Pharmacology Ch. 27,28,29

What are the common crystalloid fluids used for shock?

-Normal saline -Lactated ringer's -PlasmaLyte -5% dextrose in NS (D5W) -Hypertonic saline

A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (select all that apply) A. fatigue B. Constipation C. Anorexia D. Rash E. Blurred vision

A. Fatigue C. Anorexia E. Blurred vision Rationale : Fatigue --> and weakness are early CNS findings that may indicate digoxin toxicity Anorexia --> GI disturbances is indication (NOT constipation) Dipolopia --> visual changes, such as diplopia and yellow-tinged vision, are manifestations of digoxin toxicity Rash --> not manifestation of dig toxicity

Which assessment finding in a patient who is receiving atenolol (Tenormin) for angina would be caused for the nurse to hold the drug and contact the provider?(SATA) A. Heart rate of 50 beats/minute. B. Heart rate of 124 beats/minute. C. Blood pressure 86/56. D. Blood pressure 156/88. E. Tinnitus and vertigo

A. Heart rate of 50 beats/minute. C. Blood pressure 86/56 Rationale: Atenolol (Tenormin) decreases blood pressure and heart rate. The administration of this drug may cause significant hypotension and bradycardia in some clients,

A nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A. Remove the patch each evening . B. Cut each patch in half if angina attacks are under control C. Take off the nitroglycerin patch for 30 min if a headache occurs. D. Apply a new patch every 48hr.

A. Remove the patch each evening . Rationale: In order to prevent tolerance to nitroglycerin, the client should remove the patch for 10-12hr during each 24hr period.

Nursing assessment of a patient receiving normal serum albumin for treatment of shock should include which of the following assessments? A. breath sounds b. serum glucose levels C. potassium levels D. hemoglobin and hematocrit

A. breath sounds Rationale: Albumin is a colloid solution. Colloids pull fluid into the vascular space. Circulatory overload may occur due to this fluid shift. The nurse should assess the patient for symptoms of heart failure such as an increase in adventitious breath sounds, edema, bounding pulses, or tachycardia. Options 2, 3, and 4 are incorrect. Albumin is given to increase vascular volume and should not directly affect glucose or potassium levels or hemoglobin or hematocrit concentration

The patient in hypovolemic shock is prescribed an infusion of lactated ringer's. what is the purpose for infusing this solution in shock? (select all that apply.) A. the solution will help to replace fluid and promote urine output. B. the solution will draw water into cells. C. the solution will draw water from cells to blood vessels. D. the solution will help to maintain vascular volume. E. the solution is used to provide adequate calories for metabolic needs.

A. the solution will help to replace fluid and promote urine output. D. the solution will help to maintain vascular volume. Rationale: Crystalloid solutions such as lactated Ringer's closely approximate the electrolytes and concentration of blood plasma. They help increase vascular volume, replacing fluid and promoting adequate urine output, and help maintain normal intravascular volume. Options 2, 3, and 5 are incorrect. Lactated Ringer's is an isotonic fluid and should not cause fluid shifting into or out of the cells. It does not contain enough calories to meet the body's metabolic needs, especially in shock, which is an extremely stressful condition in the body.

The patient is being discharged with nitroglycerin (Nitrostat) for sublingual use. While planning patient education, what instruction will the nurse include? A. "swallow three tablets immediately for pain and call 911." B. "Put one tablet under your tongue for chest pain. If pain does not subside, call 911." C. "call your health care provider when you have chest pain. He will tell you how many tablets to take." D "Place three tablets under your tongue and call 911."

B. "Put one tablet under your tongue for chest pain. If pain does not subside, call 911." Rationale: At the initial onset of chest pain, sublingual nitroglycerin is administered and if the pain persists after the initial dose, the patient should seek emergency medical assistance for more definitive diagnosis and care. Options 1, 3, and 4 are incorrect. Nitro- glycerin sublingual dosing should not be swallowed, and no more than one tablet is administered at a time. Trying to reach the health care provider may cause unnecessary delays in treatment.

A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? A. Lowered heart rate B. Increased urine output C. Decreased conduction through the AV node D. Vasoconstriction of renal blood vessels

B. Increased urine output Rationale: Expect dopamine to cause increased urinary output as a result of increased renal perfusion. This occurs due to the activation of the dopamine is administered at low doses.

A patient with heart failure has an order for Lisinopril (Prinivil, Zestril). Which of the following conditions in the patient's history would lead the nurse to confirm the order with the provider? A. A history of hypertension previously treated with diuretic therapy. B. A history of seasonal allergies currently treated with antihistamines. C. A history of angioedema after taking enalapril (Vasotec) D. A history of alcoholism, currently abstaining

C. A history of angioedema after taking enalapril (Vasotec) Rationale: Angioedema is a rare but potentially serious adverse effect of ACE inhibitors; because this patient has had a previous reaction to another drug within the same group (enalapril/Vasotec), the nurse should confirm the order with the provider. Options 1, 2, and 4 are incorrect. The use of diuretics along with ACE inhibitors must be closely monitored, but this patient was previously on diuretic therapy and it may be assumed that the patient is no longer taking it. The use of antihistamines concurrently with Lisinopril may help to relieve any dry cough that occurs with the Lisinopril. While a history of alcoholism may suggest more frequent hepatic monitoring, the patient is currently abstaining.

Which should the nurse recognize are adverse effects associated with digoxin (Lanoxin)? A. Tachycardia and hypotension B. Blurred vision and tachycardia C. Anorexia and nausea D. Anorexia and constipation

C. Anorexia and nausea Rationale: Anorexia and nausea are common adverse effects of digoxin (Lanoxin).

A patient is starting to receive dobutamine by intravenous infusion for treatment of shock. This drug is particularly useful for which type of shock? A. Anaphylactic B. Septic C. Cardiogenic D. Hypovolemic

C. Cardiogenic Rationale: Dobutamine is a selective beta1-adrenergic drug that is especially beneficial when the primary cause of shock is related to heart failure, rather than hypovolemia. The resulting increases in cardiac output assists in maintaining blood flow to vital organs

The patient who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug? A. Weight and presence of edema B. Dietary intake of sodium C. Electrolytes, especially potassium D. History of sleep patterns and presence of sleep apnea

C. Electrolytes, especially potassium Rationale: Electrolytes, especially potassium for the presence of hypokalemia, should be assessed before beginning milrinone (Primacor) or any phosphodiesterase inhibitory. Hypokalemia should be corrected before administering phosphodiesterase inhibitors because this can increase the likelihood of dysrhythmias. Options 1, 2, and 4 are incorrect. Weight, presence of edema, and dietary intake of sodium will be monitored because of their relationship to HF and for therapeutic improvement, but they are not crucial to assess before beginning therapy. The patient's sleep patterns or presence of sleep apnea have no direct relationship to the drug; however, monitoring may be ordered for other reasons.

A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911? A. Immediately B. If the pain becomes more severe C. If one sublingual tablet does not relieve the pain after 5 minutes D. If the pain is not relieved after three sublingual tablets, taken 5 minutes apart

C. If one sublingual tablet does not relieve the pain after 5 minutes Rationale: With sublingual nitroglycerin, the medication should be taken at the first sign of chest pain and not be delayed until the pain is severe. The patient should sit or lie down and take 1 sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after 1 dose, the patient (or family member) should call 911 immediately. The patient can take 1 more tablet while awaiting emergency care, and a third tablet 5 minutes later, but no more than 3 tablets total. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction.

A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A. Calcium 9.2mg/dL B. Calcium 10.3mg/dL C. Potassium 3.4mEq/L D. Potassium 4.8mEq/

C. Potassium 3.4mEq/L Rationale: K+ level of 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium can cause fatal dysrhythmias especially in older clients who take digoxin. Notify the provider, who might prescribe a potassium supplement.

A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? A. Apical HRof 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL

C. Serum potassium level of 2.9 mEq/L

A patient is receiving PlasmaLyte for treatment of hypovolemic shock. When monitoring therapeutic effects, which of the following will the nurse expect to occur? A. breath sounds are clear. B. potassium, glucose, and sodium levels remain within normal range. C. blood pressure returns to within normal range and urine output increases. D. the pulse rate and ECG return to normal rate and pattern.

C. blood pressure returns to within normal range and urine output increases. Rationale: As fluid volume increases, blood pressure, cardiac output, and renal perfusion all in- crease. Blood pressure should return to normal or near- normal levels, and urine output should increase as renal perfusion increases. Options 1, 2, and 4 are incorrect. When given for hypovolemic shock, PlasmaLyte should increase intravascular volume. Breath sounds; potassium, glucose, and sodium levels; and pulse rate or ECG are not indicators of therapeutic effect.

nitroglycerin patches have been ordered for a patient with a history of angina. What teaching will the nurse give to this patient? A. Keep the patches in the refrigerator. B. Use the patches only if the chest pain is severe. C. remove the old patch and wait 6-12 hours before applying a new one. D. Apply the patch only to the upper arm or thigh areas.

C. remove the old patch and wait 6-12 hours before applying a new one. Rationale: To prevent the development of nitrate tolerance, nitroglycerin patches are often removed at night for 6 to 12 hours. Options 1, 2, and 4 are incorrect. The patches should not be kept in the refrigerator unless excessive room temperatures are anticipated and then only under the direction of the pharmacist or health care provider. Nitroglycerin patches provide long-term control of angina; they should be used regularly and not only in cases of severe chest pain. They should be applied to hair-free areas of the torso and not on the arms or legs. Muscle activity in these areas may increase drug absorption.

A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient? A. vasodilation of the coronary arteries B. increased force of cardiac contraction C. slowing of the heart rate D. maintaining adequate BP

C. slowing of the heart rate Rationale: Slowing the heart rate in patients with ischemic heart disease reduces myocardial oxygen demand and allows the coronary arteries time to fill with oxygen- and nutrient-rich blood. Beta blockers also block the irritating effects of circulating catecholamines on the heart.

The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements? Select all that apply. A. "I should limit my fluids while taking this medication." B. "It is okay to keep taking my ginseng." C. "If I have nausea, it means I must stop the medication." D. "I can drink orange juice every morning." E. "I must check my pulse and not take the medication if it is less than 60."

D. "I can drink orange juice every morning." E. "I must check my pulse and not take the medication if it is less than 60." Rationale 1: Dehydration can increase the risk for digoxin (Lanoxin) toxicity; the patient must not limit fluids. Rationale 2: Ginseng may increase the risk of digoxin (Lanoxin) toxicity. Rationale 3: Nausea, by itself, may be a side effect, but it is not necessarily indicative of digoxin (Lanoxin) toxicity. Rationale 4: Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity. Rationale 5: Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin).

A nurse is assessing a patient who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A. bruising B. Report of metallic taste C. Muscle pain D. report of anorexia

D. report of anorexia Rationale : Anorexia, blurred vision, stomach pain , and diarrhea are manifestations of digoxin toxicity

What are the s/s of shock?

-Decreased BP -Increased pulse and rr -Cool, clammy skin -Decreased LOC -Decreased urine output

What changes should the patient report to the HCP immediately when using Nitrates PO at home?

-Mental status or level of consciousness -Palpitations -Dizziness -Dyspnea -Increasing productive cough

A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? A. "Remove the prior dose before applying a new dose." B. "Rub the ointment directly into your skin until it is no longer visible." C. "Cover the applied ointment with a clean gauze pad." D. "Apply the ointment to the same skin area each time."

A. "Remove the prior dose before applying a new dose." Rational: The client should remove the prior dose before applying a new dose to prevent toxicity

What health teaching should the nurse provide for a patient receiving diltiazem (Cardizem)? (SATA) A. Avoid drinking or performing other activities requiring mental alertness until the effects of the drugs are known B. Maintain adequate fluid and fiber intake to facilitate stool passage C. Report on weight gain of 2 kg/week D. Rise slowly from prolonged periods of sitting or lying down. E. Immediately stop taking the medication if sexual dysfunction is noted.

A. Avoid drinking or performing other activities requiring mental alertness until the effects of the drugs are known B. Maintain adequate fluid and fiber intake to facilitate stool passage C. Report on weight gain of 2 kg/week D. Rise slowly from prolonged periods of sitting or lying down.

A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A. Contact provider if heart rate is less than 60/min B. Check pulse rate for 30 seconds and multiply result by 2 C. Increase intake of sodium D. Take with food if nausea occurs

A. Contact provider if heart rate is less than 60/min

The patient is receiving hydralazine with isosorbide (BiDil) for heart failure. The nurse should monitor this patient for: A. Dizziness and rapid heart rate B. Bleeding C. Tingling or cramping in the legs D. Confusion and agitation

A. Dizziness and rapid heart rate Rationale : A. Hydralazine with isosorbide may cause hypotension with reflex tachycardia, resulting in dizziness and rapid heart rate. Options B,C,D are incorrect. Hydralazine with isosorbide does not cause confusion, agitation, bleeding, or tingling of the extremities. if this occurs other causes should be investigated.

Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which of the following adverse effects of this drug? (Select all that apply.) A. Hyperkalemia B. Hypocalcemia C. Cough D. Dizziness E. Heartburn

A. Hyperkalemia C. Cough D. Dizziness Rationale: Common adverse effects of lisinopril (Prinvil) and other ACE inhibitors include cough, headache, dizziness, change in sensation of taste, vomiting and diarrhea, and hypotension. Hyperkalemia may occur, especially when the drug is taken concurrently with potassium-sparing diuretics. Options 2 and 5 are incorrect. Hypercalcemia and heartburn are not adverse effects associated with the ACE inhibitors.

The patient has heart failure and receives digoxin (Lanoxin). Prior to discharge, what will the best teaching plan by the nurse include? A. "Report development of a metallic taste in the mouth." B. "Report mental changes such as depression." C. "Stop the medication if your pulse is irregular." D. "If you miss a dose, take two doses."

B. "Report mental changes such as depression." Rationale 1: Metallic taste is not associated with digoxin. Rationale 2: Depression may occur with this drug. Rationale 3: If the pulse is irregular, the patient should notify the physician and not stop the medication unless directed to do so. Rationale 4: Patients should not take a double dose; this is considered an overdose that could lead to toxicity.

Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in patients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs? A. They contain nitrates, resulting in an overdose. B. They also decrease blood pressure through vasodilation and may result in prolonged and server hypotension when combined with nitrates C. They will adequately treat the patient's angina as well as erectile dysfunction D. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used.

B. They also decrease blood pressure through vasodilation and may result in prolonged and server hypotension when combined with nitrates Rationale : Erectile dysfunction drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) decrease BP. When combined with nitrates, severe and prolonged hypotension may result.

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client as risk for digoxin toxicity? A. Phenytoin B. Verapamil C. Warfarin D. Aluminum hydroxide

B. Verapamil Rationale: CCBs can increase digoxin levels

The patient is prescribed digoxin (Lanoxin) for treatment of HF. Which of the following statements by the patient indicates the need for further teaching? A. "I may notice my heart rate decrease" B. "I may feel tired during early treatment" C. "This drug should cure my heart failure" D. "My energy level should gradually improve"

C. "This drug should cure my heart failure" Rationale: Digoxin helps increase the contractility of the heart, thus increasing cardiac output. But it is not a cure for HF, only a treatment option. Options 1, 2, and 4 are incorrect. The patient is correct that the heart rate will decrease with the use of digoxin, tiredness may be noted in early therapy until the HF has improved, and energy levels will gradually improve.

The nurse is caring for a patient with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide? A. Flushing and headache B. Tremors and anxiety C. Sleeping and lethargy D. Light-headedness and dizziness

D. Light-headedness and dizziness Rationale : Lightheadedness and dizziness may occur secondary to the hypotension effects of the isosorbide (Isordill)

A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? A. Furosemide B. Captopril C. Ranolazine D. Metoprolol

D. Metoprolol Rationale: Metoprolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris, and is often prescribed to decrease heart rate in clients who have tachycardia

The teaching plan for a patient receiving hydralazine (Apresoline) should include which of the following points? A. Returning for monthly urinalysis testing B. Including citrus fruits, melons, and vegetables in the diet C. Decreasing potassium-rich food in the diet D. Rising slowly to standing from a lying or sitting position

D. Rising slowly to standing from a lying or sitting position Rationale: Hydralazine (Apresoline) commonly causes orthostatic hypotension, and the patient should be taught to rise slowly from a lying or sitting position to standing. Options 1, 2, and 3 are incorrect. Hydralazine does not require monthly urinalysis testing. Potassium levels will be monitored along with other electrolytes, but the patient does not need to decrease the amount of potassium-rich foods in the diet, and a healthy balance of all foods is encouraged.