Indications
Mechanism of Action
Adverse Effects
Patient education
Miscellaneous
100
What is the most common indication of Alpha1 Adrenergic Receptor Medications?
Vasoconstriction of Vessels
Because Alpha 1 receptors are located on the blood vessels and when the SNS is stimulated this causes vasoconstriction of the blood vessels
100
What is the mechanism of action of Cholinergic Antagonists?
Block the actions of acetylcholine in the Parasympathetic Nervous System.
Cardiac- small doses decrease heart rate, large doses increase heart rate
Respiratory- Decrease Bronchial secretions
CNS- Small doses: decrease muscle rigidity and large doses-drowsiness, disorientation and hallucinations
Eye- Dilated pupils
GI- Relaxation of smooth muscle, tone, GI Tract, Decrease intestinal and gastric secretions, motility and peristalsis
Genitourinary- Relaxed Detrusor Muscle, Increased constriction of internal sphincter
Glandular- Decreased Bronchial Secretions, salivation and sweating
100
What is the common adverse effect associated with ACE Inhibitors and the reason to switch to an ARB?
Cough, related to the increase of Bradykinin
100
A client is mowing his lawn on a hot Saturday afternoon and begins to have chest pain. He goes inside to sit down but continues to experience chest pain. When should he call 911?
If one sublingual nitroglycerin does not relieve the pain after 5 minutes call 911, take a second tablet and if no relief in 5 minutes take a third sublingal tablet
100
Describe the effect of when Beta- Adrenergic receptors effects of Inotropic, Chronotropic and Dromotropic stimulation.
Inotropic- Increases Contractility (Positive)
Chronotropic- Increase Heart Rate (Positive)
Dromotropic- Increase Conduction (Positive)
200
A client with hypertension is newly prescribed a beta-blocker. What is the main benefit of beta-blocker therapy?
Slow the Heart Rate and decrease contractility
Because they block beta 1 receptors in the heart and in the kidney, they block renal Beta1 receptors, causing a decrease in the release of renin. This decreases angiotensin-I-related vasoconstriction, as well as aldosterone-related fluid retention.
200
fA client asks the nurse how does the loop diuretic work?
A. The medication blocks re5absorption in the distal convoluted tubule.
B. Mechanism of action is unknown.
C. Replaces potassium for sodium in the Kidneys
D. Blocks reabsorption of sodium and chloride in the thick segment of the ascending limb of Henle's loop.
Blocks reabsorption of sodium and chloride in the thick segment of the ascending limb of Henle's loop.
200
A patient is starting Furosemide medication, the nurse will educate the patient regarding which adverse effects?
Hyponatremia, Hypochloremia, Hypokalemia, Hypotension, Ototoxicity, Hyperglycemia and Hyperuricemia
200
The nurse is educating a client who is newly prescribed a loop diuretic? What are priority teaching points to include?
2 pound weight gain in one day, 5 pound weight gain in one week. Report any Shortness of breath, Monitor blood pressure, Administer in the morning to avoid nocturia, educate on signs and symptoms of hypokalemia, educate pt to get up slowly.
200
What is the pathophysiology of Heart Failure and causes?
In adequate pumping / and or filling of the heart, unable to supply sufficient blood to meet the oxygen needs of tissues.
Causes include Hypertension, Coronary Artery Disease and Myocardial Infarction.
300
The nurse knows Adenosine therapy is used to treat which type of dysrhythmia?
Paroxysmal Supraventricular Tachycardia
Because it slows the conduction through the AV node.The slowing down of depolarization interrupts rhythms that have reentrant or circular conduction pathways in the heart
300
The nurse is educating clients with heart failure on how Digoxin works. The nurse knows the mechanism of Digoxin is what?
The mechanism of action for Digoxin in heart failure is due to increase in myocardial contractility creating a positive inotropic effect. (The heart muscle becomes too weak or stiff to pump properly, by increasing the contractility the heart is able to pump more efficiently.)
300
A patient who is on digoxin for heart failure, states they have been having vision issues and seeing a halo image. What does the nurse suspect?
Digoxin Toxicity
Other AE: includes vision changes, Brady/ Tachycardia, Headache, Fatigue, Nausea, Vomiting, Diarrhea, and Anorexia.
Drug level: 0.5 to 2 ng/ml
300
The nurse is providing education to a client on the Alpha Blocker Medication. What will the nurse involve in the teaching?
Stop medication if experiencing side effects
Able to continue to drink coffee and alcohol
Change positions slowly when getting up
Nausea, and urinary hesitancy are normal
Change positions slowly,
Should not stop medication abruptly, Avoid coffee and alcohol and nausea and urinary hesitancy are side effects.
300
There is a pre-operative order for an adult patient: Give Scopolamine, 0.7 mg IM. The medication is available in 0.4 mg/ml vials. How many milliliters will the nurse administer for this dose? Round answer using one decimal point.
1.8 ml
400
A client presents to the emergency department with shortness of breath, oxygen level at 86%, and reports some chest discomfort. Upon auscultation of the lungs the nurse hears coarse crackles and the x-ray shows fluid in the right and left lower lobes. The nurse anticipates which mediation to be ordered?
Bronchodilator
Diuretic
Adrenergic
Antianginal
Diuretic, because there is fluid in the lungs and the chest pain from the fluid is causing a heaviness or tight feeling.
Other medications will not help excrete fluid off.
400
What is the mechanism of action for Amiodarone and which dysrhythmias does it treat?
Prolongs action potential by prolonging repolarization and used for Vtach, Vfib, Atrial Fibrillation or Flutter
Amiodarone works on the electrical system of the heart by decreasing automaticity, slowing conduction through the AV node, ventricles, and Purkinje fibers, decreasing contractility, and dilating both coronary and peripheral blood vessels.
400
A client comes in for a follow-up visit and reports abdominal discomfort especially when they eat since staring the medication Bethanecol Medication (Cholinergic Agonist). The nurse knows this is an adverse effect from an interaction of which medication?
A. Carbamazepine
B. Ibuprofen
C. Rosuvastatin
D. Levothyroxine
Ibuprofen due to it is a NSAID and when combined with cholinergic agonist increases risk for gastric ulcers.
Use of Bethanecol-Increases bladder tone while relaxing the urinary sphincter.
400
A client with COPD comes into the clinic stating his respiratory medications have not been working. The nurse knows which medication action may be the cause?
A. Metoprolol
B. Atenolol
C. Carvediolol
D. Esmolol
Carvedilol because it is a nonselective cardio medication, will bind to beta 2 receptors in the lungs
The other medications are Cardio selective meaning they primarily affect beta receptors in the heart
400
Blood pressure is 208/ 110. The order reads: Give hydralazine 0.75mg/kg for Systolic blood pressure over 200. The client weighs 188 pounds. How much hydralazine will be given in mls? Available is 20mg/ml
3.2ml
Convert lbs to kg=85.4545454545
Multiply 0.75 x 85.4545454545=64.0909090909
Divide 64.0909090909 /20= 3.2ml
500
The nurse knows Phosphodiesterase inhibitors
(Milrinone) are indicated for short-term management in heart failure because of which effect?
Positive Inotropic effect (Increased contractility) and also causes a reduction in the force against which the heart must pump to eject its volume of blood from the inodilator effect
500
The nurse working in the ICU, received an order for mannitol. What is the mechanism of action?
Pulls water into the renal tubules and inhibits tubular resorption of water, creating rapid producing diuresis.
500
A patient is experiencing reflex tachycardia from a an antihypertensive medication. The nurse anticipates which medication to give?
A. Lisinopril
B. Beta Blocker
C. Dopamine
D. Digoxin
B. Beta Blocker
By lowering the blood pressure it causes this and combats it by giving a beta blocker.
500
The nurse is reviewing a clients medication list in regards to potential interactions with Amiodarone. Which medication causes concern?
A. Lithium
B. Tamsulosin
C. Warfarin
D. Ropinirole
Warfarin due to causes increase activity and increased INR levels.
500
Explain the Renin-Angiotenion-Aldosterone System in regards to how it affects Heart Failure
A decrease in cardiac output causes renal perfusion which begins the cycle where renin is secreted and converted to angiotensin 1 to angiotensin 2 which is a potent vasoconstrictor, increasing blood pressure and central venous pressure, there is release of aldosterone which retains water and sodium leading to fluid congestion, continuous activation of this system cause the signs and symptoms of heart failure.