in vasodilation. The decreased sympathetic activity leads to increased vagal activity, decreased cardiac output, and decreased release of serum epinephrine, norepinephrine, and renin, all resulting in reduced peripheral vascular resistance and increased vasodilation.

A patient taking clonidine reports flushing, dizziness, and sweating which occurred after starting amitriptyline for depression. What is the priority teaching concept for this patient? -There is no problem taking these medications together. -The patient needs to stop taking the amitriptyline. -The patient needs to take a lower dose of amitriptyline. -These medications should not be taken together.

These medications should not be taken together. The combination of clonidine and amitriptyline may cause an exacerbation of adverse side effects, including hypotensive effects.

How do LMWH molecules compare to unfractionated heparin molecules? -They are faster. -They are longer. -They are slower. -They are shorter.

They are shorter

What is the rationale for prescribing beta blockers after a myocardial infarction? -The block the limbic system -They block the conduction system -They block the SNS -They block the Parasympathetic Nervous system.

They block the SNS

How do calcium channel blockers affect the myocardium? -They have a negative inotropic effect on the myocardium. -They have a positive inotropic effect on the myocardium. -They enhance the contractility of the myocardium. -They strengthen the myocardium.

They have a negative inotropic effect on the myocardium. Calcium channel blockers, such as verapamil and diltiazem, decrease the contractile force of the muscular layer of the heart.

Why do patients taking thiazide diuretics have an increased risk for hypercalcemia? -They promote GI absorption of calcium. -They promote calcium reabsorption. -They decrease the metabolism of calcium. -They cause calcium loss in the urine.

They promote calcium reabsorption. Thiazide diuretics influence the mechanism of sodium, chloride, and calcium transport to favor calcium reabsorption.

The clinic patient has a history of angina and peripheral vascular disease, and inquires about taking sildenafil. What is the priority teaching for this patient? -These medications are safe to take together and have no adverse interactions. -These medications may be taken together, but the effects of sildenafil may take longer to achieve. -Those taking nitroglycerin should not take sildenafil due to a possible unsafe drop in the blood pressure. -Sildenafil is not safe to take with nitroglycerin, but tedalafil and vardenafil are safe.

Those taking nitroglycerin should not take sildenafil due to a possible unsafe drop in the blood pressure. Sildenafil increases the blood pressure lowering effects of nitroglycerin; therefore, these drugs should not be taken together.

The nurse should teach Mr. Smitheal that the maximum dose of nitroglycerin is what? -One tablet -Two tablets -Three tablets -Five tablets

Three tablets The maximum dose of nitroglycerin is three tablets.

How are ACE inhibitors excreted? -Through sweat -Through the liver -Through the bowel -Through the kidneys

Through the kidneys ACE inhibitors are excreted through the kidneys.

Why are most topical forms of nitroglycerin removed nightly? -To prevent the occurrence of local skin irritations. -To prevent frequent episodes of hypotension. -To avoid tolerance of the drug due to uninterrupted use of nitroglycerin preparations. -To prevent nitroglycerin-induced sleep disturbances.

To avoid tolerance of the drug due to uninterrupted use of nitroglycerin preparations. Nitroglycerin must be removed nightly for 8-12 hours to prevent drug tolerance.

What is the priority teaching for a patient newly diagnosed with hypertension and prescribed metoprolol? -To change positions slowly -To avoid foods high in sugar -To report a heart rate less than 80 beats per minute -To stop if the systolic blood pressure is less than 95 mm Hg

To change positions slowly Orthostatic hypotension is an early side effect of beta blockers and can increase the risk of falls. Patients should be taught to move and change positions slowly to minimize this risk.

Which personal hygiene practices are important to engage in for the patient taking enoxaparin? Select all that apply. - floss teeth regularly -use a soft toothbrush -shave with electric razor -Shave with metal blade razor -Rinse with mouthwash after meals

Use a soft toothbrush Shave with an electric razor

A 25-year-old female patient is being discharged from the hospital after a hypertensive crisis. New home medication includes valsartan. Which teaching points should be included by the nurse prior to discharge? Select all that apply. -Use contraceptives while taking valsartan. -Only take this medication after a full meal. -Stop taking the medication immediately if you may be pregnant. -Take your blood pressure to make sure the medication is working. -You will eventually grow out of your hypertension, as you get older.

Use contraceptives while taking valsartan. Women of childbearing age should use contraception while on valsartan, as it can cause fetal injury. Take your blood pressure to make sure the medication is working. The patient should take her blood pressure to make sure the dose of the valsartan is working.

Which steps should the nurse include in the teaching for the patient who takes enoxaparin at home? Select all that apply. -using prefilled syringe -Administer the medication in the buttock. -Administer the medication in the abdomen. -Pinch skin fold and clean with alcohol. -Shake the bottle of medication prior to drawing up. -Choose site on lateral side of abdomen at least 2" away from umbilicus.

Use prefilled syringes Administer in the abdomen Pinch skin fold and clean with alcohol Choose site on lateral side of abdomen at least 2" away from umbilicus.

What are the main actions on arteries by ARBs? -Vasodilation and increased peripheral vascular resistance -Vasodilation and decreased peripheral vascular resistance -Vasoconstriction and increased peripheral vascular resistance -Vasoconstriction and decreased peripheral vascular resistance

Vasodilation and decreased peripheral vascular resistance ARBs block angiotensin II from the angiotensin I (AT1) receptors found in many tissues, resulting in vasodilation and decreased peripheral vascular resistance.

A patient has a history of essential hypertension, smokes, and consumes 2-3 alcohol drinks each night. The patient is being discharged with a hydralazine prescription. Which potential problems should the nurse discuss with the patient? Select all that apply. -Vasospasm -Bradycardia -Hypotension -Tachypnea -Polyuria

Vasospasm Hypotension

A patient is admitted to the ICU in a coma after a motor vehicle accident. When a family member arrives the next day, the nurse learns that the patient has been taking metoprolol to treat angina. What should the nurse look for when assessing the patient? -Hyperglycemia -Bronchoconstriction -Ventricular dysrhythmias -Peripheral edema and pulmonary crackles

Ventricular dysrhythmias Abrupt withdrawal of a beta blocker medication may result in ventricular dysrhythmias.

Which medication may enhance the effects of metoprolol, thus causing excessive cardio suppression? -Insulin -Verapamil -Albuterol -Prednisone

Verapamil Verapamil is a calcium-channel blocker with similar effects on the heart. When used in combination with metoprolol, cardio suppression may result.

Prior to administering quinidine to a patient, the nurse assesses the patient for which manifestations of cinchonism? Select all that apply. -vertigo -tinnitus -ha -diarrhea

Vertigo Tinnitus HA

Which substance can cause an adverse interaction for a patient taking a loop diuretic? -Spironolactone -Warfarin -Licorice -Gingko

Warfarin Loop diuretics are highly protein bound and can displace other protein bound drugs, such as warfarin.

In teaching Mr. Walters about his new medication regimen, it is important to explain that which of his medications will be adjusted to compensate for the start of amiodarone therapy? -Warfarin decreased from 5 mg to 2.5 mg daily -Metoprolol increased from 12.5 mg to 25 mg daily -Aspirin increased from 81 mg to 325 mg daily -Metformin decreased from 500 mg to 250 mg daily

Warfarin decreased from 5 mg to 2.5 mg daily Amiodarone will increase drug levels of warfarin; therefore, it is recommended to reduce the dose by 50% prior to the start of therapy.

When should the nurse anticipate diuresis following the administration of oral furosemide? -Within 10-20 minutes -Within 30-60 minutes -Within 1.5-2 hours -Within 2.5-3 hours

Within 30-60 minutes The onset of action of oral furosemide is within 30-60 minutes.

Which laboratory value should the nurse monitor related to intravenous (IV) heparin therapy? -INR -CBC -aPTT -Platelets

aPTT

Heparin combines with which factor to inhibit thrombus formation? -Factor I -Factor VII -Antithrombin III -Prothrombin Factor II

antithrombin III Antithrombin III leads to inactivation of thrombin and prevents thrombus formation.

ACE inhibitors cause a change in which physiologic function? -Blood pressure -Cardiac output -Heart rate -Reflexes

blood pressure

Which patients are considered high-risk for receiving enoxaparin? Select all that apply. -children -older adults -pregnant women -post knee replacement -post MI

children older adults pregnant women

How does the nurse administer a statin drug with regard to meals? -give on empty stomach -give without foods -give w/o regard for meals -give with food

give w/o reguard for meals

The nurse teaches the patient taking beta blockers to avoid which type of juice? -apple -orange -grapefruit -pineapple

grapefruit

Which beverage restriction will the nurse emphasize to a patient taking quinidine? -Orange juice -Apple juice -Grapefruit juice -Cranberry juice

grapefruit juice

What is the principal site of action for statin drugs? -kidney -myocardium -plasma -liver

liver

Which laboratory values must be monitored prior to initiating statin drug therapy? -WBC -Coagulation Studies -Liver enzymes -Blood Cultures

liver enzymes

LMWHs have which pharmacokinetic property compared to unfractionated heparin? -longer half lives -shorter half lives -slower absorption -Increased protein binding

longer half lives

Which side effect of rosuvastatin (Crestor) is reported to the provider immediately? -Muscle pain -abdominal pain - muscle pain -nausea

muscle pain

unstable angina

occurs unrelated to activity

Classic Angina

occurs with exertion or stress

Except for enalaprilat, all ACE inhibitors are administered by which route? -Intramuscular -Intravenous -Oral -Suppository

oral

Which teaching information is most appropriate for a patient who smokes and is prescribed a vasodilator? -smoking increases vasospasm -smoking slows the HR -smoking dilates the blood vessels -smoking increasing blood circulation.

smoking increases vasospasm.

Hydralazine causes select dilation of arterioles and has a direct action on which muscle groups? -Striated muscle -Vascular smooth muscle -Visceral muscle -Accessory muscles

vascular smooth muscle