Antihypertension Drugs
What are the cardio-selective vs non-selective medications.
What is Atenolol, Metoprolol, Esmolol, Nebivolol vs. Carvedilol, Labetalol, Propranolol
What are the 3 different types of anginas? Define them :P
- Chronic stable angina, also known as classic or effort angina, is caused by atherosclerosis and is triggered by physical exertion or stress, such as cold weather or emotions. The pain is intense but goes away within 15 minutes with rest or medication. - Unstable angina is a more serious condition that occurs when the pain becomes more frequent and severe, sometimes even at rest. It is a warning sign that a heart attack may happen soon.
- Vasospastic angina, or Prinzmetal angina, is caused by spasms in the coronary arteries, and the pain can happen at rest without any obvious trigger, often occurring at the same time of day.
While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient?
(Extra points to define the rest!)
What is decreased HR?
Chronotropic: increased HR
Inotropic: increased contractility
Dromotropic: increased electrical impulses
This medication works by stimulating progenitor cells in the bone marrow to speed up the production of RBCs, but it requires adequate iron stores to be effective.
What is epoetin Alfa?
A preoperative nurse is preparing to perform a skin prep with povidone-iodine for a patient scheduled for abdominal surgery. The nurse should assess for which allergies that would contraindicate the use of this antiseptic solution?
What is Shellfish and Iodine
What classes of antihypertensives is recommended as a first-line treatment for hypertension in Black patients.
what is thiazide-type diuretics and CCBs
What important information should you provide to a patient regarding the storage of nitroglycerin to maintain its effectiveness?
What is store nitroglycerin in its original container, tightly closed, and away from air and moisture?
Is there an antidote for Digoxin?
What is Digitalis
When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign? (Bonus: Name 3 more!)
What is Muscle weakness is an early symptom of hypokalemia, as are hypotension, lethargy, mental confusion, and nausea. Cardiac dysrhythmias are a late symptom of hypokalemia
The order reads, ―Give 1500 mL of normal saline over 12 hours. The tubing drop factor is 15gtt/mL. The nurse will set the gravity drip infusion at how many drops per minute (gtt/min)?
What is 31 gtt/min?
What are patient teachings for a patient taking hypertensives
what is Medications to be taken exactly as ordered with avoidance of doubling up or omitting doses, No smoking, excessive alcohol intake, excessive exercise, hot climates, saunas, hot environments, Careful and cautious changing positions encouraged because of postural hypotension, Never abruptly stop meds because you are feeling better, risk for hypertensive rebound, Antihypertensives may lead to depression and sexual dysfunction
What factors should the nurse consider when administering nitroglycerin ointment?
What is thin layer on clean dry hairless skin, use gloves or tongue depressor to apply, do not rub it into the skin: cover it with occlusive dressing, rotate sites, make sure to remove all residual with soap and water
A patient is taking digoxin and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, ―I am seeing a funny yellow color around the lights. What is the nurse‘s next action?
What is Assess the patient for symptoms of digoxin toxicity
A patient is thinking about becoming pregnant, what vitamin should be started?
What is started at least one month prior to conception and continued through early pregnancy to reduce the risks of neural tube defects.
A 79-year-old patient is receiving a quinolone for a complicated incision infection. Given the patient's age, the nurse should closely monitor for which serious adverse effect associated with this drug class?
What is tendonitis and tendon rupture?
What labs to monitor when patient on ARBs/ACE, and what is the normal value?
What is Na (135-145) and K (3.5 - 5.0)
A patient has been on a beta blocker for 4 weeks as part of his antianginal therapy and has a history of type 2 diabetes mellitus and hyperthyroidism. What adverse effects should the nurse include in the discussion?
a. Watch for unusual weight loss.
b. Monitor your pulse for increased heart rate.
c. Use the hot tub and sauna at the gym as long as time is limited to 15 minutes.
d. Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia.
D. Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia.
A patient has a digoxin level of 1.8 ng/mL. What is the nurse's interpretation of this level?
What is within the therapeutic range?
A 60 y.o. patient receiving warfarin for A-fib reports sudden pain and discoloration in both toes. Upon examination, the nurse the toes appear darker than usual, with some tenderness. The patient mentions the symptoms started a few days after starting the warfarin regimen. What should the RN refer to this as?
What is Purple Toe Syndrome?
The provider orders 500 mg of acetaminophen PO every 6 hours as needed for pain. The pharmacy provides 250 mg tablets. How many tablets should the nurse administer per day?
What is 8 tablets
A 58-year-old patient has been taking enalapril for hypertension. The provider discontinues the medication and prescribes an angiotensin II receptor blocker (ARB). What side effects led to this change?
What is nonproductive cough and angioedema
If a patient is experiencing unstable angina, what steps should be taken when using nitroglycerin to manage the situation?
What is sit or lie down, place one tablet under the tongue, wait 5mins, if pain does not improve call 911, take another tablet under tongue, wait 5mins, if pain not improved take another one
You are taking care of a 72 y.o. patient with a hx of HTN, CHF, and A-fib. Vitals: 110/70 mmHg, 58 bpm, 16RR, 98.6F, RA 95%. The patient reports dizziness and fatigue. Lab results: K - 3.2 mEq/L, Creat: 1.2 mg/dL. Which medication should the nurse hold?
A. Lisinopril
B. Hydrochlorothiazide
C. Digoxin
D. Aspirin
Rationale:
Digoxin should be held because the patient has low potassium (3.2 mEq/L). Low potassium can make digoxin more dangerous by causing a slow heart rate and other heart problems. Holding digoxin until the potassium level is corrected is the safest choice.
Lisinopril is safe to continue since the patient’s kidney function (creatinine 1.2 mg/dL) is stable and there's no sign of kidney issues.
Hydrochlorothiazide – While diuretics like furosemide can lower potassium, thiazide diuretics don’t usually cause significant electrolyte imbalances unless taken long-term. If the patient had a thiazide instead of furosemide, the potassium drop might be less severe.
Aspirin helps prevent blood clots, especially in atrial fibrillation. There’s no reason to stop it, as the patient isn't showing signs of bleeding.
A 65 y.o. patient with liver disease and massive GI bleeding has a prolonged PT and aPTT. Which blood product is the most appropriate to correct the coagulation deficiency?
What is Fresh Frozen Plasma (FFP)
A nurse is administering IV vancomycin to a post-operative gastrointestinal surgery patient. Which nursing interventions are appropriate?
a. Monitoring serum creatinine levels btestbanks.com btestbanks.com
b. Restricting fluids while the patient is on this medication
c. Warning the patient that a flushed feeling or facial itching may occur
d. Instructing the patient to report dizziness or a feeling of fullness in the ears e. Reporting a trough drug level of 11 mcg/mL and holding the drug
f. Reporting a trough drug level of 24 mcg/mL and holding the drug
What is A, C, D, F
Rationale - Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remains critical to patient safety. Monitor nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. In addition, adequate hydration (at least 2 L of fluids every 24 hours unless contraindicated) is most important to prevent nephrotoxicity. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.