Saunders: Pharmacology/Cardiovascular

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

Vital signs

A child is being sent home on digoxin (Lanoxin) 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."

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 (Lanoxin). Which statement by the mother indicates a need for further teaching?

"I can mix the medication with food."

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

"I can skip a dose once a week."

A client is being discharged home, and the health care provider has prescribed spironolactone (Aldactone) 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."

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

"I need to notify the health care provider if nausea occurs."

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 (Lanoxin) and hydrochlorothiazide (HCTZ) prescribed for daily use. Which statement by the client indicates that a need for further teaching is needed?

"I should decrease my intake of foods high in potassium, such as bananas."

A client is being discharged to home following recovery from an anterior myocardial infarction with recurrent angina. The client will be taking diltiazem (Cardizem), isosorbide dinitrate (Isordil), and nitroglycerin (Nitrostat) 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."

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

"I will weigh myself every day."

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

"I'll continue my nicotinic acid from the health food store."

A client is on nicotinic acid (niacin) 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 (Motrin IB) taken 30 minutes before the nicotinic acid should decrease the flushing."

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."

The nurse is reinforcing discharge teaching to the client who was given a prescription for nifedipine (Adalat) 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."

The nurse is monitoring a client receiving furosemide (Lasix) 40 mg orally daily. Which should indicate to the nurse that a therapeutic effect has occurred?

A blood pressure of 128/80 mm Hg

A client reports to the clinic for follow-up after a 1-month treatment with acebutolol (Sectral). 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

The nurse is monitoring a client receiving spironolactone (Aldactone) 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

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

Acetylsalicylic acid (aspirin)

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

The nurse prepares to administer digoxin (Lanoxin) 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.

The nurse is caring for a client with chronic heart failure who is taking digoxin (Lanoxin) 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.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium (Coumadin). 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.

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 (Tenormin)

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

Audible expiratory wheezes

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

Avoid taking products containing acetylsalicylic acid (aspirin).

A client is being treated for heart failure and is receiving digoxin (Lanoxin). The client's vital signs are blood pressure 85/50 mm Hg, pulse 96 beats per minute, 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

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

Blood pressure and heart rate

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

Blood pressure declines.

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

A client with heart failure who is taking furosemide (Lasix) and digoxin (Lanoxin) 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.

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

Citrus fruits

Vasopressin (Pitressin) 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

A client has taken his first dose of lisinopril (Zestril) 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.

Thrombolytic therapy is being administered to a client following an acute inferior myocardial infarction. Which goal should the nurse plan for the client taking this medication?

Dissolve the thrombus.

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 (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which assessment data supports this diagnosis?

Double vision, loss of appetite, and nausea

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

A client taking an aldosterone antagonist known as eplerenone (Inspra) 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

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 (Lasix)

A child with a right-to-left cardiac shunt is receiving propranolol (Inderal-LA). 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

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

Heart failure

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

I can stop taking the prescribed digoxin (Lanoxin) after starting this new medication."

A client who has begun taking fosinopril (Monopril) 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.

Warfarin sodium (Coumadin) is prescribed for a client. The nurse expects that the health care provider will prescribe which laboratory test to monitor for a therapeutic effect of the medication?

International Normalized Ratio (INR)

The nurse has a prescription to give a client a scheduled dose of digoxin (Lanoxin). 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

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) 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

A client is being discharged with a prescription for propranolol (Inderal). 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.

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

Monitor for signs of bleeding.

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

Muscle pain and weakness

A client receiving total parenteral nutrition (PN) has a history of heart failure. The health care provider has prescribed furosemide (Lasix) 40 mg orally daily to prevent fluid overload. The nurse should monitor which laboratory value to identify an adverse effect from this medication?

Potassium

The nurse is preparing to administer furosemide (Lasix) 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

A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem) for several months. The client is seen by the health care provider, and Prinzmetal's angina is diagnosed. The nurse planning care for the client understands that which action of the medication will provide a therapeutic effect for this new diagnosis?

Prevents influx of calcium ions in vascular smooth muscle

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

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.

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

Spinach

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 (Aldactone)

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

Sulfa drugs

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

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

Takes the client's blood pressure

A 1-year-old child has been prescribed digoxin (Lanoxin) 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.

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

The development of audible expiratory wheezes

The nurse is scheduled to administer a dose of digoxin (Lanoxin) 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.

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

Weight

The nurse has completed client teaching about heart failure and prescribed medications that include digoxin (Lanoxin) and furosemide (Lasix). 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

A health care provider (HCP) writes a prescription for digoxin (Lanoxin), 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.

The nurse is caring for a client who is taking metoprolol (Lopressor). 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.

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

The nursing student demonstrates understanding of the pathophysiology of reflex tachycardia in the client taking an antihypertensive medication by making which statement?

"When blood pressure begins to decrease, the heart responds with tachycardia as a compensatory mechanism to raise the blood pressure."

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

Beef

A client with myocardial infarction is a candidate for alteplase (Activase) 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

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

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

Blood pressure

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

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

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

Decrease in blood pressure

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?"

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

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

A client who has developed atrial fibrillation that is not responding to medication therapy has begun taking warfarin (Coumadin). 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

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

The nurse is reviewing laboratory results of a digoxin level for the client taking digoxin (Lanoxin). Which laboratory result would warrant health care provider notification immediately?

2.5 ng/mL

A client receiving nifedipine (Procardia) for angina complains of feeling listless, with generalized weakness and no energy. The nurse recognizes that which statement is true in regard to these symptoms?

These symptoms are expected effects of the medication.

A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. 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 diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic.

A client with chronic atrial fibrillation is being started on amiodarone (Cordarone) 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."

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

"This medication will decrease my blood glucose.

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

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

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

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

-Visual disturbances -Nausea and vomiting -Serum digoxin level of 2.3 ng/mL

A client is being discharged from the hospital on warfarin (Coumadin) 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.

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

Anorexia

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

Apical pulse rate

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

Bananas

The nurse is preparing to administer digoxin (Lanoxin), 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

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

Hypokalemia, hyperglycemia, sulfa allergy

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

"I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

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

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

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

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

Nitroglycerin (Nitrostat)