Cardiovascular
Intravenous heparin therapy is prescribed for a client. While implementing, the nurse ensures that which of the following medications is available on the nursing unit?
a. Protamine sulfate
b. Potassium chloride
c. Aminocaproic acid (amicar)
d. Vitamin K
What is A? Protamine Sulfate
Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrahge should occur. Vitamin K is an antidote for warfarin sodium. Amniocaproic acid is the antidote for thrombolytic therapy. Potassium chloride is administered for a potassium diet.
Which medication is not a benzodiazepine?
a. alprazolam
b. buspirone
c. diazepam
d. lorazepam
What is b
Benzos end in either zolam or zepam
A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions?
A. "I should limit the use of the inhaler to early morning and bedtime use"
B."It is important to not shake the canister because that can damage the spray device."
C. "I should hold one nostril closed while I insert the spray into the other nostril"
D. "The inhaler tip is inserted into the nostril and pointed towards the inside nostril wall."
C. "I should hold one nostril closed while I insert the spray into the other nostril"
Rationale: When using an intranasal inhaler, it is important to close off one nostril while inhaling to ensure the best inhalation of the spray. Use of the inhaler is not limited to mornings and bedtime. The canister should be shaken immiediately before use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhalation of the medication.
A client with atrial fibrilation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving a therapeutic effect based on which of the following results?
a. Prothrombin time of 12.5 sec
b. activated partial thromboplastin time of 60 seconds
c. activated partial thromboplastin time of 28 seconds
d. activated partial thrombin time longer than 120 seconds
What is D? Activated partial thrombin time longer than 120 seconds
Rationale: PT is used to assess response to warfarin (Coumadin) therapy. Normal activated partial thromboplastin time should be 1.5-2.5 times normal value.
2) The client states to the nurse, “I take citalopram (Celexa) 40 mg every day as prescribed. I also been take St. John’s wort 750 mg daily for the past 2 weeks”. Which of the following indicate that the client is developing serotonin syndrome? Select all that apply.
1. confusion 2. restlessness 3. constipation 4. diaphoresis 5. ataxia
1,2,4,5
Rationale: Serotonin syndrome includes mental status changes such as confusion, restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps and hyperreflexia. Constipation is not associated with it.
A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply.
A. Operating machinery and driving may be dangerous when taking antihistamines.
B. Continue taking antihistamines even if nasal infection develops.
C. The effect of antihistamines is not felt until a day later.
D. Do not use alcohol with antihistamines
E. Increase fluid intake to 2,000ml/day
What is A,D,E
Antihistamines have an anticholinergic action and a drying effect. They reduce nasal, salivary, and lacrimal gland hypersecretions (runny nose, tearing, and itchy eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during use. The client should ensure adequate fluid intake of atleast 8 glasses per day due to the drying effect of this drug.
A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug?
A. Heal the ulcer
B. Protect the ulcer surface from acids
C. Reduce acid concentration
D. Limit gastric acid secretion
What is D. Limit gastric acid secretion
Rationale: Ranitidine is a Histamine-2 receptor antagonist, meaning that is reduces gastric acid secretion. Anti-secretory or proton-pump inhibitors such as Prilosec, help ulcers heal quickly in 4-8 weeks. Cytoprotective drugs such as Carafate protect the ulcer surface against acid, bile and pepsin. Antacids are responsible for reducing acid concentration and helping to reduce symptoms.
A 66-year-old client complaining of not feeling well is seen. The client is taking several meds for the control of heart disease and hypertension. These medications include atenolol, digoxin, and chlorothiazide. A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?
a. Dypsnea, edema, and palpitations
b. Chest pain, hypotension, and paresthesia
c. Double vision, loss of appetite, and nausea
d. Constipation, dry mouth, and sleep disorder
What is c? Double vision, loss of appetite, and nausea
These are early signs of toxicity. Additional signs of toxicity are bradycardia, difficulty reading, other visual alterations such as green and yellow vision or seeing spots or halos, confusion, vomiting, diarrhea, and decreased libido and impotence.
3) Which of the following comments indicates that a client understands the nurse’s teaching about sertraline (Zoloft)?
a. “Zoloft will probably cause me to gain weight”
b. “This medication can cause delayed ejaculations”
c. “Dry mouth is a permanent side effect of Zoloft”
d. “I can take my medicine with St. John’s wort”
What is b. “This medication can cause delayed ejaculations”
Rationale: Sertraline is an SSRI which can cause decreased libido and sexual dysfunction. SSRI’s do not cause weight gain, but can cause decreased appetite and weight loss. Dry mouth is a possible side effect, but is temporary. St. John’s wort should not be taken with SSRI's because it can cause serotonin syndrome.
The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving Isoniazid (INH) and Rifampin (Rifamate) for treatment of tuberculosis?
A. Take the medication with antacids
B. Double the dosage if a drug dose is missed
C. Increase intake of dairy products
D. Limit alcohol intake
D. Limit alcohol intake
Rationale: INH and Rifamate are hepatotoxic drugs. The client should be warned to limit the intake of alcohol during drug therapy. These drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after drug administration. The client should not double the dose due to potential toxicity. Clients taking these drugs should avoid foods rich in tyramine, such as cheese and dairy products, to avoid development of hypertension.
A client is being treated with procainamide (Procanbid) for cardiac dysrhytmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
a. Administer prescribed nitroglycerin tablets
b. Measure the heart rate on the rhythm strip
c. Obtain a 12-lead electrocardiogram immediately
d. Auscultate the client’s apical pulse and obtain a blood pressure
What is d. Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first.
A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?
A. Irregular heartbeat
B. Constipation
C. Pedal edema
D. Decreased pulse rate
A. Irregular heartbeat
Irregular heartbeats should be reported promptly to the PCP. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because it has an adrenergic effect on beta-adrengergic receptors in the heart. This adverse effect should be immediately reported to a provider. This medication is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.
5. The nurse is monitoring a client taking propanolol (Inderal). Which assessment data 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 mmHg followed by a blood pressure of 138/72
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
What is b. The development of audible expiratory wheezes
Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. Beta blockers may induce this reaction, particularly in clients with COPD, or asthma. Normal decreases in BP and HR are expected. Insomnia is a frequent mild side effect and should be monitored.
Which of the following therapeutic classes of drugs is used to treat tachycardia and angina in a client with pheochromocytoma?
a. Angiotensin- converting enzymes (ACE inhibitors)
b. Calcium channel blockers
c. Beta blockers
d. Diuretics
c. Beta blockers-
Rationale: A beta blocker is administered to block the cardiac-stimulating effects of epinephrine. ACE inhibitors and calcium channel blockers do not block sympathetic activity like beta blockers do and diuretics decrease fluid volume and peripheral resistance, not sympathetic activity.