Chp 39
A patient has been prescribed an antiarrhythmic drug for cardiac arrhythmia. Which of the following possible adverse effects of the drug should the nurse inform the patient about?
1) Hypertension
2) Insomnia
3) Lightheadedness
4) Urinary frequency
Ans 3
Lightheadedness is a possible adverse effect seen with antiarrhythmic drug therapy. Other adverse effects include hypotension, somnolence, and urinary retention.
A client arrives at an urgent care center com-
plaining of dyspnea and a hacking cough. The
nurse assessing the client notes that there are
distended jugular veins, edema of the extrem-
ities, and reduced ejection fraction. Which of
the following conditions do these symptoms
indicate?
1. Heart failure
2. Glomerulonephritis
3. Pulmonary disease
4. Hypothyroidism
Answer: 1
RATIONALE:
These signs and symptoms indicate that the client is experiencing heart failure. The symptoms of heart failure are cough, dyspnea, weakness, anorexia, and unusual fatigue. The signs of heart failure include pitting edema and distended jugular veins. There is also a reduced ejection fraction.
A nurse is caring for a client taking antiplatelet drugs. What instruction should the nurse include in the teaching plan for this client?
1. Use a soft toothbrush
2. Take foods low in vitamin K
3. Take medication with food
4. Take the drug at a different time each day
Answer: 1
RATIONALE:
The nurse should instruct the client to use a soft toothbrush, and to consult a dentist regarding routine oral hygiene, including the use of dental floss.
A client has been admitted to an urgent care
facility for the treatment of severe acute
angina. A nurse is administering sublingual
nitroglycerin to the client every 5 minutes.
After administrating how many doses of
nitroglycerin should the nurse report to the
primary health care provider if there has
been no improvement?
1. 3 doses in a 15-minute period
2. 5 doses in a 30-minute period
3. 7 doses in a 30-minute period
4. 9 doses in a 60-minute period
Answer: 1
RATIONALE:
The nurse should administer three doses of sublingual nitroglycerin in a 15-minute period. If the pain worsens or if there is no improvement in the pain, the primary health care provider should be notifed. In such cases, a change of dosage or alternate drug therapy may be required.
A client with diabetes mellitus and hypertension is on insulin and enalapril for hypertension. Which of the following risks would occur with the combined administration of both drugs?
1. Increased risk of hypersensitivity reaction
2. Increased risk of electrolyte imbalance
3. Increased risk of hypoglycemia
4. Increased risk of hypotensive effect
Answer: 3
RATIONALE: An increased risk of hypoglycemia
occurs with the combined use of insulin and ACEI
drugs like enalapril
A nurse is required to monitor the vitals signs of a patient with paroxysmal atrial tachycardia who is on an antiarrhythmic agent. Which of the following pulse rates should the nurse report immediately to the primary health care provider?
1) 82 bpm
2) 92 bpm
3) 102 bpm
4) 142 bpm
Ans 4
The nurse should notify the primary health care provider immediately when the pulse rate is below 60 beats per minute or above 120 beats per minute.
Cardiotonic drugs are used to treat which
medical condition? Select all that apply.
1. Heart failure
2. Hypothyroidism
3. Hyperlipidemia
4. Atrial fibrillation
5. Hypertension
Answer: 1, 4
RATIONALE:
Cardiotonic drugs are used to treat heart failure if other treatments fail to improve client status, and to treat atrial fibrillation
A client is administered a thrombolytic drug.
The drug is known to cause bleeding. Which of
the following symptoms of internal bleeding
should the nurse monitor for in the client?
Select all that apply.
1. Black, tarry stools
2. Hematuria
3. Leg cramps
4. Petechiae
5. Coffee-ground emesis
Answer: 1, 2, 4, 5
RATIONALE: The nurse should observe for symptoms such as abdominal pain; coffee-ground emesis; black, tarry stools; hematuria; bleeding under the skin; joint pain; and spitting or coughing up blood in the client.
Which activity is most likely to precipitate an
angina attack?
1. Watching TV late at night
2. Cutting vegetables at a sink
3. Sitting in a boat
4. Climbing a fight of stairs
Answer: 4
RATIONALE:
Any activity that increases the workload of the heart, such as exercise or simply climbing stairs, can precipitate a painful angina attack.
When assessing a 40-year-old client, the nurse observes an increase in the client’s blood pressure. Which of the following changes in blood pressure is indicative of prehypertension?
1. Systolic pressure between 120 and 139 mm Hg
2. Systolic pressure between 100 and 119 mm Hg
3. Systolic pressure between 80 and 99 mm Hg
4. Systolic pressure between 60 and 79 mm Hg
Answer: 1
RATIONALE:
Systolic pressure between 120 and 139 mm Hg is indicative of prehypertension. Prehypertension poses a risk for the development of hypertension. Individuals with such blood pressure changes should practice certain lifestyle changes
A nurse is caring for an 86-year-old patient on antiarrhythmic drugs. Which of the following signs, if present, indicates the development of heart failure in the patient?
1) Decrease in weight
2) Shortness of breath
3) Increased volume of urine
4) Chills and fever
Ans 2
Shortness of breath may be seen as a sign of heart failure in older patients on antiarrhythmic drug therapy. Other signs include an increase in weight and a decrease in urine output.
A nurse is educating a group of nursing stu-
dents on the uses of digitalis. For which of
the following conditions may digitalis be
used?
1. Ventricular tachycardia
2. Atrioventricular block
3. Atrial fibrillation
4. Renal failure
Answer: 3
RATIONALE:
Digitalis can be used in atrial fibrillation.
Which of the following is used to treat a warfarin (Coumadin) overdose?
1. Protamine
2. Urokinase
3. Phytonadione (Vit K)
4. Alteplase
Answer: 3
RATIONALE: Phytonadione (vitamin K) is indicated
for the treatment of warfarin overdose.
A nurse is educating a group of nursing
students on the various effects of calcium
channel blockers on the heart. Which of the
following are the effects of calcium channel
blockers on the heart? Select all that apply.
1. Increase the heart rate
2. Slow the conduction velocity
3. Depress myocardial contractility
4. Cause rapid atrial muscle contraction
5. Dilate the coronary arteries
Answers: 2, 3, 5
RATIONALE:
Calcium channel blockers affect the
heart by:
■ Slowing the conduction velocity of the cardiac
impulse
■ Depressing myocardial contractility
■ Dilating coronary arteries and arterioles, which
in turn deliver more oxygen to cardiac muscle.
Dilation of peripheral arteries reduces the workload of the heart. The end effect of these drugs is the same as that of the nitrates. An increased blood flow results in an increase in the oxygen supply to surrounding tissues.
Once a client develops primary hypertension,
therapy should last for how long?
1. Until blood pressure is 120/80 mm Hg
2. 1 year
3. For life
4. 5 years
Answer: 3
RATIONALE:
Once primary hypertension develops, management of the disorder becomes a lifetime task
A patient who is on antiarrhythmic drug therapy complains of nausea after taking the drug. Which of the following instructions should the nurse provide the patient to help alleviate nausea?
1) Take the drug 2 hours before eating food
2) Lie down flat for at least 1 hour after taking the drug
3) Eat small, frequent meals rather than large meals
4) Drink lots of water after taking the medicine
Ans 3
The nurse should instruct the patient to eat small, frequent meals instead of larger ones. This will help alleviate nausea, which is a common adverse effect seen with the use of antiarrhythmic drugs. The nurse should instruct the patient to avoid lying flat for at least 2 hours after meals to prevent nausea. The drug should be administered with meals to avoid gastric upset. Drinking lots of fluid after the drug may lead to vomiting, if there is nausea.
A client has been admitted for heart failure
and is on digoxin. The nurse monitoring the
client notes that the serum digoxin level is
2.5 mg/mL. Which of the following signs
would validate a case of digoxin toxicity?
Select all that apply.
1. Anorexia
2. Headache
3. Weakness
4. Blurred vision
5. Vomiting
Answer: 1, 4, 5
RATIONALE:
The signs of digoxin toxicity include anorexia, blurred vision, and vomiting. Headache and weakness are the adverse effects of digoxin, even at normal dosage, and do not signify digoxin toxicity.
Enoxaparin (Lovenox) should be administered
via which route?
1. Subcutaneous injection
2. Intramuscular injection
3. Intravenous infusion
4. Orally
Answer: 1
RATIONALE: Enoxaparin (Lovenox) is administered
via subcutaneous injection
Nitrates can result in which of the following
adverse reactions? Select all that apply.
1. Headache
2. Flushing
3. Diarrhea
4. Hypotension
5. Blurred vision
Answer: 1, 2, 4
RATIONALE:
Adverse reactions associated with antianginal medications include headache, dizziness, weakness, restlessness, hypotension, flushing, and rash.
Which of the following lowers blood pressure primarily via suppression of the renin-angiotensin-aldosterone system?
1. Verapamil (Calan)
2. Diltiazem (Cardizem)
3. Lisinopril (Prinivil)
4. Furosemide (Lasix)
Answer: 3
RATIONALE:
Angiotensin-converting enzyme inhibitors (ACEIs) act primarily to suppress the renin-angiotensin aldosterone system and lisinopril is an ACEI. Verapamil and diltiazem are calcium channel blockers and furosemide is a diuretic
When drug therapy is started and a new or worsening arrhythmia happens, what is the term for this cardiac event?
1) Atrial fibrillation
2) Proarrhythmia effect
3) Atrial flutter
4) Threshold
Ans 2
Antiarrhythmic drugs may cause new arrhythmias or worsen existing arrhythmias, even though they are administered to resolve an existing arrhythmia. This phenomenon is called the proarrhythmic effect.
A nurse is caring for a client on digitalis. The
client complains of nausea and vomiting
after 2 days of digitalis administration.
Which of the following is the appropriate
nursing intervention in this situation? Select
all that apply.
1. Ensure that the client takes double the drug dosage
2. Ensure the client consumes small, frequent meals
3. Ensure the client consume fluid 1 hour before meals
4. Ensure the client rinses his or her mouth after the consumption of meals
5. Restrict fluid consumption at meal times
nswer: 2, 4, 5
RATIONALE:
The appropriate intervention is to ensure that the client consumes small, frequent meals; restricts fluid intake at meals; and rinses the mouth after meals. These are techniques that help control nausea and vomiting. Fluid intake at meals will increase the feeling of nausea. Fluid intake should be avoided 1 hour before meals. Doubling the drug dosage will worsen the condition.
A client is undergoing warfarin drug therapy.
After taking the drug, the client develops
signs of GI bleeding. Which of the following
tasks is the best intervention to monitor
bleeding by the nurse?
1. Inspect urine for red-orange color
2. Monitor vital signs every 4 hours
3. Inspect for bright red to black stools
4. Monitor client’s fluid intake and output
Answer: 3
RATIONALE:
The nurse should inspect for bright red to black stools, which are an indication of GI bleeding. Inspecting the urine for red-orange color is not a reliable indicator of bleeding when oral anticoagulants are taken. They may impart a red-orange color to alkaline urine, making it diffcult to detect hematuria; in such conditions a urinalysis would be necessary to detect hematuria.
Nitrates should not be used in clients with
which of the following?
1. Closed-angle glaucoma
2. Asthma
3. Diabetes
4. Hypertension
Answer: 1
RATIONALE: Nitrates are contraindicated in clients
with known hypersensitivity, severe anemia,
closed-angle glaucoma, head trauma, cerebral
hemorrhage, and constrictive pericarditis.
A nurse is required to educate clients on the consequences of hypertension. Which of the following may develop as a consequence of hypertension? Select all that apply.
1. Adrenal tumor
2. Blindness
3. Stroke
4. Heart disease
5. Obesity
Answers: 2, 3, 4
RATIONALE:
Heart disease, blindness, and stroke can occur as a consequence of hypertension. Hypertension causes the heart to work harder and leads to the production of atherosclerosis. Obesity and adrenal tumor are risk factors for the development of hypertension and are not the consequences of hypertension.