Keep the Beat
A client is anxious before cardiac surgery and has a blood pressure of 168/94 mm Hg with a heart rate of 108 bpm. The provider orders Inderal (propranolol) IV to help control heart rate and blood pressure. Explain how this medication works to lower blood pressure and heart rate.
Propranolol (Inderal) blocks beta-adrenergic receptors in the heart, reducing the effects of epinephrine and norepinephrine. This slows the heart rate, decreases contractility, and lowers blood pressure by reducing cardiac workload.
Before a knee replacement surgery, the nurse administers an IV antibiotic to prevent infection at the incision site. This first-generation cephalosporin is commonly used for surgical prophylaxis and is effective against many gram-positive bacteria.
Cefazolin (Ancef)
This stool softener helps prevent straining without stimulating the bowel.
Docusate sodium (Colace)
A client arrives at the clinic with sudden, severe pain and swelling in the big toe joint. The provider prescribes a medication to relieve inflammation during an acute gout attack.
Colchicine (Colcrys)
An older adult with heart failure has fatigue, shortness of breath, and an irregular apical pulse. The nurse prepares to administer Lanoxin (digoxin). Explain how this medication works to improve cardiac output and slow the heart rate.
Digoxin increases the force of myocardial contraction (positive inotrope) and slows electrical conduction through the AV node, allowing more efficient filling and improved cardiac output. It also lowers heart rate by increasing vagal tone.
A client being treated for a urinary tract infection develops new-onset ankle pain, and the nurse suspects a possible adverse effect of this drug. This fluoroquinolone antibiotic is used for urinary and respiratory infections, but can cause tendon rupture.
Ciprofloxacin (Cipro)
This antiemetic blocks serotonin receptors to prevent nausea and vomiting.
Ondansetron (Zofran)
A client with rheumatoid arthritis is started on a medication that helps reduce joint pain and swelling by suppressing the immune response.
Methotrexate (Rheumatrex)
A client with heart failure is prescribed Aldactone (spironolactone) along with furosemide (Lasix). Describe the differences in how Aldactone and furosemide work, including their effects on potassium levels.
Furosemide (Lasix) is a loop diuretic that works in the loop of Henle to block sodium and water reabsorption. Causes potassium loss (hypokalemia risk). Provides rapid and strong diuresis to reduce fluid overload in heart failure.
Aldactone (spironolactone) is a potassium-sparing diuretic that works in the distal tubule by blocking aldosterone. Retains potassium and promotes mild fluid loss. Helps counteract potassium loss caused by furosemide while still reducing fluid volume.
A client with pneumocystis pneumonia is prescribed an antibiotic that requires increased fluid intake to prevent crystalluria. This sulfa drug is used to treat urinary and respiratory infections and should be taken with plenty of water.
Trimethoprim-sulfamethoxazole (Bactrim)
This medication is a proton pump inhibitor that reduces gastric acid production.
Pantoprazole (Protonix)
A client diagnosed with chronic hepatitis C begins combination antiviral therapy. The nurse educates the client that the medication helps prevent viral replication and is not effective when used alone.
Simeprevir (Olysio)
A client develops ventricular tachycardia after a myocardial infarction. The provider orders Cordarone (amiodarone) IV. Explain how this medication works to correct the arrhythmia.
Amiodarone prolongs the action potential and refractory period in cardiac tissue, slowing electrical conduction through the heart. This helps stabilize abnormal rhythms and prevents recurrent ventricular arrhythmias.
A client with community-acquired pneumonia is prescribed an antibiotic similar to ciprofloxacin but designed for respiratory infections. This fluoroquinolone antibiotic treats sinus and lung infections and should be given separately from antacids.
Levofloxacin (Levaquin)
This osmotic laxative helps reduce ammonia levels in hepatic encephalopathy.
Lactulose (Chronulac)
A client with acute asthma exacerbation is given an IV corticosteroid to reduce airway inflammation and improve breathing. This glucocorticoid is also used to treat cerebral edema and severe allergic reactions by suppressing the immune response.
Dexamethasone (Decadron)
A postoperative client following hip replacement is prescribed Lovenox (enoxaparin) 40 mg subcutaneously once daily. Explain how this medication works to prevent blood clots.
Enoxaparin enhances the activity of antithrombin III, which inhibits factor Xa and thrombin, preventing the formation of new clots. It’s a low molecular weight heparin that reduces the risk of deep vein thrombosis and pulmonary embolism.
A client is prescribed cefazolin (Ancef) before surgery to prevent infection. What common side effects should the nurse educate the client about?
Gastrointestinal: nausea, vomiting, diarrhea
Hypersensitivity: rash, itching, possible anaphylaxis
Rare: superinfections (e.g., C. difficile)
This resin exchanges sodium for potassium to treat hyperkalemia.
Sodium polystyrene sulfonate (Kayexalate)
A client with rheumatoid arthritis is started on a biologic injection that blocks tumor necrosis factor (TNF) to reduce joint inflammation and slow disease progression. The nurse teaches about infection risk with this therapy.
Etanercept (Enbrel)