The key to my constricted little heart <3
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?
A. Complaints of insomnia
B. Audible expiratory wheezes
C. Blood pressure of 136/84 from 162/90 mm Hg
D. Heart rate of 86 beats per minute decreased to 78
B. Audible expiratory wheezes
Propranolol is a beta blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. A normal decrease in blood pressure and heart rate is expected. Insomnia is a frequent mild side effect and should continue to be monitored.
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?
A. Ask the client when the hoarseness first developed.
B. Determine the client's ability to breathe effectively.
C. Determine the client's blood pressure to determine effectiveness.
D. Instruct the client to stay in the resting position to prevent dizziness.
B. Determine the client's ability to breathe effectively.
The client is experiencing angioedema, an adverse effect of the medication, which involves facial swelling and hoarseness. Assessing the ability to breathe effectively takes priority over assessing the blood pressure, preventing dizziness, or determining how long the client has been hoarse.
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?
A. 0.5 ng/mL
B. 0.9 ng/mL
C. 1.4 ng/mL
D. 2.5 ng/mL
D. 2.5 ng/mL
Digoxin has a narrow therapeutic range. The therapeutic range is 0.5 to 2 ng/mL. Drug levels higher than therapeutic level greatly increase the risk of toxicity. The results noted in options 1, 2, and 3 are within therapeutic range.
The nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which should the nurse recognize as potential adverse effects? Select all that apply.
A. Nausea
B. Tinnitus
C. Hypotension
D. Hypokalemia
E. Photosensitivity
F. Increased urinary frequency
B. Tinnitus
C. Hypotension
D. Hypokalemia
Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.
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?
A. Sodium level
B. Glucose level
C. Blood urea nitrogen
D. White blood cell count
B. Glucose level
Propranolol, a beta blocker, is used in the palliative treatment of hypercyanotic episodes. It can cause hypoglycemia if administered in a child who is NPO or hypovolemic. The nurse should monitor glucose levels every 4 to 6 hours if the child is NPO or hypovolemic and receiving propranolol. The health care provider should be notified if the glucose level is less than 60 mg/dL. The laboratory tests noted in options 1, 3, and 4 are not related to the administration of this medication.
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?
A. Temperature
B. Respirations
C. Blood pressure
D. Radial pulse rate
C. Blood pressure
Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse should check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations, apical pulse and temperature may be checked, these vital signs are not the most important assessments related to administration of this medication.
Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply:*
A. Inactivates bradykinin by breaking it down
B. Dilates vessels
C. Causes the kidneys to keep sodium and water
D. Converts Angiotensin I to Angiotensin II
A and D
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?
A. Heart rate
B. Temperature
C. Respirations
D. Blood pressure
A. Heart rate
Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.
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?
A. Monitoring weight loss
B. Monitoring temperature
C. Monitoring blood pressure
D. Monitoring potassium level
C. Monitoring blood pressure
Bumetanide is a loop diuretic. Hypotension is a common side effect associated with the use of this medication. The other options also require assessment but are not the priority.
Atenolol hydrochloride (Tenormin) is prescribed for a hospitalized client. The nurse should perform which as a priority action before administering the medication?
A. Listen to the client's lung sounds.
B. Check the client's blood pressure.
C. Check the recent electrolyte levels.
D. Assess the client for muscle weakness.
B. Check the client's blood pressure.
Atenolol hydrochloride is a beta blocker used to treat hypertension. Therefore, the priority nursing action before administration of the medication is to check the client's blood pressure. The nurse also checks the client's apical heart rate. If the systolic blood pressure is below 90 mm Hg or the apical pulse is 60 beats per minute or lower, the medication is withheld and the registered nurse and/or health care provider is notified. The nurse should check baseline renal and liver function tests. The medication may cause weakness, and the nurse should assist the client with activities if weakness occurs.
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?
A. The development of complaints of insomnia
B. The development of audible expiratory wheezes
C. A baseline blood pressure of 150/80 mm Hg, followed by a blood pressure of 138/72 mm Hg after two doses of the medication
D. A baseline resting heart rate of 88 beats/min, followed by a resting heart rate of 72 beats/min after two doses of the medication
B. The development of audible expiratory wheezes
Audible expiratory wheezes may indicate a serious adverse reaction: bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
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?
A. Tell the client not to take the medication with food.
B. Suggest that the client taper the dose until taste returns to normal.
C. Inform the client that impaired taste is expected and generally disappears in 2 to 3 months.
D. Tell the client that a request will be made to the health care provider (HCP) to change the prescription.
C. Inform the client that impaired taste is expected and generally disappears in 2 to 3 months.
ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval, and the medication should never be stopped abruptly.
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?
A. "You may give the medication using a medication dropper."
B. "Give the medication in the morning 20 to 30 minutes before a feeding."
C. "If your child vomits the dose, repeat the dose and then resume the schedule in the morning."
D. "If you forget to give the medication in the morning, omit the dose and resume it the following morning."
B. "Give the medication in the morning 20 to 30 minutes before a feeding."
Digoxin should be given in the morning before a feeding so that a parent can get in the routine of administering the medication. The medication must be accurately measured and drawn up in a syringe, never measured in a dropper. If the dose is vomited, it is skipped that day and the dose is resumed the next day. If the medication is forgotten in the morning, it is given as soon as remembered that day.
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?
A. Potassium level
B. Creatinine level
C. Cholesterol level
D. Blood urea nitrogen (BUN)
A. Potassium level
Furosemide is a loop diuretic. The medication causes a decrease in the client's electrolytes, especially potassium, sodium, and chloride. Administering furosemide to a client with a low potassium level could precipitate ventricular dysrhythmias. The options of BUN and creatinine reflect renal function. The cholesterol level is unrelated to the administration of this medication.
A client is being treated with atenolol (Tenormin) for hypertension. The client tells the nurse, "I am very tired and weak since I began taking the medication." Based on the client's statement, the nurse determines that the client is experiencing which problem?
A. Common side effect
B. Signs and symptoms of the flu
C. Difficulty with clearing the airway
D. Lack of support services for assistance at home
A. Common side effect
Atenolol is a beta blocker that causes a decreased heart rate and blood pressure and a decrease in cardiac output; this results in fatigue and weakness as common side effects. If this interferes with the client's activity level, the dosage can be adjusted to eliminate these side effects. There are no data in the question that indicate that the remaining options are correct.
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.
A. Angina
B. Glaucoma
C. Hypertension
D. Dysrhythmias
E. Acute kidney injury
F. Glomerulonephritis
A. Angina
C. Hypertension
D. Dysrhythmias
Calcium-channel blockers are medications that prevent calcium ions from entering cells. These agents have their greatest effects on the heart and blood vessels. They are used widely to treat hypertension, angina pectoris, and cardiac dysrhythmias. They are not used to treat glaucoma, acute kidney injury, or glomerulonephritis.
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?
A. "There must be some mistake; I will check the medication prescriptions."
B. "The medication causes relaxation in your arteries and veins and decreases the heart's work."
C. "The medication makes your heart beat faster, and this improves blood flow to your tissues."
D. "An additional medication will be added to the ACE inhibitor to strengthen your heart muscle."
B. "The medication causes relaxation in your arteries and veins and decreases the heart's work."
ACE inhibitors produce multiple benefits in heart failure. By lowering arteriolar tone, these medications improve regional blood flow, and by reducing cardiac afterload, they increase cardiac output. By causing venous dilation, they reduce pulmonary congestion and peripheral edema. By dilating blood vessels in the kidney, they increase renal blood flow and thereby promote excretion of sodium and water. This loss of fluid has two beneficial effects: (1) it helps reduce edema and (2) by lowering blood volume, it decreases venous return to the heart, thereby reducing right-heart size. Also by suppressing aldosterone and by reducing local production of angiotensin II in the heart, ACE inhibitors may prevent or reverse pathological changes in cardiac structure. Therefore, options 1, 3, and 4 are incorrect.
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?
A. "I can mix the medication with food."
B. "I need to take the child's pulse before administering the medication."
C. "If more than one dose is missed, I need to call the health care provider."
D. "If the child vomits after the medication is given, I should not repeat the dose."
A. "I can mix the medication with food."
Medication should not be mixed with food because this method of administration would not ensure that the child received the prescribed dose. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. In addition, the parents should be instructed that if a dose is missed and it is not identified until 4 or more hours later, the dose should not be administered. If more than one dose is missed, the health care provider needs to be notified.
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?
A. Count the radial and carotid pulses every morning.
B. Check the blood pressure every morning and evening.
C. Stop taking the medication if the pulse is higher than 100 beats per minute.
D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.
D. Withhold the medication and call the HCP if the pulse is less than 60 beats per minute.
An important component of taking this medication is monitoring the pulse rate; however, it is not necessary for the client to take both the radial and carotid pulses. It is not necessary for the client to check the blood pressure every morning and evening because the medication does not directly affect blood pressure. It is most important for the client to know the guidelines related to withholding the medication and calling the HCP. The client should not stop taking a medication.
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?
A. "I will take the dose at the same time each day."
B. "I will avoid sudden discontinuation of this medication."
C. "I will take the medication with food if GI upset occurs."
D. I can stop taking the prescribed digoxin (Lanoxin) after starting this new medication."
D. I can stop taking the prescribed digoxin (Lanoxin) after starting this new medication."
Medication-specific teaching points for atenolol (Tenormin) include taking the medication exactly as prescribed, not abruptly discontinuing the medication, taking the medication with food if GI upset occurs, wearing a Medic-Alert bracelet or tag, and having periodic checks of heart rhythm and blood counts.
The nurse should question a prescription for a calcium channel blocker in a patient with which condition?
A. Dysrhythmia
B. Hypotension
C. Angina pectoris
D. Increased intracranial pressure
B.
Calcium channel blockers cause smooth muscle vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.
A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply:*
A. Decreases SVR (systemic vascular resistance) and blood pressure
B. Constriction of the vessels
C. Kidneys will excrete water and sodium
D. Kidneys will retain potassium.
E. Increases SVR (systemic vascular resistance) and blood pressure
A, C, and D.
What type of drug is Digitalis?
Belonging to a group of drugs called cardiac glycosides, digitalis is most commonly used to restore adequate circulation in patients with congestive heart failure, particularly as caused by atherosclerosis or hypertension.
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?
A. Weight
B. Radial pulse
C. Hemoglobin
D. Serum creatinine clearance
A. Weight
Daily weight should be monitored because this reflects the fluid status of the client who is receiving a diuretic. Option 2 is a general assessment and does not relate directly to fluid balance. Options 3 and 4 are laboratory measurements that are not prescribed routinely by the nurse and would not be done on a daily basis in a long-term care facility.
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?
A. Ferrous sulfate
B. Atenolol (Tenormin)
C. Cyclobenzaprine (Flexeril)
D. Conjugated estrogen (Premarin)
B. Atenolol (Tenormin)
Atenolol is a beta blocker. Beta blockers should not be stopped abruptly, and the health care provider should be contacted about the administration of this medication before surgery. If a beta blocker is stopped abruptly, the myocardial need for oxygen is increased. Cyclobenzaprine is a skeletal muscle relaxant. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Conjugated estrogen is an estrogen used for hormonal replacement therapy in postmenopausal women. The other three medications may be withheld before surgery without undue effects on the client.