Hemodynamics
A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:
a. cardiac afterload.
b. cardiac preload.
c. myocardial contractility.
d. venous return.
c. myocardial contractility.
Beta1-adrenergic agents help increase the heart's stroke volume by increasing myocardial contractility. Cardiac afterload is determined primarily by the degree of peripheral resistance caused by constriction of arterioles; increasing afterload would decrease stroke volume. Beta1-adrenergic agents do not affect afterload. Cardiac preload is the amount of stretch applied to the cardiac muscle before contraction and is determined by the amount of venous return. Beta1-adrenergic agents do not affect cardiac preload. Venous return is determined by the systemic filling pressure and auxiliary muscle pumps and is not affected by beta1-adrenergic agents. When you hear beta1 think myocardial contractility
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?
a. Furosemide [Lasix]
b. Hydrochlorothiazide [HydroDIURIL]
c. Mannitol [Osmitrol]
d. Spironolactone [Aldactone]
ANS: A
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.
A patient with type 1 diabetes is taking insulin. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient?
a. Metoprolol has no effect on diabetes mellitus or on your insulin requirements.
b. Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose.
c. Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely.
d. Metoprolol may potentiate the effects of the insulin, so the dose should be reduced.
ANS: C
Because metoprolol may mask the signs of hypoglycemia, the patient should monitor the blood glucose closely and report changes to the prescriber. Metoprolol does have an indirect effect on diabetes mellitus and/or insulin requirements in that it may mask the signs of hypoglycemia, causing the patient to make a healthcare decision based on the drug-to-drug interaction rather than actual physiologic factors. The patient should not increase the insulin, because metoprolol will cause a decrease in blood glucose, increasing the risk of a hypoglycemic reaction. The patient should not reduce the dose of insulin when taking metoprolol, because this might alter serum glucose levels.
Although metoprolol tartrate is a selective β adrenergic blocker, this short‐acting agent has been reported to decrease insulin sensitivity. The main difference between metoprolol tartrate and metoprolol succinate is that metoprolol tartrate is only available as an immediate-release tablet which means it must be taken several times per day, whereas metoprolol succinate is an extended-release tablet that can be taken once a day. Antihypertensive therapy with a long‐acting, selective β‐blocking agent ER metoprolol had no effect on insulin sensitivity in diabetic.
Which of the following is a calcium channel blocker?
A. Lisinopril
B. Amlodipine
C. Metoprolol
B. Amlodipine
What is a common side effect of ACE inhibitors like lisinopril?
A. Dry cough
B. Constipation
C. Bradycardia
Correct: A. Dry cough
A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug?
a. Decreased stroke volume
b. Increased stroke volume
c. Decreased myocardial contractility
d. Increased myocardial contractility
ANS: A
Constriction of arterioles increases the load against which the heart must pump to eject blood. Increased constriction of arterioles would decrease, not increase, the stroke volume of the heart. Myocardial contractility is determined by the sympathetic nervous system, acting through beta1-adrenergic receptors in the myocardium.
11. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern?
a. Elevated creatinine clearance
b. Elevated serum potassium level
c. Normal blood glucose level
ANS: A
Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient's potassium level.
The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching?
a. I need to stop the medication if my heart rate increases.
b. I should not drive while taking this medication.
c. I should take the first dose at bedtime.
d. I will stop taking the medication if I feel dizzy.
ANS: C
Orthostatic hypotension is a common side effect of this class of drugs and is most severe with the first dose. Administering the first dose at bedtime eliminates the risk associated with this first-dose effect. Tachycardia is an expected side effect; if severe, it can be treated with other medications. Patients should not drive during the first 12 to 24 hours after taking these agents, because fainting and dizziness may occur, but they may drive after that. Dizziness is not an indication for stopping the drug; patients who experience dizziness are instructed to sit or lie down until symptoms pass.
A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching?
a. I may become constipated, so I should increase fluids and fiber.
b. I may experience a rapid heart rate as a result of taking this drug.
c. I may have swelling of my hands and feet, but this will subside.
d. I may need to increase my digoxin dose while taking this drug.
ANS: A
Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced.
Which lab value is most important to monitor with ACE-Is and ARBs?
A. Potassium
B. Sodium
C. Calcium
A. Potassium
A patient’s arterial pressure decreases after sedation. Which compensatory response would the nurse expect?
a. Decreased HR
b. Increased HR
c. Syncope
d. Decreased BP
Ans: B
When arterial pressure decreases, the vasoconstrictor center causes constriction of nearly all arterioles, leading to an increase in peripheral resistance (so BP would actually increase), constriction of veins, increasing venous return, and subsequent acceleration of the heart rate.
Which diuretic is potassium-sparing?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
C. Spironolactone
A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats/min, and the rhythm is regular. What action should the nurse take next?
a. Administer the drug as prescribed.
b. Request an order for atropine.
c. Withhold the dose and document the pulse rate.
d. Withhold the dose and notify the prescriber.
ANS: D
A beta blocker, such as propranolol, should not be given if the pulse is lower than 60 beats/min; therefore, the nurse should withhold the dose and notify the prescriber. Administering the dose as prescribed would not be appropriate, because the patient's pulse rate is too slow at this time. The dose should be withheld and the prescriber notified. The patient's heart rate is slow, and atropine may be necessary if the bradycardia persists, but the first step is to withhold the dose of propranolol. Withholding the dose and documenting the pulse rate is an appropriate but incomplete nursing intervention. The nurse must notify the prescriber to obtain further orders related to
22. A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:
a. AV blockade.
b. gingival hyperplasia.
c. migraine headaches.
d. reflex tachycardia.
ANS: A
Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia.
ACE inhibitors are renal-protective because they:
A. Decrease renal arteriole pressure
B. Increase renal vasoconstriction
C. Increase preload
A. Decrease renal arteriole pressure
Which parameter represents the amount of blood the heart pumps per minute?
A. Stroke Volume
B. Cardiac Output
C. Afterload
Correct: B. Cardiac Output
The nurse should monitor for hypokalemia in patients taking:
A. Spironolactone
B. Furosemide
C. ACE inhibitors
B. Furosemide
Which effect is expected from beta blockers?
A. Increased heart rate
B. Decreased contractility
C. Bronchodilation
B. Decreased contractility
Calcium channel blockers lower blood pressure by:
A. Increasing heart rate
B. Relaxing vascular smooth muscle
C. Constricting arterioles
B. Relaxing vascular smooth muscle
Which statement indicates understanding of ARB therapy?
A. “I should expect a dry cough.”
B. “This drug blocks angiotensin II receptors.”
C. “It increases sodium retention.”
Correct: B. “This drug blocks angiotensin II receptors.”
Which factor primarily determines afterload?
A. Venous return
B. Vascular resistance
C. Heart rate
Correct: B. Vascular resistance
The nurse should administer diuretics at what time of day?
A. Morning
B. Afternoon
C. Bedtime
A. Morning
Alpha blockers such as prazosin primarily cause vasodilation of the:
A. Arteries
B. Veins
C. Arteries and Veins
C. Arteries and Veins
Alpha-1 adrenergic receptors are located on both arterial and venous smooth muscle.
When you block these receptors (as with prazosin), you inhibit sympathetic-mediated vasoconstriction → vasodilation occurs in both vascular beds.
Arterial dilation → ↓ afterload (less resistance the heart pumps against)
Venous dilation → ↓ preload (less blood returning to the heart)
Combined effect → ↓ BP and possible first-dose orthostatic hypotension
A patient on nifedipine complains of swollen ankles. What causes this?
A. Fluid overload
B. Peripheral vasodilation
C. Heart failure
B. Peripheral vasodilation
Which drug should not be taken with ACE inhibitors?
A. NSAIDs
B. Beta blockers
C. Diuretics
A. NSAIDs