pharm 2 exam 1

A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer?

"A reduction usually is seen within 2 weeks."

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response?

"ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."

A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?

"Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome."

A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?

"Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones."

A nurse is giving aspirin to a patient during acute management of STEMI. The patient asks why a chewable tablet is given. Which response by the nurse is correct?

"Aspirin is absorbed more quickly when it is chewed."

A patient with atrial fibrillation is taking verapamil (Calan). The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?

"Atrial dysrhythmias can have life-threatening effects on ventricular function."

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

ACE inhibitors

A diabetic patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:

ACE inhibitors and beta blockers.

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

"Beta blockers block the actions of angiotensin II."

A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching?

"Beta blockers can help control hypertension."

A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?

"Beta blockers do not help relax coronary artery spasm."

A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy?

"Fibrinolytics should be used with caution in patients with a history of cerebrovascular accident."

A nurse is providing discharge teaching instructions for a patient taking cholestyramine (Questran). Which statement made by the patient demonstrates a need for further teaching?

"I can take cholestyramine with my hydrochlorothiazide."

A nurse is providing patient education about colesevelam (Welchol), a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?

"I cannot take digoxin while on this medication."

A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching?

"I may become constipated, so I should increase fluids and fiber."

A nurse provides teaching for a patient who will begin taking procainamide (Procanbid) for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching?

"I may have increased bruising, but this is a temporary side effect."

A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone (Cordarone) for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching?

"I may have itching, malaise, and jaundice, but these symptoms will subside."

A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching?

"I may need long-term therapy with another cardiac medication after the procedure."

A female patient who is not taking any other medications is prescribed aliskiren (Tekturna), a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?

"I should take this medication 1 hour before sitting down to a meal."

A patient who is taking furosemide (Lasix) and digoxin will begin taking captopril (Capoten). The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?

"I should take this medication on a full stomach."

A nurse is preparing to assist a nursing student in administering intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?

"I will monitor the heart rate frequently to assess for reflex tachycardia."

A patient who has been taking verapamil (Calan) for hypertension complains of constipation. The patient will begin taking amlodipine (Norvasc) to prevent this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed?

"I will need to take a beta blocker to prevent reflex tachycardia."

A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching?

"I will need to take potassium supplements when adding this drug."

A patient with a history of angina and hypertension is being started on nicotinic acid (Niacin). The nurse is providing patient education. What statement made by the patient demonstrates a need for further teaching?

"I will take Tylenol with my medication to reduce the inflammatory effects."

During discharge instruction, a nurse wants to assess a patient's understanding of treatment with cholestyramine (Questran). Which statement made by the patient best demonstrates a need for additional teaching?

"I will weigh myself weekly."

A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?

"If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack."

A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching?

"It relaxes coronary artery spasms."

A patient in the emergency department has severe chest pain. The nurse administers morphine intravenously. The patient asks the nurse why morphine is given. Which response by the nurse is correct?

"Morphine helps by relieving pain and reducing the cardiac oxygen demand."

A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?

"Reflex tachycardia can negate the desired effects of vasodilators."

A nurse is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for further teaching?

"Skeletal muscles relax to allow the free flow of blood."

Lovastatin (Mevacor) is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?

"Take lovastatin with your evening meal."

A prescriber orders ramipril (Altace) for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching?

"Taking this medication helps reduce my risk of stroke and heart attack."

A nurse is caring for a patient with hypertension and diabetes. The patient's prescriber recently ordered an angiotensin-converting enzyme (ACE) inhibitor. Which statement by the patient indicates understanding of the nurse's teaching about this drug?

"This drug will help lower my blood pressure and will benefit my kidneys."

A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching?

"Two or more drugs will lower blood pressure more quickly."

A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?

"Variant angina is the result of increased oxygen demand by the heart."

A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?

"When my symptoms subside, I may discontinue the medications."

A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?

"When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."

A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate?

"You should come into the clinic for liver enzymes in 1 month."

A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?

"You should continue your exercise program to increase your HDL serum levels."

A patient with hypertension is admitted to the hospital. On admission the patient's heart rate is 72 beats per minute, and the blood pressure is 140/95 mm Hg. After administering an antihypertensive medication, the nurse notes a heart rate of 85 beats per minute and a blood pressure of 130/80 mm Hg. What does the nurse expect to occur?

A decrease in the heart rate back to baseline in 1 to 2 days

A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.)

ACE inhibitors, Antiplatelet drugs, Calcium channel blockers, Cholesterol-lowering drugs

Patients with a history of myocardial infarction should take which medications indefinitely? (Select all that apply.)

ACE inhibitors, Aspirin, Beta blockers

A patient arrives in the emergency department complaining of chest pain that has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient's electrocardiogram reveals elevation of the ST segment. Initial cardiac troponin levels are negative. The patient is receiving oxygen via nasal cannula. Which drug should be given immediately?

Aspirin 325 mg chewable

A prescriber has ordered propranolol (Inderal) for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history?

Asthma

A nurse is reviewing a patient's medications before administration. Which drug-to-drug interactions should most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?

Eplerenone (Inspra) and spironolactone (Aldactone)

A nurse is caring for a patient who is receiving verapamil (Calan) for hypertension and digoxin (Lanoxin) for heart failure. The nurse will observe this patient for:

AV blockade.

A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action?

Administer the drug as ordered, because this is a desired effect.

Which medications are included in first-line therapy for heart failure? (Select all that apply.)

Agents that inhibit the renin-angiotensin-aldosterone system (RAAS), Beta blockers, Diuretics

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development?

Aldosterone antagonist

Which are therapeutic uses for verapamil? (Select all that apply.)

Angina of effort, Cardiac dysrhythmias, Essential hypertension

A patient is admitted to the coronary care unit from the emergency department after initial management of STEMI. A primary percutaneous coronary intervention has been performed. The nurse notes an initial heart rate of 56 beats per minute and a blood pressure of 120/80 mm/Hg. The patient has a history of stroke and a previous myocardial infarction. Which order will the nurse question?

Beta blocker

Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?

Beta blockers and calcium channel blockers

The potassium-sparing diuretic spironolactone (Aldactone) prolongs survival and improves heart failure symptoms by which mechanism?

Blocking aldosterone receptors

A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do?

Contact the provider to suggest ordering a transdermal patch for this patient.

A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication?

Cough

A patient has been taking digoxin (Lanoxin) 0.25 mg, and furosemide (Lasix) 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?

Check the patient for other symptoms of digitalis toxicity.

A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?

Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

A patient will be taking amiodarone (Cordarone). Which baseline tests are necessary before this medication is started? (Select all that apply.)

Chest radiograph and pulmonary function tests, Ophthalmologic examination, Thyroid function tests

A patient with hypertension who has been taking captopril (Capoten) for several months is admitted to the hospital. The patient reports that food "tastes funny." What will the nurse do?

Compare the patient's admission weight to a previous weight.

The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?

Decrease in cardiac work

Which are expected effects of cardiac glycosides? (Select all that apply.)

Decreased heart rate, Modulation of neurohormonal systems, Positive inotropic effects

A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug?

Decreased stroke volume

A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her?

Discuss using methyldopa instead while she is pregnant.

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

Drink extra fluids and avoid driving when drowsy.

An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family?

End-of-life care

A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient?

Evaluating ankle edema

A female patient who begins taking spironolactone (Aldactone) as an adjunct to furosemide (Lasix) complains that her voice is deepening. What will the nurse do?

Explain that this drug binds with receptors for steroid hormones, causing this effect.

A patient is being started on nicotinic acid (Niaspan) to reduce triglyceride levels. The nurse is providing patient education and should include which adverse effects? (Select all that apply.)

Facial flushing, Gastric upset, Itching

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication?

Furosemide (Lasix)

A hospitalized patient complains of acute chest pain. The nurse administers a 0.3 mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse's next step?

Give a second dose of nitroglycerin in 5 minutes.

A nurse is preparing to administer digoxin (Lanoxin) to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?

Give the dose of digoxin and notify the provider of the potassium level.

A patient diagnosed with STEMI is about to undergo a primary percutaneous coronary intervention (PCI). Which combination of pharmacotherapeutic agents will be given to augment this procedure?

Heparin, aspirin, and clopidogrel

The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?

Hydralazine (Apresoline)

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

Hydrochlorothiazide and nadolol

A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP?

Hypertension

A patient with moderate heart failure begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?

Improved exercise tolerance

A patient with a history of hypertension is admitted for a procedure. If the patient's arterial pressure decreases, which clinical manifestation would the nurse expect to see?

Increased heart rate

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?

Increased tissue perfusion

A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?

Instruct the patient not to get up without assistance.

A man asks a nurse why he cannot use digoxin (Lanoxin) for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not first-line therapy for which reason?

It does not correct the underlying pathology of heart failure.

The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias?

It doubled the risk of a second MI.

A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?

It may be uncomfortable enough that the drug will need to be discontinued.

A patient has undergone a primary percutaneous coronary intervention with a sirolimus-eluting stent. The provider has ordered a daily dose of 243 mg of aspirin. What will the nurse tell this patient about the dose of aspirin?

It will decrease to 162 mg per day in 3 months.

A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?

Move slowly from sitting to standing when taking this drug.

A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do?

Notify the provider and ask about adding a beta blocker medication.

A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?

Notify the provider and discuss ordering a beta blocker for this patient.

A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine (Mexitil) for pain caused by peripheral neuropathy. What does the nurse do?

Notify the provider to request that another drug be used for peripheral neuropathy pain.

A patient is taking digoxin (Lanoxin) and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what? (Select all that apply.)

Phenytoin (Dilantin), Serum electrolytes

Which medications are most likely to cause postural hypotension? (Select all that apply.)

Prazosin (Minipress), Captopril (Capoten), Losartan (Cozaar)

A prescriber is considering prescribing the amiodarone derivative dronedarone (Multaq) for a patient with atrial flutter. The nurse should be concerned about which of the following?

QT interval of 520 msec

A patient with angina who is taking ranolazine (Ranexa) has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin (Zithromax) for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient's heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient's care. Which action is correct?

Question the order for azithromycin (Zithromax).

An Asian patient comes to the clinic. Upon assessment, the nurse notes a slight yellow tint to the skin and sclera, edema, and hepatomegaly. The drug history reveals that the patient has been taking rosuvastatin (Crestor) for 6 months. The nurse is concerned, because rosuvastatin (Crestor) has been shown to do what?

Reach levels twice as high in Asians as in Caucasians, resulting in a greater chance of hepatotoxicity

A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?

Recheck the patient's blood pressure in the other arm.

A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time?

Reduce the rate of infusion.

A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process?

Renal artery stenosis

A patient has undergone a PCI, and the provider orders clopidogrel to be given for 12 months, along with an ACE inhibitor and heparin. What will the nurse do?

Request an order for aspirin.

A prescriber has ordered rosuvastatin (Crestor) for a patient with non-alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse before administration of this drug?

Review the baseline liver function test results.

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?

Sodium nitroprusside (Nitropress) IV

A nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy. Which information, identified during history taking, would contraindicate this type of therapy?

The patient has a history of a small cerebral aneurysm.

A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?

The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia.

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

The patient should stop taking the medication and contact her provider immediately.

A patient taking gemfibrozil (Lopid) and rosuvastatin (Crestor) concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?

The patient's creatinine kinase levels

A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient's electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur?

Torsades de pointes

A patient is taking digoxin (Lanoxin) and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?

Withhold the quinidine and contact the provider to report the ECG finding.

A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:

a thiazide diuretic.

A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:

adding a calcium channel blocker to this patient's drug regimen.

A female patient with essential hypertension is being treated with hydralazine (Apresoline) 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to:

administer a beta blocker.

A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate:

administering intravenous norepinephrine (NE) and isoproterenol.

A nurse is reviewing a patient's medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____.

anticoagulant effects; increased

A patient is taking a drug that interferes with venous constriction. The nurse will tell the patient to:

ask for assistance when getting out of bed.

A patient with heart failure who has been given digoxin (Lanoxin) daily for a week complains of nausea. Before giving the next dose, the nurse will:

assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.

A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:

caution the patient not to get up without assistance.

A nurse is assessing a patient with heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of:

decreased force of ventricular contraction.

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for:

decreased urine output.

A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request:

discontinuing the quinidine.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone (Aldactone). The nurse will make sure that the patient:

does not take potassium supplements.

A patient is taking a calcium channel blocker (CCB) for stable angina. The patient's spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:

help relax peripheral arterioles to reduce afterload.

A patient is taking enalapril (Vasotec). The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:

hyperkalemia.

A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:

increase the time the heart is in diastole.

A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:

increases automaticity in the Purkinje fibers.

A patient with new-onset exertional angina takes a nitroglycerin sublingual tablet, but the pain intensifies. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:

intravenous nitroglycerin and a beta blocker.

A patient with heart failure who takes a thiazide diuretic and digoxin (Lanoxin) is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:

is experiencing worsening of the disease.

A prescriber orders verapamil (Covera HS) for a patient who is taking digoxin (Lanoxin) and warfarin. The nurse will expect the prescriber to _____ the dose of _____.

lower; digoxin

A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). The nurse should be concerned if the patient complains of:

muscle pain.

A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:

myocardial contractility.

A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual's medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of:

myopathy.

A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child's parents, the nurse will expect to:

perform a detailed health history on the child.

A patient begins taking nifedipine (Procardia), along with a beta blocker, to treat hypertension. The nurse understands that the beta blocker is used to:

prevent reflex tachycardia.

A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, "Nitroglycerin:

promotes vasodilation, which reduces preload and oxygen demand."

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside (Nitropress) and oral hydralazine (Apresoline). The nurse will explain that this is done to prevent:

rebound hypertension.

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:

serum electrolyte levels.

A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:

the DASH diet, sodium restriction, and exercise.

The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that _____ results in the lowest cardiac output, and treatment includes _____.

ventricular fibrillation; defibrillation

A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:

verapamil as an adjunct to nitroglycerin therapy.