Cardiovascular
Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures while implementing this prescription, 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
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.
1) After a period of of unsuccessful treatment with elavil (amitriptyline), a woman diagnosed with depression is switched to a MAOI. Which statement by the client indicates the client understands the side effects of MAOI?
a. “I need to increase my intake of sodium”
b. “I must refrain from strenuous exercise”
c. “I must refrain from eating aged cheese or yeast products”
d. “I should decrease my intake of foods containing sugar”
c.“I must refrain from eating aged cheese or red wine”-
Rationale: MAO inhibitor. Patients taking MAO inhibitors should avoid tyramine-rich foods which cause a negative reaction when mixed.
1) The client with Type 1 diabetes mellitus is taught to take (Humulin R) at 0700 each day. The client should be instructed that the GREATEST risk of hypoglycemia will occur at about what time?
a. 0900
b. 1100
c. 1300
d. 1400
Rationale: It is when it peaks
A person taking a statin med for high cholesterol should not take with grapefruit juice.
a. true
b. false
a. true
inhibits the CYP4A ( p450) and keep the med around too long.
Nitroglycerin is a potent:
a. vasoconstrictor
b. vasodialator
c. antihypertensive
d. antilipid
B. vasodialator
A client with atrial fibrillation 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
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 like my physician prescribed. I have also been taking 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.
2) A client has recently been diagnosed with type 2 diabetes mellitus and is to take Glucophage. When teaching the client about the drug, the nurse explains that tolbutamide is believed to lower the blood glucose level by which of the following actions?
a. Potentiating that action of insulin
b. Lowering the renal threshold of glucose
c. Stimulating insulin release from functioning beta cells in the pancreas
d. Combining with glucose to render it inert.
c. Stimulating insulin release from functioning beta cells in the pancreas.
Rationale: Glucophage is from the sulfonylurea group lower blood glucose by stimulating already functioning Beta cells in the pancreas to release insulin. In addition, these agents increase the number of insulin receptors in the body.
Bile sequestrants work by enhancing the LDL levels.
a. true
b. false
b. false
decrease LDL levels
A patient receiving potassium via IV , complains that is stings. What should you do?
a. stop the IV and change sites
b. call the provider
c. Slow the rate and/or add normal saline with it
d. increase the rate till the pain goes away
C. slow and possibly add normal saline
A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several meds for the control of heart disease and hypertension. These medications include atenolol, digoxin, and lasix. 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
c. Double vision, loss of appetite, and nausea
Rationale: 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 sexual dysfunction”
c. “Dry mouth is a permanent side effect of Zoloft”
d. “I can take my medicine with St. John’s wort”
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.
A patient taking metformin is going to have a CT with contrast dye today. When should he stop the med?
a. no need to stop medb. 48 hours after contrast
c. do not take the day of contrast
d. stop it 48 hours before contrast
c. stop the day of and do not start back up till 48 hours after
While taking antilipid meds a patient should have their liver enzyme levels monitored.
a. trueb. false
a. true
If a patient is on spirolactone ( aldactone) and they ask if they should be taking potassium supplements, you will say:
a. yes, it is crucial to take these supplements
b. no need to take because this is a potassium depleting med.
c. yes, if they do not take these supplements their heart could stop.
d. no need to take because this is a potassium sparing med.
D. it is potassium sparing
4. A client is being treated with lidocaine for a cardiac dysrhytmia. Following intravenous administration of the medication, the client complains of dizziness. What interventions 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
d. Signs of toxicity from lidocaineinclude confusion, dizziness, drowsiness, decreased urination, nausea, vomiting and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first.
4) The client with acute mania is prescribed 600 mg of lithium (lithium carbonate) PO TID. The physician also orders 200 mg of ibuprofen PO prn for pain. Which action should the nurse take?
a. administer the medication as ordered
b. question the physician about the order
c. Administer the ibuprofen, but not the lithium
d. Consult with the nursing supervisor before administering the medication
Rationale: The combination of both decrease the effects of lithium.
In drawing up lantus into the syringe, what should you consider?
a. it can mixed with any insulin
b. it can only be mixed with regular insulin
c. it can only be mixed with NPH
D. it should never have any other insulin mixed in the same syringe.
d. never mix with other insulin
A cholesterol level over 200 would always warrant starting a patient on a antilipid medication.
a. true
b. false
b. false
Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin (Nitro-Dur) patch?
A. "If you get chest pain, apply a second patch next to the first patch."
B. "If you get a headache, remove the patch for 4 hours and then reapply."
C. "Make sure to rub a lotion or cream on the skin before putting on a new patch."
D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder."
D. Prepare the site before applying
5. A nurse is monitoring a client who is 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
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.
5) The patient is taking an SSRI for one week and states it isn't helping. What do you do?
a. It must not be the right med for you.
b. It usually works in 2 days.
c. You must not be taking it correctly.
d. It takes anywhere from 4-6 weeks to see improvement.
Rationale: It takes a period of time to see the effects.
Prednisone can affect the blood sugar of a patient in which way?
a. makes blood sugar go down
b. makes blood sugar go up
c. does not have an affect on blood sugar
d. can make the blood sugar peak and valleyb. causes hyperglycemia
It is desired to have a LDL less than 100 and a HDL greater than 40.
a. true
b. false
a. true
The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload. What is preload?" Which statement by the nurse explains preload to this patient?
A. "It is the blood return to the heart."
B. "It is the oxygen demand of the heart."
C. "It is the pressure against which the heart must pump."
D. "It is dilation of arteries and veins throughout"
A. it is the blood return to the heart