Cardiac Glycosides, Antidysrhythmics
A patient takes digoxin for heart failure. Which patient assessment should the nurse use to determine that therapy is effective?
a. Increased fatigue
b. Urine output 30 ml/hr
c. Regular heart rate of 55 beats/minute.
d. Increased appetite
What is a urine output 30 ml/hr?
Rationale: Digoxin improves cardiac output and circulation, which improves urine output. If digoxin is working appropriately, fatigue should decrease, not increase. Heart rate below 60 beats/minute may indicate digitalis toxicity. Digoxin may help patients feel better so they have an increased appetite, but it is the not the indicator the nurse would use to determine that therapy is effective.
What should concern the nurse when caring for a patient taking furosemide and digoxin?
a. The medications given together will significantly increase urine output.
b. The digoxin will decrease the effectiveness of furosemide.
c. These medications given together may lead to digitalis toxicity.
d. Digoxin levels should be increased when given with furosemide.
What is these medications given together may lead to digitalis toxicity?
Rationale: If the patient takes digoxin with a loop diuretic, digitalis toxicity can result. Loop diuretic may decrease potassium levels. Hypokalemia enhances the action of digoxin and increase the risk for digitalis toxcity.
What is the first method of control for an individual with pre-hypertension?
a. Place the patient on a low-dose diuretic.
b. Place the patient on a low-dose ACE inhibitor.
c. Place the patient on a lifestyle modification plan.
d. Place the patient on calcium channel blockers.
What is place the patient on a lifestyle modification plan?
Rationale: The first step in treating pre-hypertension is lifestyle changes.
Why is heparin such an effective anticoagulant?
a. It inhibits clotting factors II, III, and IV.
b. It inhibits the action of thrombin.
c. It promotes lysis of existing thrombi.
d. It promotes the conversion of fibrinogen to fibrin.
What is it inhibits the action of thrombin?
Rationale: Heparin inhibits the conversion of prothrombin to thrombin.
Which condition is an important adverse effect of HMG-CoA reductase inhibitors?
a. Migraines
b. Chest pain
c. Renal failure
d. Rhabdomyolysis
What is rhabdomyolysis?
Rationale: Rhabdomyolysis, which causes muscle aches or weakness, is a rare but important adverse effect of an HMG-CoA reductase inhibitor. This should be reported to the health care provider immediately, as muscle degeneration may become fatal.
Which medication is standard therapy for heart failure can result in impaired potassium excretion?
a. Loop diuretic
b. Cardiac glycoside
c. Angiotensin-II receptor blocker
d. Angiotensin-converting enzyme inhibitor
What is angiotensin-converting enzyme inhibitor?
Rationale: The potassium-retaining properties associated with ACE inhibitors necessitates closer monitoring of the serum potassium and patient teaching that includes avoiding potassium foods and notifying providers about all medications. Angiotensin-II receptor blockers may impact potassium excretion but not as much as ACE inhibitors. Loop diuretics will decrease potassium levels, not increase them. Cardiac glycosides will not impact potassium excretion.
Which mediation should the nurse question in a patient taking a potassium-sparing medication?
A. digoxin
B. lisinopril
C. furosemide
D. metoprolol
What is lisinopril?
Rationale: Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, should not be given with a postassium-sparing medication as it can cause a life-threatening increase in potassium.
Which ethnic group does not respond with the desired reduction in blood pressure to beta blockers?
a. African Americans
b. Native Americans
c. Hispanics
d. Asians
What is African Americans?
Rationale: African-American hypertensive patients do not respond with the desired reduction in blood pressure beta blockers alone for the control of hypertension. Instead, hypertension in the African-American population can be controlled by combining beta blockers with diuretics.
What is the best time frame for alteplase to be given following an acute myocardial infarction (AMI)?
a. Within 4 hours
b. Within 6 hours
c. Within 8 hours
d. Within 10 hours
What is within 4 hours of an AMI?
Rationale: Alteplase should be given within 4 hours to a patient following an AMI.
What test should be monitored in patients taking a statin?
a. Blood glucose levels
b. AST and ALT
c. BUN and Creatinine
d. Electrolytes
What is AST and ALT?
Rationale: Blood levels of cholesterol, triglycerides, AST, ALT, and creatine phosphokinase should be measured in a patient taking a statin.
What sodium channel blocker drug is only given for the treatment of ventricular dysrhythmias?
a. Verapamil
b. Quinidine
c. Propranolol
d. Lidocaine
What is lidocaine?
Rationale: Quinidine is the oldest class IA drug. It works by blocking sodium channels, delaying repolarization, and prolonging the QT interval. Lidocaine is a class 1B sodium channel blocker and is given for ventricular dysrhythmias. Propranolol is a class II and is used in the management of cardiac tachydysrhythmias such as atrial and ventricular tachycardia. Verapamil is a class IV calcium channel blocker that converts supraventricular tachycardia to a sinus rhythm.
What hormone is blocked by potassium-sparing diuretics?
a. antiduretic hormone
b. aldosterone
c. atrial natriuretic hormone
d. angiotensin
What is aldosterone?
Rationale: Aldosterone is a mineralocorticoid hormone that promotes sodium retention and potassium excretion. Postassium-sparing diuretics interfere withthe sodium-potassium pump controlled by the mineralocorticoid hormone aldosterone.
What may occur when a patient taking a beta blocker begins taking nonsteroidal antiinflammatory drugs (NSAIDS) for arthritis?
a. Decreased effect of the NSAIDS
b. Increased bleeding
c. Decreased effect of the beta blocker
d. Increased stomach irritation
b. What is decreased effect of the beta blocker?
Rationale: Taking beta blockers and NSAIDS together will lessen the impact of the beta blocker on decreasing blood pressure.
Matching
A heparin antagonist 1.vitamin K
A medication that breaks 2. alteplase down the clot directly
A warfarin sodium antagonist 3.protamine sulfate
What is 3., 2., 1.?
After initiating statin therapy, how long will it take for the treatment to be effective?
a. 2 to 4 weeks
b. 6 to 8 weeks
c. 2 to 4 months
d. 6 to 8 months
What is 2 to 4 months?
Rationale: Reduction of LDL cholesterol may be seen as early as 2 months after initiating therapy.
Which antidysrhythmic has the following side/adverse effects: nausea, vomiting, constipation, optic neuropathy, bradycardia, hypotension, blue-grey skin discoloration, and hallucinations?
a. Amiodarone
b. Procainamide
c. Propranolol
d. Verapamil
What is Amiodarone?
Ratonale: Take amiodarone with food or milk if GI symptoms occur. Report sensitivity to light, dizziness, syncope, or hallucinations to provider. Report pulse slower than 60 beats/min to provider. Be aware that skin discoloration may occur.
Which diuretic has the highest potential for ototoxicity?
a. hydrochlorothiazide
b. furosemide
c. spironolactone
d. mannitol
What is furosemide?
Rationale: Hearing impairment although rare, may occure with loop diuretics.
Which medication should be used with caution administering to a patient who has diabetes mellitus and hypertension?
a. ACE inhibitors
b. Calcium channel blockers
c. Potassium-sparing diuretics
d. Beta blockers
What is beta blockers?
Rationale: Beta blockers should be used with caution in individuals with diabetes may mask the early signs of hypoglycemia (rapid heart rate and tremor).
A patient had an orthopedic surgery and is prescribed enoxaparin. What would the nurse teach the patient and/or family members about this low-molecular-weight heparin before discharge?
a. Visual demonstration of intramuscular heparin administration is recommended.
b. Prothrombin time and international normalized ratio-monitoring will be done weekly.
c. Avoidance of green leafy vegtables is recommended.
d. Watch for bleeding or excessive bruising.
What is watch for bleeding or excessive bruising?
What should concern the nurse about a patient taking a fibrate and warfarin?
a. This combination will decrease the effects of warfarin.
b. This combination will increase bleeding and bruising.
c. The patient will experience a greater incidence of constipation.
d. This medication combination will increase the risk of liver failure.
What is this combination will increase bleeding and bruising?
Rationale: When a fibrate and warfarin are taken together, increased bleeding and bruising may occur.
A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (Select all that apply.)
a. Have the patient sit or lie down when taking a nitroglycerin sublingual tablet.
b. Teach the patient who has taken nitrolycerin to call 911 if chest pain persists.
c. Apply the nitroglycerin patch to a hairy area to protect skin from burning.
d. Call the health care provider after taking 5 tablets if chest pain persists.
e. Advise the patient not to drink water while taking nitroglycerin.
What is a.,b. and e.?
Rationale: Orothostatic hypotension, dizziness syncope can occur after taking. If pain does not subside, then 911 should be called after taking the first tablet, not HCP. Nitrogylcerin patch is applied to a relatively hairless area of the skin such as the upper arm.
The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorthiazide? (Select all that apply.)
a. Monitor patients for signs of hypoglycemia.
b. Administer ordered potassium supplements.
c. Assess blood pressure before administration.
d. Assess for decreased cholesterol and triglyceride levels.
e. Notify the health care provider if a patient has had oliguria for 24 hours.
What is b., c., and e.?
Rationale: Thiazide diuretics are used primarily for patients with normal renal function. Thiazides cause a loss of sodium, potassium, and magnesium, but they promote calcium reabsorption. Thiazides affect glucose tolerance, so hyperglycemia can also occur. They act directly on arterioles to cause vasodilation, which can lower blood pressure. Side effects include hyperlipidemia.
Which diuretic is most frequently prescribed for controlling hypertension by decreasing fluid volume?
a. Furosemide
b. Hydrochlorothiazide
c. Spironolactone
d. Bumetanide
What is hydrochlorothiazide?
Rationale: Hydrochlorothiazide is the most frequently prescribed diuretic for controlling mild hypertension by decreasing excess fluid volume. It can be used alone for recently diagnosed or mild hypertension, or it can be used with other antihypertensive drugs. Many antihypertensive drugs can cause fluid retention; therefore diuretics are often administered together with antihypertensive agents.
A patient is taking warfarin 5 mg/day for atrial fibrillation. The patient's international normalized ratio is 3.8. The nurse would consider the international normalized ratio to be what?
a. Within normal range
b. Elevated range
c. Low range
d. low-average range
What is elevated range?
Rationale: An INR between 2-3 is generally an effective therapeutic range for people taking warfarin.
A patient has a low-density lipoprotein of 175 mg/dL and a high-density lipoprotein of 30 mg/dL. what teaching should the nurse implement?
A. Discuss medications ordered, dietary changes, and exercise.
B. No changes in lifestyle are needed; continue with the current plan.
C. Discuss how to have fat intake be 40% of caloric intake.
D. Begin keeping a food diary and schedule laboratory work to be repeated in 6 months.
What is begin keeping a food diary and schedule laboratory work to be repeated in 6 months?
Rationale: Serum lab values: Cholesterol <200; triglycerides 40-150; LDL <100; HDL >40. total fat intake should be 30% or less. Non-drug therapy should be initiated to decrease cholesterol for 6 months.