Heart Meds <3
Which of the following patients would benefit from antiplatelet medications?
A. A patient with high blood pressure
B. A patient with a stent in a coronary artery
C. A patient with an allergy to aspirin
D. A patient with diabetes
B. A patient with a stent in a coronary artery.
Patients with coronary artery stents are at risk for clot formation at the stent site, so antiplatelet medications are used to prevent this and reduce the risk of a heart attack.
The provider orders Atropine 1 mg IV STAT. Vial is labeled 0.2 mg/ml. How many ml will you administer?
5 mL/dose
A patient is taking Digoxin. What medication on the patient’s medication list increases the patient’s risk of experiencing Digoxin toxicity?
A. Furosemide
B. Metformin
C. Nitroglycerin
D. Coumadin
A. Furosemide
Is a loop-diuretic and this medication wastes potassium. Remember hypokalemia (low potassium level) increases the risk of a patient developing Digoxin toxicity. Hypercalcemia (>10.2 mg/dL) and hypomagnesemia ( < 1.5 mg/dL)also increases Digoxin toxicity.
A 32-year-old pregnant woman (26 weeks gestation) with a history of hypothyroidism is on levothyroxine 150 mcg daily. At her prenatal visit, her TSH is 6.8 mU/L (High) and Free T4 is low. She reports fatigue, dry skin, and difficulty concentrating.
What is the most appropriate nursing action?
A. Increase her levothyroxine dose by 30-50% and recheck TSH in 4 weeks.
B. Advise her to stop levothyroxine to avoid fetal hyperthyroidism.
C. Switch her to a combination of levothyroxine and liothyronine (T3).
D. Administer IV levothyroxine immediately.
(A) Correct – Pregnancy increases thyroid hormone requirements, often by 30-50%, due to increased metabolism and estrogen-induced TBG (thyroxine-binding globulin) production. Levothyroxine doses should be adjusted immediately to prevent fetal cognitive impairment.
A 72-year-old patient with a history of heart failure, chronic kidney disease (CKD) stage 3, and atrial fibrillation is prescribed digoxin 0.125 mg daily and furosemide 40 mg daily.
During assessment, the nurse notes:
What is the best nursing action?
A. Administer digoxin and encourage potassium-rich foods.
B. Hold digoxin, notify the provider, and assess for toxicity.
C. Administer digoxin and document the findings.
D. Give furosemide and recheck potassium levels in 4 hours.
(B) Correct – Low potassium + impaired kidney function + bradycardia = HIGH digoxin toxicity risk. The nurse must hold the dose, assess for signs of toxicity (nausea, vision changes, arrhythmias), and notify the provider.
🔑 Key Takeaway: Hypokalemia + digoxin = TOXICITY RISK! Hold the dose if HR <60 bpm and assess for symptoms.
Antiarrhythmics can cause which of the following side effects? Select all that apply.
A. Bradycardia
B. Hypotension
C. New arrhythmias
D. Alteration of magnesium and/or potassium levels
E. Rash
F. Lung toxicity
All of the answers above are correct.
Doctor orders Dobutamine 4 mcg/kg/min IV infusion. The patient weighs 198 lb. You are supplied with a bag of Dobutamine that reads 250mg/250 ml. How many mL/hr will you administer?
21.6 mL/hour
What is the therapeutic range of the drug Digoxin?
A. 2-3.5 ng/mL
B. 0.1-2 ng/mL
C. 0.5-2 ng/mL
D. 3.5-5 ng/mL
C. A normal Digoxin level should be 0.5 – 2 ng/mL.
Any levels greater than 2 ng/mL is considered toxic.
A 28-year-old pregnant patient with newly diagnosed hypothyroidism is prescribed levothyroxine. Which of the following statements by the nurse demonstrates an appropriate understanding of levothyroxine therapy during pregnancy?
A. "Levothyroxine should be discontinued during pregnancy to avoid fetal harm."
B. "Your levothyroxine dosage may need to be increased, and your TSH levels should be monitored throughout pregnancy."
C. "Since hypothyroidism doesn’t affect pregnancy outcomes, treatment can be delayed until after delivery."
D. "Levothyroxine therapy should be replaced with an alternative medication to prevent maternal hyperthyroidism."
(B) Correct – Pregnancy increases thyroid hormone demands. Most pregnant patients with hypothyroidism require a higher dose of levothyroxine, and TSH levels should be monitored every 4 weeks during the first half of pregnancy to ensure proper thyroid function.
A 56-year-old patient with a DVT (deep vein thrombosis) is on IV heparin and is started on warfarin 5 mg daily. The nurse notes that the INR is 1.2 on day 3.
What is the best nursing action?
A. Stop heparin since warfarin is now started.
B. Continue heparin until INR is 2-3, then discontinue.
C. Increase warfarin to 10 mg for faster effect.
D. Give vitamin K to prevent warfarin complications.
(B) Correct – Heparin is continued until INR reaches 2-3, then discontinued, to prevent clotting.
A patient is prescribed Diltiazem for the treatment of a cardiac disorder. Which findings below would require the nurse to hold the ordered dose of Diltiazem and notify the physician for further orders? Select all that apply:
A. Blood pressure 158/98
B. EKG shows 3rd Degree Atrioventricular Block
C. EKG shows Atrial Fibrillation
D. Heart Rate 46 beats per minute
B. EKG shows 3rd Degree Atrioventricular Block
D. Heart Rate 46 beats per minute
Diltiazem is a calcium channel blocker that helps treat arrhythmias (supraventricular tachycardia and atrial fibrillation), hypertension, and angina. It is contraindicated if bradycardia or 2nd/3rd AV blocks occur.
Instructions on a vial of 1 g Doxil instructs to reconstitute with normal saline to make a concentration of 1 mg/ml. After reconstituting two vials, you would administer ___________ milliliters of the reconstituted drug to administer 500 mg ordered dose.
500 mL/dose
A 53-year-old male is admitted to the ER. The patient is a farmer and was out in a field spraying an insecticide that is an organophosphate agent. The patient is experiencing severe muscle tremors, drooling, and diaphoresis. The diagnosis is organophosphate poisoning. What medication below do you anticipate the physician to order for this patient?
A. Atropine
B. Glucagon
C. Physostigmine
D. Succimer
A. Atropine
A nurse is educating a patient about levothyroxine administration. Which statement by the patient indicates a need for further teaching?
A) “I will take my medication on an empty stomach every morning.”
B) “I should take my medication at the same time every day.”
C) “I can take my levothyroxine with my calcium supplement.”
D) “I will notify my doctor if I have palpitations or chest pain.”
C) “I can take my levothyroxine with my calcium supplement.”
Calcium supplements interfere with levothyroxine absorption and should be taken at least 4 hours apart.
A 40-year-old patient with major depressive disorder (MDD) resistant to SSRIs is prescribed phenelzine (Nardil), an MAOI.
Which meal choice should the nurse immediately question?
A. Grilled chicken with steamed rice
B. Spaghetti with tomato sauce
C. Pepperoni pizza with aged cheese
D. Scrambled eggs with toast
(C) Correct – Pepperoni, aged cheese, and processed meats contain tyramine, which can cause a hypertensive crisis with MAOIs.
🔑 Key Takeaway: Avoid tyramine-rich foods (aged cheese, wine, cured meats, beer, fermented foods) with MAOIs to prevent hypertensive crisis!
You're providing discharge instructions to a patient who will be taking a calcium channel blocker at home. Which statement by the patient demonstrates they did NOT understand the teaching instructions and needs re-education?
A. "I will follow a low-fat and high-fiber diet."
B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice."
C. "This medication can enlarge my gums so I will maintain good oral hygiene.”
D. "I will monitor my blood pressure regularly because this medication can cause low blood pressure."
B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice."
The patient should AVOID grapefruit juice while taking CCBs because this could lead to an increase in drug levels.
Physician's order says "Infuse Regular Insulin at 4 units/hr". You're supplied with an IV bag of the prescribed medication that reads "100 units per 100 mL". How many hours will it take for this IV bag to infuse?
25 hours
Your patient who is taking a statin develops yellowing of the skin, abdominal pain in the right upper quadrant, and nausea. What lab result(s) below correlates with this finding? Select All That Apply:
A. Elevated ALT and AST level
B. Elevated BUN and creatinine
C. Decreased WBC
D. Decreased Hbg
A. Elevated ALT and AST level
Liver injury is a risk with statins. Therefore, a liver functions test (LFTs) should be ordered to assess the liver’s function. The patient is presenting with signs and symptoms of liver injury. An elevated ALT and AST level would correlate with these presenting signs and symptoms.
Which patient statement indicates correct understanding of levothyroxine therapy?
A) “I will stop taking this medication when my thyroid function normalizes.”
B) “I need to avoid grapefruit juice because it can delay absorption.”
C) “I should take this medication with food to prevent nausea.”
D) “If I feel anxious and have tremors, I should just wait a few weeks for my body to adjust.”
B) “I need to avoid grapefruit juice because it can delay absorption.”
Grapefruit juice may delay the absorption of levothyroxine. The medication is a lifelong treatment and should be taken on an empty stomach. Signs of overdose, such as tremors and anxiety, should be reported immediately.
A Type 1 diabetic patient receives lispro insulin (Humalog) 10 units subcutaneously at 0800 and then starts refusing breakfast.
What is the priority action?
A. Encourage the patient to eat and monitor blood glucose closely.
B. Administer IV dextrose to prevent hypoglycemia.
C. Administer regular insulin instead.
D. Skip the meal and recheck glucose in 3 hours.
(A) Correct – Lispro is rapid-acting (peaks in 30-90 min). If the patient refuses food, hypoglycemia is likely. Encourage eating or provide a glucose source (carb).
You're developing a plan of care for a patient with fluid volume overload related to heart failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing interventions will you include in the patient's plan of care? Select all that apply:
A. Perform and assess daily weights.
B. Educate the patient about consuming a low potassium diet.
C. Strict measuring of the patient's daily intake and output.
D. Encourage the patient to drink 2 L of fluids per day.
E. Assess lung sounds every shift.
A, C, and E. The patient with heart failure exacerbation can experience fluid volume overload because the heart is failing to pump blood forward. This causes blood to backflow into the lungs causing pulmonary edema and respiratory distress. It can also cause edema in the extremities. A loop diuretic will help remove this extra fluid by altering the way the kidneys reabsorb sodium and water. The nurse should monitor the patient for dehydration, effectiveness of the medication (decrease in edema, clear lung fields), electrolyte imbalances, and measuring intake and output. Therefore daily weights, measuring I and O’s, and assessing lungs sounds are the answers.
The healthcare provider ordered 500 mL of IV fluids to be infused at a rate of 150 mL/hr. The IV tubing set has a drop factor of 20 gtts/mL. You started the infusion at 0700 on 8/10. Determine the flow rate (gtts/min), and how long it will take for the infusion to complete?
50 gtts/min; 3 hours and 20 minutes
Select ALL the statements below that are INCORRECT about Benzodiazepines?
A. “Benzodiazepines are CNS stimulants.”
B. “Benzodiazepines provide the most therapeutic and safest effects when prescribed with opioids.”
C. “Benzodiazepines can be used to treat seizures.”
D. “Narcan is the antidote used to reverse toxicity caused by Benzodiazepines.”
A, B, and D.
Benzodiazepines are CNS depressants, they should NOT be used with opioids (the FDA has issued a black box warning on this due to the increased risk of overdose), and Flumazenil is the antidote for Benzodiazepines.
A nurse is providing education to a patient newly prescribed levothyroxine for hypothyroidism. Which of the following statements indicate that further teaching is needed? (Select all that apply.)
A. "I can take my levothyroxine with breakfast to help me remember to take it every day."
B. "If I start feeling better, I can stop taking my medication."
C. "If I forget to take my dose in the morning, I can double up the next day to catch up."
D. "I should take my medication at the same time each day, preferably on an empty stomach."
E. "Since I have diabetes, I need to closely monitor my blood sugar levels while taking this medication."
F. "I should report any symptoms of chest pain or palpitations to my healthcare provider immediately."
*(B) Correct – Hypothyroidism is a lifelong condition requiring continuous medication. Stopping the drug without provider guidance can lead to severe complications, including myxedema coma.
*(C) Correct – Doubling up on doses is unsafe and can lead to symptoms of hyperthyroidism, such as tachycardia, palpitations, and arrhythmias. If a dose is missed, the patient should take it as soon as possible but never take extra doses.
(A) Incorrect – Levothyroxine should be taken on an empty stomach, at least 30-60 minutes before breakfast, to enhance absorption. Taking it with food can decrease absorption.
(D) Incorrect – Levothyroxine should be taken at the same time every day, preferably in the morning before food, to maintain consistent hormone levels.
(E) Incorrect – Levothyroxine can alter glucose metabolism, and patients with diabetes should monitor blood sugar levels, but this statement does not indicate a misunderstanding.
(F) Incorrect – Chest pain, palpitations, and other cardiovascular symptoms could indicate levothyroxine overdose or cardiac complications. Reporting these symptoms is appropriate.
A 50-year-old patient with a history of hypertension, asthma, and diabetes is prescribed propranolol (Inderal) 40 mg BID for BP control.
Which assessment finding would require immediate intervention?
A. BP of 135/82 mmHg
B. HR of 68 bpm
C. Audible wheezing and dyspnea
D. Fasting blood sugar of 150 mg/dL
**(C) Correct – Propranolol is a non-selective beta-blocker that can trigger bronchospasms in asthmatic patients. This is an EMERGENCY!
🔑 Key Takeaway: NEVER give non-selective beta-blockers (propranolol, nadolol) to asthma patients due to the risk of fatal bronchospasm.