PHARM - Cardiovascular

A client has received atropine sulfate intravenously during a surgical procedure. The nurse monitors the client for which side effect of the atropine sulfate in the postoperative period?

Urinary retention Rationale: Atropine sulfate is an anticholinergic medication that causes tachycardia, drowsiness, blurred vision, dry mouth, constipation, and urinary retention. The nurse monitors the client for any of these effects in the postoperative period.

The nurse is reinforcing instructions to a client with essential hypertension about medication therapy with irbesartan. Which client statement would indicate a need for further teaching?

"The medication reduces my need for exercise." Rationale: The medication irbesartan is an antihypertensive, and as with any antihypertensive, the client must maintain a healthy lifestyle that includes dietary modifications and exercise. Antihypertensives should be taken in the morning. Smoking and consuming caffeine must be avoided. The client should be taught how to monitor his own blood pressure.

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level?

Activated partial thromboplastin time (aPTT) of 55 seconds Rationale: The aPTT will assess the therapeutic effect of heparin sodium. The normal aPTT is 30 to 40 sec. To maintain a therapeutic level, the aPTT should be 1.5 to 2.5 times the normal value. The PT and INR will assess for the therapeutic effect of warfarin sodium. A decreased thrombocyte count can cause bleeding.

The nurse is caring for a client with chronic heart failure who is taking digoxin 0.125 mg daily. Before administering the medication, the nurse reviews the serum digoxin level that was drawn earlier in the day. The result is 1 ng/mL. Which action should the nurse take based on this laboratory result?

Administer the dose of the medication as scheduled. Rationale: The normal therapeutic range for digoxin is 0.5 to 2 ng/mL. A value of 1 is within therapeutic range, and the nurse should administer the next dose as scheduled. Options 1 and 4 are unnecessary. An apical pulse must be obtained before each dose of digoxin is administered. It is incorrect to administer the digoxin based on the client's last pulse rate, although a comparison of pulse rates may be appropriate.

The nurse is reinforcing dietary instructions to a client who is taking triamterene. The nurse instructs the client that it is acceptable to consume which food item daily?

Apple Rationale: Triamterene is a potassium-retaining diuretic, which means that the client must avoid the intake of foods high in potassium. Banana, Avocado and Baked Potato are high-potassium food items.

The nurse is planning to administer amlodipine to a client. The nurse should plan to check which before giving the medication?

Blood pressure and heart rate Rationale:Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction.

The nurse is administering a dose of a prescribed diuretic to an assigned client. The nurse should plan to monitor the client for hypokalemia as a side effect of therapy if the client is receiving which medication?

Bumetanide Rationale: Bumetanide is a loop diuretic that places the client at risk for hypokalemia. The nurse would carefully monitor both the serum potassium levels and the client for signs of hypokalemia as well as encourage intake of high-potassium foods. The other medications listed are potassium-sparing diuretics.

A client is being treated with atenolol for hypertension. The client tells the nurse, "I am very tired and weak since I began taking the medication." Based on the client's statement, the nurse determines that the client is experiencing which problem?

Common side effect Rationale:Atenolol is a beta blocker that causes a decreased heart rate and blood pressure and a decrease in cardiac output; this results in fatigue and weakness as common side effects. If this interferes with the client's activity level, the dosage can be adjusted to eliminate these side effects. There are no data in the question that indicate Signs and symptoms of the flu, Difficulty with clearing the airway, or Lack of support services for assistance at home are correct.

Vasopressin is prescribed for the client with diabetes insipidus. During data collection, the nurse is particularly cautious in checking the client for which preexisting condition?

Coronary artery disease Rationale: Because of its powerful vasoconstrictive actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction, especially if administered to clients with coronary artery disease. In addition, vasopressin may cause gangrene by decreasing blood flow in the periphery.

A client is being discharged with a prescription for propranolol. When reinforcing instructions to the client about the medication, the nurse should include which information?

Medication should be withheld if the pulse rate drops below 60 beats per minute. Rationale: Most beta blockers may be administered with food or on an empty stomach, but propranolol is absorbed best if taken with meals or directly after eating. Exercise will not prevent orthostatic hypotension. Hot showers and baths are not advised because of their vasodilating effect. The client needs to be instructed how to take the pulse rate and to notify the health care provider if the heart rate falls below 60 beats per minute.

The nurse is discharging a client from the hospital who was given a prescription for atorvastatin. The nurse should tell the client to report which adverse effect to the health care provider immediately?

Muscle pain and weakness Rationale:Atorvastatin can injure muscle tissue. The muscle injury can progress to myositis, which is muscle inflammation associated with moderate elevation of creatine kinase ([CK] an enzyme released from injured muscle). Myositis, in turn, may progress to potentially fatal rhabdomyolysis, defined as muscle disintegration or dissolution associated with a marked elevation of CK and possibly with renal failure. Tiredness and Fatigue and Flushing and Redness are not related to atorvastatin therapy. Flatulence and Constipation is an expected side effect.

A client has a prescription for niacin. The nurse determines that the client understands the importance of this therapy if the client verbalizes the importance of which periodic monitoring?

The serum cholesterol level Rationale:Niacin is used as adjunctive therapy in the management of hyperlipidemia. This is used in conjunction with a low-fat, low-cholesterol diet; exercise; and smoking cessation. Serum cholesterol and triglyceride levels are monitored periodically to assess the effectiveness of therapy. The laboratory studies of creatinine level, renal function studies and blood urea nitrogen level all assess renal function.

The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL (9.95 mmol/L). The client is taking cholestyramine. Which statement made by the client indicates the need for further teaching?

"I'll continue my nicotinic acid from the health food store." Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications can also cause liver abnormalities so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

The nurse is preparing to administer furosemide to a client with a diagnosis of heart failure. Which is the most important laboratory test result for the nurse to review before administering this medication?

Potassium level Rationale: Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with a low potassium level could precipitate ventricular dysrhythmias. The options of BUN and creatinine reflect renal function. The cholesterol level is unrelated to the administration of this medication.

A client is being discharged from the hospital on warfarin for venous thromboembolism (VTE) prevention. Which instructions should the nurse reinforce in the client's teaching plan? Select all that apply.

Wear a Medic Alert bracelet. Check urine and stool for blood. Notify your dentist before an appointment. Rationale: Warfarin is an anticoagulant and bleeding is the major complication. Teaching for the client includes wearing a Medic Alert bracelet to notify health care providers an anticoagulant is being taken. Blood in the urine and stool may indicate the dose is too high. Certain dental procedures require temporarily stopping an anticoagulant because of the risk of bleeding. The prescribed dosage must be taken at the same time each day to maintain therapeutic effect. A double dose to make up for a missed dose is not done because this will increase the risk of bleeding.

A client is being treated for moderate hypertension and has been taking diltiazem for several months. The client is seen by the health care provider, and Prinzmetal's angina is diagnosed. The nurse is instructing the client about diltiazem. Which client statement indicates a need for further teaching?

"I have to limit my coffee, but I can drink all the fruit juice I want." Rationale: Diltiazem is a calcium-channel blocker that inhibits calcium influx through the slow channels of the membrane of smooth muscle cells. Calcium-channel blockers decrease myocardial oxygen demands and block calcium channels, thereby decreasing the force of contraction of the ventricular tissue. Client teaching about diltiazem includes taking pulse and blood pressure and keeping a record, changing position slowly, avoiding hazardous activities until stabilized, limiting caffeine consumption, and avoiding grapefruit juice.

A client taking an aldosterone antagonist known as eplerenone for hypertension asks about side effects of this medication. The nurse tells the client that which sign/symptom is a side effect?

Elevated potassium level Rationale: Eplerenone is a selective aldosterone receptor blocker. The medication is used for hypertension and heart failure and has one significant side effect, hyperkalemia.

A client is receiving heparin sodium by continuous intravenous (IV) infusion. The licensed practical nurse (LPN) is concerned that the client received a bolus of medication when the tubing was removed from the IV pump during a gown change. The LPN immediately notifies the registered nurse or health care provider and then checks to see whether which medication is available in the medication supply area in case it is prescribed?

Protamine sulfate Rationale: If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin is at risk for bleeding. A partial thromboplastin time (PTT) will be drawn and evaluated. If the results of the PTT are too high, a dose of protamine sulfate, the antidote for heparin, may be prescribed. Aminocaproic acid is an antifibrinolytic (inhibits clot breakdown). Enoxaparin is an anticoagulant. Vitamin K is the antidote for warfarin sodium.

A client is being discharged to home following recovery from an anterior myocardial infarction with recurrent angina. The client will be taking diltiazem, isosorbide dinitrate, and nitroglycerin sublingually as needed, and the nurse reinforces information to the client about the medications. Which statement by the client indicates a need for further teaching about the medications?

"I should notify my doctor immediately if I experience headaches with any of these medications." Rationale: Because of the vasodilating effects of nitrates, headache is a common side effect. Medical attention is not needed unless the headaches increase in severity or frequency. All three medications are nitrates, which improve myocardial circulation by dilating coronary arteries and collateral vessels, thus increasing blood flow to the heart. These medications are used to help prevent the frequency, intensity, and duration of anginal attacks. Nitrates should be stored in a cool place and in a dark container. Heat and light cause these medications to break down and lose their potency.

The nurse is reinforcing discharge teaching to the client who was given a prescription for nifedipine for blood pressure management. Which instructions should the nurse reinforce? Select all that apply.

"Take pulse rate each day." "Weigh at the same time each day." "Palpitations may occur early in therapy." "Be careful when rising from sitting to standing." Rationale: Nifedipine is a calcium-channel blocker. Its therapeutic outcome is to decrease blood pressure. Its method of action is blockade of the calcium channels in vascular smooth muscle, promoting vasodilation. Side effects that can occur early in therapy include reflex tachycardia (palpitations) and first-dose hypotension, leading to orthostatic hypotension. Weight should be checked regularly to monitor for early signs of heart failure. Also the client is taught to take his or her own pulse. Nifedipine does not affect serum calcium levels. Increased water intake is not indicated in the client with cardiovascular disease.

A child is being sent home on digoxin after being diagnosed with a congenital heart defect. The medication needs to be given once a day. Which should the nurse reinforce in the teaching plan for the family?

"Give the medication in the morning 20 to 30 minutes before a feeding." Rationale: Digoxin should be given in the morning before a feeding so that a parent can get in the routine of administering the medication. The medication must be accurately measured and drawn up in a syringe, never measured in a dropper. If the dose is vomited, it is skipped that day and the dose is resumed the next day. If the medication is forgotten in the morning, it is given as soon as remembered that day.

The nurse is caring for a child with heart failure and provides instructions to the mother regarding the procedure for administration of the prescribed digoxin. Which statement by the mother indicates a need for further teaching?

"I can mix the medication with food." Rationale: Medication should not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents should be instructed that if a dose is missed and it is not identified until 4 or more hours later, the dose should not be administered. If more than one dose is missed, the health care provider needs to be notified.

A client who takes a diuretic every evening expresses frustration with the medication and wants to stop therapy. When the nurse explores the reasoning, the client says, "It keeps me up all night. I feel as though I should bring my pillow into the bathroom!" Which action can the nurse suggest to assist the client in successfully adapting to this therapy?

Switching to a morning administration of the medication Rationale:Diuretic therapy should be administered in the morning to cause the least possible disruption in the client's sleep cycle.

A client with chronic atrial fibrillation is being started on maintenance therapy with atenolol for dysrhythmia suppression. The nurse determines that the client needs further teaching about this medication when making which statement?

"I can stop taking the prescribed digoxin after starting this new medication." Rationale: Medication-specific teaching points for atenolol include taking the medication exactly as prescribed, not abruptly discontinuing the medication, taking the medication with food if GI upset occurs, wearing a Medic-Alert bracelet or tag, and having periodic checks of heart rhythm and blood counts.

A client is experiencing impotence after taking an antihypertensive medication. The client states, "I would sooner have a stroke than keep living with the side effects of this medication." The nurse should make which appropriate response to the client?

"You are concerned about the side effects of your medication?" Rationale: Reflection of the client's comment lets the client know that you are hearing his concerns without judging. The nurse cannot understand what the client is experiencing ("I can understand completely."). "That health care provider should change your prescription." devalues the health care provider's judgment. "You wouldn't really want to have a stroke." is confrontational and unsupportive.

The nurse notes that a client is being treated with nesiritide. The nurse should expect this client to be experiencing which disorder?

Heart failure Rationale: Nesiritide is a synthetic form of human B-type natriuretic peptide (BNP) indicated only for short-term, intravenous therapy of hospitalized clients with acutely decompensated heart failure. It is not used for Ploycythermia, Hepatic failure or Myocardial Infarction disorders.

A client with angina pectoris who was given a first dose of newly prescribed nitroglycerin sublingual tablets complains of slight dizziness and headache. The nurse takes which action first?

Takes the client's blood pressure. Rationale: Clients receiving nitroglycerin for the first time are more likely to experience side effects of this coronary vasodilator, which includes a drop in blood pressure and headache. The nurse should take the blood pressure first. The nurse can then give acetaminophen for headache and document or report the side effects. The nurse should not ignore a client's concerns (tells the client not to worry about it.).

The nurse has completed client teaching about heart failure and prescribed medications that include digoxin and furosemide. The nurse documents that the teaching goals have been met if the client states knowing to report which symptom?

Weight gain of 2 to 3 pounds in a few days Rationale: Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. A high urine output is expected with these medications. A cough that accompanies a cold is normal. A sudden increase in appetite is insignificant.

The nurse has reinforced instructions to a client receiving enalapril maleate. Which statement by the client indicates a need for further teaching?

"I need to notify the health care provider if nausea occurs." Rationale: If nausea occurs, it is not necessary to notify the health care provider. The client should be instructed to consume noncaffeinated carbonated beverages, unsalted crackers, or dry toast to alleviate the nausea. To reduce the hypotensive effect of this medication, the client is instructed to rise slowly from a lying to a sitting position and to permit the legs to dangle from the bed momentarily before standing. The client should report signs of a sore throat or fever to the health care provider because these may indicate infection. The client should be notified that several weeks may be needed for the full therapeutic effect of blood pressure reduction. The client should also be instructed not to skip doses or discontinue the medication because severe rebound hypertension can occur.

A client reports to the clinic for follow-up after a 1-month treatment with acebutolol. The nurse determines that a therapeutic effect of the medication has occurred if which response is noted?

A blood pressure of 130/84 mm Hg Rationale: Acebutolol is a beta-adrenergic blocker used primarily to manage mild to moderate hypertension or cardiac dysrhythmias. The expected therapeutic response is a controlled blood pressure within normal limits. Although a pulse rate of 88 beats per minute is also normal, no reference is made regarding the quality or regularity of the pulse.

A client who has developed atrial fibrillation that is not responding to medication therapy has begun taking warfarin. The nurse is reinforcing dietary discharge teaching with the client. The nurse should plan to teach the client to avoid which food while taking this medication?

Broccoli Rationale:Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables such as broccoli, cabbage, turnip greens, and lettuce. Cherries, Potatoes, and Spaghetti are foods that are lower in vitamin K.

The nurse is collecting data from a client with hypertension being treated with diuretic therapy. The nurse should monitor the client for hypokalemia if the client is receiving which diuretic?

Bumetanide Rationale: Bumetanide is a loop diuretic, which places this client at risk for hypokalemia. The nurse assesses this client carefully for signs of hypokalemia, monitors serum potassium levels, and encourages intake of potassium sources in the diet. Spironolactone, triamterene, and amiloride HCl are potassium-retaining diuretics.

The nurse is caring for a client who has been taking diuretics on a long-term basis. The nurse reviews the medication record, knowing that which medications if prescribed for this client would place the client at risk for hypokalemia?

Bumetanide Rationale: Bumetanide is a potassium-losing loop diuretic. The client on this medication would be at risk for hypokalemia. Spironolactone, triamterene, and amiloride hydrochloride are potassium-retaining diuretics.

A client is diagnosed with pulmonary embolism and is to be treated with thrombolytic therapy. The nurse should report which priority data collection finding to the registered nurse before initiating this therapy?

Blood pressure of 198/110 mm Hg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore, the nurse should report the results of the blood pressure to the registered nurse before initiating therapy. The findings in the remaining options may be present in the client with pulmonary embolism.

A hospitalized client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions should the nurse take? Select all that apply.

Check the client's pain level. Check the client's blood pressure. Administer a second nitroglycerin, 0.4 mg, sublingually Rationale: The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain for a total dose of three tablets. The registered nurse is notified immediately if a client complains of chest pain. In this situation, because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would check the client's pain level and the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.

A client with heart failure who is taking furosemide and digoxin calls the nurse and complains of anorexia and nausea. The nurse should take which action?

Check the result of the potassium level drawn 3 hours ago. Rationale: Anorexia and nausea are two of the common symptoms associated with digoxin toxicity, which is compounded by hypokalemia. The nurse should first check the results of the potassium level. This would provide additional data to report to the health care provider, which is a key follow-up nursing action. The nurse would not hold the furosemide without a prescription to do so given the information provided. The nurse would withhold the digoxin and notify the registered nurse who would contact the health care provider because digoxin toxicity is suspected. The nurse would not administer an antiemetic without further investigating the client's problem. The digoxin blood level should also be checked.

The nurse is reinforcing medication instructions to a client who has been prescribed simvastatin. Which is the action of simvastatin?

It inhibits hepatic synthesis of cholesterol. Rationale: The process of cholesterol reduction begins with inhibition of hepatic HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. In response to decreased cholesterol production, hepatocytes synthesize more HMG-CoA reductase. As a result, cholesterol synthesis is restored. However, for reasons that are not fully understood, inhibition of cholesterol synthesis causes hepatocytes to synthesize more low-density lipoproteins (LDL) receptors.

The nurse reinforces dietary instructions to a client who will be taking warfarin sodium. The nurse tells the client to avoid which food item?

Spinach Rationale: Warfarin sodium is an anticoagulant. Anticoagulant medications act by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K often are omitted from the diet. Vitamin K-rich foods include green, leafy vegetables; fish; liver; coffee; and tea.

The nurse is scheduled to administer a dose of digoxin to a client with atrial fibrillation. The client has a potassium level of 4.6 mEq/L. Which would be the nurse's next action?

The dose should be administered as prescribed. Rationale: Hypokalemia can make the client more susceptible to digoxin toxicity. The nurse monitors the results of potassium levels drawn on the client. The normal reference range of potassium for an adult is 3.5 to 5.0 mEq/L. If the potassium level is low, the dose is withheld and the health care provider is notified. In this situation, the dose should be administered as prescribed because the potassium level is within the normal range.

Nifedipine has been prescribed for a client with Raynaud's disease, and the nurse reinforces medication instructions with the client about the medication. Which statement by the client indicates a need for further teaching?

"Nausea and drowsiness are expected, and if they occur, I don't really need to worry about it." Rationale: Nifedipine is a calcium antagonist that reduces smooth muscle contractibility by inhibiting the movement of calcium ions in slow channels. Its side effects include headache, flushing, peripheral edema, and postural hypotension. Overdose of the medication produces nausea, drowsiness, confusion, and slurred speech. If signs of overdose occur, the health care provider is notified.

The nurse is monitoring a client receiving spironolactone by mouth daily. Which data would indicate to the nurse that the client is experiencing a side effect related to the medication?

A potassium level of 5.2 mEq/L Rationale: Spironolactone is a potassium-retaining diuretic. Side effects include hyperkalemia, dehydration, hyponatremia, and lethargy. Although the concern with most diuretics is hypokalemia, this medication is potassium-retaining, which means that the concern with the administration of this medication is hyperkalemia. The normal sodium level is 135 to 145 mEq/L, and the normal potassium level is 3.5 to 5.0 mEq/L. Additional side effects include nausea, vomiting, cramping, diarrhea, headache, ataxia, drowsiness, confusion, and fever. Dry skin is unrelated to the administration of this medication.

A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication?

Acetylsalicylic acid Rationale: Ticlopidine hydrochloride is a platelet aggregation inhibitor. It is used to decrease the risk of thrombotic strokes in clients with precursor symptoms. Because it is an antiplatelet agent, other medications that precipitate or aggravate bleeding should be avoided during its use. Therefore, aspirin or any aspirin-containing product should be avoided.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium. The nurse is told that the client's prothrombin time is 18 seconds with a control of 11 seconds. Which action should the nurse plan?

Administer the next dose of warfarin sodium. Rationale: The therapeutic range for prothrombin time (PT) is one and one half to two times the control for clients at high risk for thrombus. Based on the client's control value, the therapeutic range for this individual is 16.5 to 22 seconds. The nurse should administer the next dose as usual.

The nurse is reviewing the health care provider's prescription sheet for the preoperative client, which states that the client must be on nothing by mouth (NPO) status after midnight. The nurse should clarify whether which medication should be given to the client rather than withheld?

Atenolol Rationale: Atenolol is a beta blocker. Beta blockers should not be stopped abruptly, and the health care provider should be contacted about the administration of this medication before surgery. If a beta blocker is stopped abruptly, the myocardial need for oxygen is increased. Cyclobenzaprine is a skeletal muscle relaxant. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Conjugated estrogen is an estrogen used for hormonal replacement therapy in postmenopausal women. The other three medications may be withheld before surgery without undue effects on the client.

A client recently began medication therapy with propranolol. The nurse should be most concerned after noting the presence of which effect in this client?

Audible expiratory wheezes Rationale: Propranolol is a beta blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. A normal decrease in blood pressure and heart rate is expected. Insomnia is a frequent mild side effect and should continue to be monitored.

A client with a history of hypertension has been prescribed triamterene. The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit?

Bananas Rationale: Triamterene is a potassium-retaining diuretic, and the client should avoid foods high in potassium. Fruits that are naturally higher in potassium include avocados, bananas, fresh oranges and mangoes, nectarines, papayas, and dried prunes and other dried fruits.

A client with myocardial infarction is a candidate for alteplase therapy. The nurse assisting in the care of this client is aware that it will be necessary to monitor for which adverse effect of this therapy?

Bleeding Rationale: Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots. Because of its action, the principal adverse effect is bleeding. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare. Allergic reaction is not a frequent response. Muscle weakness is not an adverse effect of this medication.

A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is most important for the nurse to check before administering a second dose of the medication?

Blood pressure Rationale: Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse should check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations, apical pulse, and temperature may be checked, these vital signs are not the most important assessments related to administration of this medication.

A client returning to the medical nursing unit following cardiac catheterization has a stat prescription to receive a dose of procainamide. The licensed practical nurse assisting in caring for the client obtains which piece of equipment to adequately determine the client's response to this medication?

Cardiac monitor Rationale: Procainamide is an antidysrhythmic medication often used to treat ventricular dysrhythmias that do not adequately respond to lidocaine. The effectiveness of this medication is best determined by evaluating the client's cardiac rhythm. Therefore, a cardiac monitor is of greatest value, although the blood pressure cuff and pulse oximeter would provide general information about the client's cardiovascular status. A glucometer is not needed for this client with the information presented.

The nurse in the preoperative holding unit administers a dose of scopolamine to a client. The nurse monitors the client for which common side effect of the medication?

Dry mouth Rationale: Scopolamine is an anticholinergic medication that causes the frequent side effects of dry mouth, urinary retention, decreased sweating, and pupil dilation. Each of the incorrect options is the opposite of a side effect of this medication.

A client has arrived at the emergency department complaining of weakness, an irregular heartbeat, and lethargy. The nurse is attempting to discover what caused these symptoms. The nurse asks the client "Have you been prescribed any new medications?" The client tells the nurse "About 2 weeks ago I was prescribed a drug to make me pee, but I don't know the name." The nurse determines that the client is referring to which medication?

Furosemide Rationale: Furosemide is a potassium-losing diuretic. As a diuretic, it will cause the client to urinate ("pee"). However, it may lower the serum potassium level as well, which can result in weakness, fatigue, and changes in the electrical activity of the heart causing an irregular heartbeat, bradycardia, and other ECG abnormalities. Oxybutynin is used for an overactive bladder to reduce the frequency of urination when only a small amount of urine is in the bladder and would not cause this client's symptoms. Digoxin and metoprolol are cardiac medications used to regulate the heart rate, not to assist in urination, so although these medications' side effects may cause similar symptoms, neither would be the medication the client was prescribed to increase urination.

A child with a right-to-left cardiac shunt is receiving propranolol. The health care provider visits the child and writes prescriptions in the child's record. The licensed practical nurse (LPN) reviews the prescriptions and notes that the child is placed on a nothing-by-mouth (NPO) status. The LPN consults with the registered nurse and prepares to monitor which parameter closely?

Glucose level Rationale: Propranolol, a beta blocker, is used in the palliative treatment of hypercyanotic episodes. It can cause hypoglycemia if administered in a child who is NPO or hypovolemic. The nurse should monitor glucose levels every 4 to 6 hours if the child is NPO or hypovolemic and receiving propranolol. The health care provider should be notified if the glucose level is less than 60 mg/dL.

The nurse has a prescription to give a client a scheduled dose of digoxin. Before administering the medication, the nurse routinely screens for which signs/symptoms that could indicate early signs of digoxin toxicity?

Loss of appetite, nausea, and vomiting Rationale: Loss of appetite and nausea are early signs of digoxin toxicity. Other signs of digoxin toxicity include bradycardia, visual alterations (e.g., green and yellow vision or seeing spots or halos), confusion, vomiting, or diarrhea.

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia?

Low blood glucose level Rationale: ß-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Therefore low blood glucose level is the most reliable indicator of hypoglycemia.

Clients who are given a prescription for sildenafil should be taught that a potentially fatal medication interaction can occur with which medication?

Nitroglycerin Rationale: Both sildenafil and nitrates promote vasodilation and hypotension. If these medications are combined, life-threatening hypotension could result. Therefore, sildenafil is contraindicated for clients taking nitrates. At least 24 hours should elapse after the last dose of sildenafil before a nitrate is given.

A client is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory monitoring should the nurse plan to check during a continuous heparin infusion? Select all that apply.

Platelets Activated partial thromboplastin time (aPTT) Rationale: A continuous heparin infusion requires monitoring the platelet count for heparin-induced thrombocytopenia and activated partial thromboplastin time to monitor blood clotting time. Warfarin is monitored using the international normalized ratio (INR). The INR is a standardized system of reporting prothrombin time (PT). Recombinant factor VIIa is used to reverse the anticoagulant effect of fondaparinux.

A health care provider tells the nurse that a potassium-retaining diuretic is being prescribed for the client with heart failure. The nurse reviews the health care provider's prescriptions expecting that which medication will be prescribed?

Spironolactone Rationale: Spironolactone is a potassium-retaining diuretic that promotes sodium excretion while conserving potassium. Furosemide, Ethacrynic acid, and Hydrochlorothiazide identify diuretics that do not conserve potassium.

The nurse has a prescription to give a first dose of hydrochlorothiazide to an assigned client. The nurse should question the prescription if the client had a history of allergy to which item?

Sulfa drugs Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. A sulfa allergy must be communicated to the pharmacist, health care provider, nurse, and other health care providers.

Isosorbide mononitrate is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action should the nurse suggest to the client?

Take the medication with food. Rationale: Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the PHCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.

A client with aldosteronism has been instructed on spironolactone treatment. Which client statement indicates that the client needs further teaching about the medication?

This medication will decrease my blood glucose." Rationale: Spironolactone is a potassium-retaining diuretic. It does not lower blood glucose. Spironolactone counteracts the effect of aldosterone, promotes sodium and water excretion, decreases circulating volume, and therefore decreases blood pressure and inhibits the excretion of potassium.

A client with angina pectoris has just been started on medication therapy with nitroglycerin. In planning care for this client, the nurse should place priority on measuring which data?

Vital signs Rationale: The nurse would place priority on measuring vital signs, especially the blood pressure, because of the vasodilator action of the medication. Drug levels are not measured for nitroglycerin, and the medication does not affect serum glucose level. Intake and output may be measured as part of the general plan of care for the client with heart disease, but it is not directly related to administration of this medication.

The nurse is preparing to administer digoxin, 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?

Heart rate Rationale: Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the RN, who would then contact the PHCP.

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol?

The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction: bronchospasm. ß-Blockers may induce this reaction particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

Thrombolytic therapy was administered to a client following an acute inferior myocardial infarction. The nurse giving discharge instructions to the client evaluates a need for further teaching when the client makes which statement?

"I will apply pressure for 10 minutes for minor bleeding." Rationale: Thrombolytic medication causes lysis of blood clots. Client teaching includes reporting a temperature over 104° F (40° C), which can be an indicator of internal bleeding. Other instructions include avoiding venous or arterial punctures and rectal temperatures. Fevers can be treated with acetaminophen or aspirin. Pressure should be applied for 30 seconds to a minor bleeding site. Inform the primary health care provider if this does not attain hemostasis.

The nurse is caring for a client who is receiving hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameters?

Blood pressure Rationale: Hydralazine is an antihypertensive medication used in the management of moderate to severe hypertension. It is a vasodilator medication that decreases afterload, so it is important that the blood pressure be monitored. The remaining options are not specifically related to determining the effectiveness of this medication.

A client who has begun taking fosinopril is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. Which suggestion would provide the best support for the client?

Inform the client that impaired taste is expected and generally disappears in 2 to 3 months. Rationale: ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without PHCP approval, and the medication should never be stopped abruptly.

The nurse is assisting in developing a plan of care for a client receiving warfarin sodium. The nurse selects which problem as the priority in caring for this client?

Potential for injury Rationale: Anticoagulant therapy predisposes the client to injury because of the inhibitory effects of the medication on the body's normal blood-clotting mechanism. Bruising, bleeding, and hemorrhage may occur in the course of activities of daily living and with other activities. Potential for infection, Fluid volume overload, and Potential for inability to tolerate activity are not specifically related to the care of a client receiving anticoagulants.

The nurse is caring for a client who has been prescribed furosemide and is monitoring for adverse effects associated with this medication. Which should the nurse recognize as potential adverse effects? Select all that apply.

Tinnitus Hypotension Hypokalemia Rationale: Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noting which signs and symptoms? Select all that apply.

Visual disturbances Nausea and vomiting Serum digoxin level of 2.3 ng/mL (2.93 nmol/L) Rationale: Signs and symptoms of digoxin toxicity include gastrointestinal signs, bradycardia, visual disturbances, and hypokalemia. A therapeutic serum digoxin level ranges from 0.8 to 2.0 ng/mL (1.02 to 2.56 nmol/L). The serum potassium level should be between 3.5 mEq/L (3.5 mmol/L) and 5.0 mEq/L (5.0 mmol/L). The apical pulse must be greater than or equal to 60 beats per minute.

A health care provider (HCP) writes a prescription for digoxin, 0.25 mg daily. The nurse teaches the client about the medication and tells the client that it is important to do which?

Withhold the medication and call the HCP if the pulse is less than 60 beats per minute. Rationale: An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.

The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril orally daily. The nurse evaluates the need for further teaching when the client makes which statement?

"I can skip a dose once a week." Rationale: Lisinopril is an antihypertensive angiotensin-converting enzyme inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.

A client is taking nicotinic acid for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions?

"Ibuprofen taken 30 minutes before the nicotinic acid should decrease the flushing." Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals; this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the PHCP.

The client has been prescribed nifedipine. The nurse is instructing the client about nifedipine. Which client statement indicates a need for further teaching?

"If I see empty tab shells in my stool, I need to report it to my doctor." Rationale: Client teaching about nifedipine includes changing position slowly to avoid orthostatic hypotension and avoiding grapefruit juice and alcohol. The client is not to discontinue nifedipine abruptly but gradually taper dosage. If empty tab shells appear in stools, it is not significant.

The nurse prepares to administer digoxin to a 3-year-old with a diagnosis of heart failure and notes that the apical heart rate is 120 beats per minute. Which nursing action is appropriate?

Administer the digoxin. Rationale:The normal apical heart rate for a 3-year-old is 80 to 125 beats per minute. Because the apical heart rate is within normal range, holding the medication, notifying the RN, and rechecking the apical heart rate in 15 minutes are inappropriate.

A potassium-retaining diuretic is prescribed for a client with heart failure. Which foods should the nurse instruct the client to avoid?

Bananas Rationale: When the client is taking a potassium-retaining diuretic, the client should avoid foods high in potassium. A banana contains 451 mg of potassium. Cranberry juice (1 cup) contains 61 mg of potassium. A plum contains 48 mg of potassium, and 1 ounce of cheddar cheese contains 28 mg of potassium.

A client arrives at the health care clinic for follow-up care and evaluation of the effectiveness of prazosin. Which finding indicates a therapeutic effect related to the use of this medication?

Decrease in blood pressure Rationale: Prazosin is an antihypertensive medication. The principal indication for its use is hypertension. A decrease in blood pressure indicates a therapeutic effect of the medication. Increase in platelet count, increased red blood cell count, and decrease in blood glucose level are unrelated to the use of this medication.

A client has taken his first dose of lisinopril about 2 hours ago and begins to develop fullness in his face and hoarseness. Which action should the nurse take first?

Determine the client's ability to breathe effectively. Rationale: The client is experiencing angioedema, an adverse effect of the medication, which involves facial swelling and hoarseness. Assessing the ability to breathe effectively takes priority over assessing the blood pressure, preventing dizziness, or determining how long the client has been hoarse.

The nurse is planning to administer hydrochlorothiazide to a client. Which are concerns related to the administration of this medication?

Hypokalemia, hyperglycemia, sulfa allergy Rationale: Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

A client is being treated for acute heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats per minute; and respirations, 24 breaths per minute. After the initial dose, which is the priority assessment?

Monitoring blood pressure Rationale: Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The options monitor weight loss, temperature, and potassium level also require assessment but are not the priority.

The nurse is reviewing laboratory results of a digoxin level for the client taking digoxin. The digoxin level is 2.5 ng/mL, which indicates digoxin toxicity. Which signs and symptoms should the nurse note? Select all that apply.

Nausea Syncope Bradycardia Rationale: Digoxin has a narrow therapeutic range. The therapeutic range is 0.8 to 2 ng/mL. Drug levels higher than the therapeutic level greatly increase the risk of toxicity. Classic symptoms of digitalis toxicity are yellow-green halos around lights, nausea, diarrhea, and confusion

The nurse is asked to assist in preparing a heparin sodium infusion for a client with a diagnosis of thrombophlebitis. Which items should the nurse have available for this procedure? Select all that apply.

Protamine sulfate Intravenous tubing Intravenous infusion controller Intravenous insertion equipment Rationale: Phytonadione is the antidote for warfarin sodium, so this is an unnecessary item. Protamine sulfate is the antidote for heparin and should be available if heparin overdose occurs. Heparin is administered by the intravenous (IV) route, so IV insertion equipment is needed. IV tubing will be necessary for connection of the IV solution with the prescribed heparin dosage to the client's IV catheter. Heparin is always infused via an IV pump or controller.

The nurse is caring for a client who is taking metoprolol. The nurse measures the client's blood pressure (BP) and apical pulse immediately before administration. The client's BP is 122/78 mm Hg and the apical pulse is 58 beats per minute. Based on this data, which is the appropriate action?

Withhold the medication. Rationale: Metoprolol is classified as a beta-adrenergic blocker and is used in the treatment of hypertension, angina, and myocardial infarction. Baseline nursing assessments include measurement of BP and apical pulse immediately before administration. If the systolic BP is below 90 mm Hg and the apical pulse is below 60 beats per minute, the nurse should withhold the medication and document this action. Although the registered nurse should be informed of the client's vital signs, it is not necessary to do so immediately. The medication should not be administered because the data are outside of the prescribed parameters for this medication. The nurse should not administer half of the medication or alter any dosages at any point in time.

A client with chronic atrial fibrillation is being started on amiodarone as maintenance therapy for dysrhythmia suppression. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching?

"I will stop taking the prescribed anticoagulant after starting this new medication." Rationale: Amiodarone is used for the dysrhythmia, atrial fibrillation. The medication will have no effect in preventing thrombus formation within the atria, so anticoagulants need to be continued. The medication increases sun sensitivity so protective measures are essential. Thyroid function studies should be monitored because the medication can affect thyroid function. Because the medication can cause corneal microdeposits, follow-up with the ophthalmologist is important.

The nurse is monitoring a client receiving furosemide 40 mg orally daily. Which indicator should inform the nurse that a therapeutic effect has occurred?

A blood pressure of 128/80 mm Hg Rationale: Furosemide is a loop diuretic used primarily in the treatment of hypertension. It may be used alone or in combination with other antihypertensives. It also may be used in the treatment of edema associated with heart failure (HF), renal disease, or hepatic cirrhosis. Overdose of the medication produces acute, profound water loss; volume and electrolyte depletion; dehydration; decreased blood volume; and circulatory collapse. The presence of edema would not indicate a therapeutic effect. The normal sodium level is 135 to 145 mEq/L, and the normal potassium level is 3.5 to 5.0 mEq/L. A sodium level of 130 mEq/L and a potassium level of 3.1 mEq/L indicate abnormal electrolyte values.

The nurse is attending an in-service education session on the therapeutic use of calcium-channel blockers. The instructor of the session determines that teaching has been effective when the nurse correctly identifies that these medications are used for which disorders? Select all that apply.

Angina Hypertension Dysrhythmias Rationale: Calcium-channel blockers are medications that prevent calcium ions from entering cells. These agents have their greatest effects on the heart and blood vessels. They are used widely to treat hypertension, angina pectoris, and cardiac dysrhythmias. They are not used to treat glaucoma, acute kidney injury, or glomerulonephritis.

The nurse notes that a client in a long-term care facility is receiving a daily dose of furosemide. The nurse writes in the care plan to monitor which parameter on a daily basis?

Weight Rationale:Daily weight should be monitored because this reflects the fluid status of the client who is receiving a diuretic. The radial pulse is a general assessment and does not relate directly to fluid balance. Hemoglobin and serum creatinine clearance are laboratory measurements that are not prescribed routinely by the nurse and would not be done on a daily basis in a long-term care facility.

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as characteristic of which description?

Within the therapeutic range Rationale: The normal aPTT varies between 20 and 36 seconds depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. Thus, the client's aPTT is within the therapeutic range, and the dose should remain unchanged.

A client has been given a prescription for gemfibrozil. The nurse plans to instruct the client to limit intake of which food while taking this medication?

Beef Rationale: Gemfibrozil is a lipid-lowering agent. It is given as part of a therapeutic regimen that also includes dietary counseling, specifically the limitation of saturated and other fats in the diet. Therefore, the intake of red meats is limited. Fish, foods that are spicy, and citrus products do not affect the cholesterol level.

A client takes digoxin 0.25 mg by prescription every day. When the nurse enters the client's room with the medication, the client's meal tray is untouched and the client says he has no appetite. Which action is the most appropriate?

Listen to the client's apical pulse. If it is less than 60 beats per minute, withhold the medication. Rationale: Anorexia is a common early sign of digoxin toxicity. Another sign of digoxin toxicity is an apical pulse rate of less than 60 beats per minute. If the apical pulse rate is less than 60 beats per minute, the dose should be withheld and the health care provider notified. The remaining options are incorrect actions and would harm the client (administer one half the prescribed amount to avoid digoxin toxicity.) or delay needed intervention (check the client's temperature, radial pulse rate, and respiratory rate. and offer to bring back the digoxin to the client when his appetite improves.). Additionally, a radial pulse is not as accurate as an apical pulse and should not be used to determine the possibility of digoxin toxicity.

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium. Which statement made by the client reflects the need for further teaching?

"I will take enteric-coated aspirin for my headaches because it is coated." Rationale: Aspirin-containing products should be avoided while taking this medication. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel with emergency information.

A client is being discharged home, and the health care provider has prescribed spironolactone for the client. The nurse reinforces instructions to the client about the medication. Which statement by the client indicates a need for further teaching by the nurse?

"I know I need to eat foods that are high in potassium because of the diuretic effect of the medication." Rationale: This medication is a potassium-retaining diuretic that is used to treat edema, hypertension, fluid retention and overload, and to increase urine output. Because the medication is a potassium-retaining diuretic and an adverse effect of the medication is hyperkalemia, the client should be cautioned about consuming foods that are high in potassium.

The nurse has provided discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium. The nurse reminds the client to do which?

Avoid taking products containing acetylsalicylic acid. Rationale: Warfarin sodium is an anticoagulant. The client should avoid taking aspirin because of its antiplatelet properties and should avoid taking other over-the-counter medications without checking with the health care provider first because they could contain ingredients that would interact with the warfarin sodium. The client should avoid alcohol while taking warfarin sodium per health care provider's directions. The client should take the medication at the same time each day to increase compliance and keep therapeutic blood levels stable.

The health care provider has prescribed morphine sulfate intravenous push for a client with pulmonary edema. Which therapeutic effects should the nurse expect in this client? Select all that apply.

Relief of anxiety Reduction of oxygen consumption Improvement in efficacy of breathing Rationale: Pulmonary edema requires pharmacological treatment. Morphine sulfate administrated by intravenous push is used in clients with pulmonary edema for its cardiovascular effects and to relieve anxiety. It relieves anxiety thereby decreasing oxygen demand. It reduces preload and afterload, vasodilating pulmonary and systemic blood vessels decreasing oxygen demand, and improving efficacy of breathing. Decreasing the respiratory rate and preventing cardiac dysrhythmias are not therapeutic effects of morphine.

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?

Have heparin sodium available. Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.

A client with heart failure is being discharged to home and will be taking furosemide. The nurse determines that teaching has been effective if the client makes which statement?

"I will weigh myself every day." Rationale: A client taking furosemide must be able to monitor fluid status throughout therapy. Monitoring daily weight is the easiest and most accurate way to accomplish this. "I will measure my urine output." and "I will check my ankles every day for swelling." are incorrect because of the difficulty of assessing fluid status accurately in this way. Additionally, in order for "I will measure my urine output." to be correct, fluid intake would also need to be measured. "I will take my pulse every day." is incorrect and unrelated to the administration of furosemide.

Warfarin sodium is prescribed for a client. The nurse expects that the primary health care provider will prescribe which laboratory tests to monitor for a therapeutic effect of the medication? Select all that apply.

Prothrombin time (PT) International normalized ratio (INR) Rationale: The INR will assess for the therapeutic effect of warfarin sodium, and the aPTT will assess the therapeutic effect of heparin sodium. The platelet count will assess the client's potential for bleeding. Warfarin sodium doses are determined based on the results of the INR. The PT also is used to determine warfarin dosage. The D-dimer is used to detect pulmonary embolism and disseminated intravascular coagulation (DIC). The APTT is used to determine heparin dosage.

A 1-year-old child has been prescribed digoxin to treat heart failure (HF). When should the nurse plan on withholding the prescribed dose of the medication?

The child's pulse is less than 80 beats per minute. Rationale: The normal pulse rate for a 1-year-old child is about 100 beats per minute. A missed dose is withheld if 4 hours have elapsed. Fever is not a contraindication to giving the medication. Knowing that a sign of digoxin toxicity is a decreased heart rate, the most likely choice is pulse less than 80 bpm, which indicates a relative bradycardia.

A client receiving total parenteral nutrition (PN) has a history of heart failure. The health care provider has prescribed furosemide 40 mg orally daily to prevent fluid overload. The nurse is giving instructions about taking furosemide in relation to the client's health plan. Which statement by the client indicates a need for further teaching?

"I need to talk to my doctor about increasing my digoxin." Rationale: Furosemide is a potassium-losing diuretic. Instructions include a need for a high-potassium diet or potassium replacement, rising slowly from a lying or sitting position because orthostatic hypotension may occur, and taking the medication early in the day to prevent sleeplessness and nocturia. Furosemide can increase the risk of toxicity of lithium, nondepolarizing skeletal muscle relaxants, digoxin, salicylates, aminoglycosides, and cisplatin.

The nurse is preparing to administer digoxin to an adult client. The nurse checks which important item before administering the medication?

Apical pulse rate Rationale:Digoxin is a cardiac glycoside that is used to manage and treat heart failure and to control ventricular rates in clients with atrial fibrillation. Before administering the medication, the nurse needs to assess the apical heart rate for 60 seconds. If the pulse rate is less than 60 beats per minute in an adult client, the nurse would withhold the medication and contact the health care provider because a low pulse rate may be an indication of toxicity. Blood pressure, Neurological signs, and level of consciousness may be a component of the assessment depending on the client's diagnosis. However, these assessments are not specifically associated with the use of digoxin.

The nurse is assisting in monitoring a client who received hydralazine hydrochloride to treat autonomic dysreflexia. Which finding accurately indicates that the medication is effective?

Blood pressure declines. Rationale: Hydralazine hydrochloride is a potent ganglionic-blocking agent that will decrease the blood pressure by vasodilation. It may be given by slow intravenous push during an episode of extreme hypertension.

A client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include a beta blocker, digoxin, and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which assessment data supports this diagnosis?

Double vision, loss of appetite, and nausea Rationale: Double vision, loss of appetite, and nausea are signs of digoxin toxicity. Additional signs of digoxin toxicity include bradycardia, difficulty reading, visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, decreased libido, and impotence.

The nurse is reinforcing dietary instructions to a client who is taking spironolactone. The nurse instructs the client to avoid which food in the daily diet?

Citrus fruits Rationale:Spironolactone is a potassium-retaining diuretic. Hyperkalemia is the principal adverse effect. Clients are instructed to restrict their intake of potassium-rich foods such as citrus fruits and bananas. Rice, Salad, and Oatmeal are appropriate food items to include in the daily diet.

A client is being discharged following treatment for left-sided heart failure. The nurse is reinforcing teaching the client the purpose, actions, adverse effects, and use of digoxin and hydrochlorothiazide prescribed for daily use. Which statement by the client indicates a need for further teaching?

"I should decrease my intake of foods high in potassium such as bananas." Rationale: Digoxin is a cardiac glycoside and hydrochlorothiazide is a diuretic. Clients on digoxin have an increased risk of digoxin toxicity from the potassium-depleting effect of hydrochlorothiazide. Therefore, the diet should be high in potassium. The client should take the pulse before taking cardiac glycosides. A combined therapeutic effect of these medications is to increase urine output. The increased blood flow to the kidneys from enhanced cardiac contractility from the digoxin will promote urinary output. Hydrochlorothiazide increases urine excretion of sodium and water by inhibiting sodium reabsorption in the nephron. For the best therapeutic effects, these medications should be taken at the same time in the morning to avoid sleep disturbances from the need to urinate.

A client taking an angiotensin-converting enzyme (ACE) inhibitor reviewed the medication information sheet and notes that the medication is used to treat hypertension. He states, "I have heart failure. Why am I taking this medicine?" The nurse responds by making which statement?

"The medication causes relaxation in your arteries and veins and decreases the heart's work." Rationale: ACE inhibitors produce multiple benefits in heart failure. By lowering arteriolar tone, these medications improve regional blood flow, and by reducing cardiac afterload, they increase cardiac output. By causing venous dilation, they reduce pulmonary congestion and peripheral edema. By dilating blood vessels in the kidney, they increase renal blood flow and thereby promote excretion of sodium and water. This loss of fluid has two beneficial effects: (1) it helps reduce edema and (2) by lowering blood volume, it decreases venous return to the heart thereby reducing right-heart size. Also by suppressing aldosterone and by reducing local production of angiotensin II in the heart, ACE inhibitors may prevent or reverse pathological changes in cardiac structure.

The nurse is caring for a client receiving digoxin. The nurse monitors the client for which early manifestation of digoxin toxicity

Anorexia Rationale: Digoxin is a cardiac glycoside used to manage and treat heart failure and to control ventricular rates in clients with atrial fibrillation. The most common early symptoms of toxicity include gastrointestinal disturbances such as anorexia, nausea, and vomiting. Neurological abnormalities also can occur early and include fatigue, headache, depression, weakness, drowsiness, confusion, and nightmares. Facial pain, personality changes, and ocular disturbances (photophobia, light flashes, halos around bright objects, yellow or green color perception) are also signs of toxicity but are not early signs.

Atenolol hydrochloride is prescribed for a hospitalized client. The nurse should perform which as a priority action before administering the medication?

Check the client's blood pressure. Rationale: Atenolol hydrochloride is a beta blocker used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse should check baseline renal and liver function tests. The medication may cause weakness, and the nurse should assist the client with activities if weakness occurs.

The nurse should anticipate the use of which medications in the treatment of the client with heart failure? Select all that apply.

Diuretics Cardiac glycosides Phosphodiesterase (PDE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors Rationale: Medications recommended for treatment of heart failure include diuretics, cardiac glycosides such as digoxin, PDE inhibitors, and ACE inhibitors. Clients in heart failure do not need anticoagulants or anticholinergics.

The hospitalized client with angina continues to have chest pain after the initial administration of a sublingual nitroglycerin tablet. The nurse should take which action?

Provide a second sublingual dose in 5 minutes. Rationale: To terminate an acute anginal attack, sublingual nitroglycerin should be administered as soon as the pain begins. Administration should not be delayed until the pain has become severe. In the hospitalized client, if pain is not relieved in 5 minutes, the client should take another dose sublingually, and then a third tablet is taken 5 minutes later. Anginal pain that does not respond to nitroglycerin may indicate myocardial infarction. If the client is having a myocardial infarction, distraction techniques such as deep breathing and imagery will not relieve the pain.

A client who is taking hydrochlorothiazide has also been prescribed triamterene. The client asks the nurse why both medications are required. Which response is the most accurate to give to the client?

Triamterene is a potassium-retaining (sparing) diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic. Rationale: Potassium-retaining (sparing) diuretics include amiloride, spironolactone, and triamterene. They are weak diuretics that are used in combination with potassium-excreting diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics.

A client is being treated for heart failure and is receiving digoxin. The client's vital signs are blood pressure 85/50 mm Hg, pulse 96 beats per minute, and respirations 26 breaths per minute. To evaluate therapeutic effectiveness of this medication, the nurse should expect which change in the client's vital signs?

Blood pressure 98/60 mm Hg, pulse 80 beats per minute, respirations 24 breaths per minute Rationale: The main function of digoxin is inotropic. The increased myocardial contractility is associated with increased cardiac output causing a rise in the blood pressure in a client with heart failure. Digoxin also has a negative chronotropic effect (decreases heart rate) and will therefore cause a slowing of heart rate. As cardiac output improves, there should be an improvement in respirations as well.