Cardiac Medications
A client with chest pain is prescribed intravenous nitroglycerin (Tridil). Which assessment is of greatest concern for the nurse initiating the NTG drip? 1. Serum potassium is 3.5mEq/L. 2. Blood pressure is 88/46. 3. ST Elevation is present on the ECG. 4. Heart rate is 61.
What is 2. Blood pressure Rationale: NTG is a vasodilator that will lower BP. The client is having chest pain and the ST elevation indicates injury to the myocardium, which may benefit from NG. The potassium and heart rate are within normal limits.
The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate the client has a : 1. Low sodium level. 2. High glucose level. 3. High calcium level. 4. Low potassium level.
What is 4. Rationale: A low serum potassium level predisposes the client to digoxin toxicity. Because potassium inhibits cardiac excitability, a low serum level would mean the client is prone to increased excitability. Sodium, glucose and calcium levels do not contribute to digoxin toxicity.
A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). A nurse assesses the results of which laboratory study to monitor for the adverse effects from this medication? 1. Kidney function 2. Blood glucose level 3. WBC count 4. Liver function studies
What is 3. Rationale: A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the WBC count. Agranulocytosis could be fatal if undetected.
A nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side effects of this medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating
What is 2. Rationale: The most common side effects related to this medication include CNS and GI system dysfunction. Fluoxetine affects the GI system by causing N/V, cramping & diarrhea.
The client has been on treatment for rheumatoid arthritis for 3wks. During administration of etanercept (Enbrel), it is most important for the nurse to assess what? 1) the injection site for itching & edema 2) the WBC and platelet counts 3) whether the client is experiencing fatigue and joint pain 4) a metallic taste in the mouth, w/ loss of appetite
What is the WBC and platelet count. Rationale: infection and pancytopenia are side effects of this drug. Lab tests are performed prior to and during treatment with this drug. Abnormal WBC and platelet counts would alert the nurse to a potentially life-threatening infection.
A client with acute chest pain is receiving IV morphine sulfate. Which of the following results are the intended effects of morphine in this client. Select all that apply. 1. Reduces myocardial oxygen consumption. 2. Promotes reduction in respiratory rate. 3. Prevents ventricular remodeling. 4. Reduces blood pressure and heart rate. 5. Reduces anxiety and fear.
What is 1, 4 and 5. Rationale: Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial consumption, blood pressure and heart rate. Morphine also reduces anxiety and fear due to its sedative effects and slowing of the heart rate. It can depress respirations but such an effect may lead to hypoxia, which should be avoided in treatment of chest pain. ACE inhibitors not morphine prevent ventricular remodeling.
A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply. 1. Angel food cake. 2. Banana 3. Dried fruit. 4. Orange juice. 5. Peppers.
What is 2, 3, and 4. Rationale: Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit and oranges are high in potassium. The others are low in potassium.
A client's medication reconciliation contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, a nurse would administer the dose: 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression
What is 2. Rationale: Zoloft is classified as an anti-depressant. Zoloft is generally administered once every 24 hours, either in the evening or the morning. Evening administration may be preferable because drowsiness is a side effect.
Colchicine is prescribed for a client with gout. The nurse reviews the client's record, knowing that this med would be used with caution in which of the following disorders? 1) Myxedema 2) Renal failure 3) Hypothyroidism 4) Diabetes Mellitus
What is renal failure. Rationale: Use this drug cautiously w/older adults, debilitated clients, and clients with renal, cardiac, and GI disease.
When administering a thrombolytic drug to the client experiencing a myocardial infarction, the nurse explains that the purpose of the drug is to: 1. Help keep him well hydrated. 2. Dissolve clots he may have. 3. Prevent kidney failure. 4. Treat potential cardiac arrhythmias.
What is 2. Rationale: Thrombolytic drugs are administered within the first 6 hours after the onset of an MI to lyse clots and reduce the extent of myocardial damage.
A client with heart failure is taking digoxin IV. The nurse should determine the effectiveness of the drug by assessing which of the following: 1. Dilated coronary arteries. 2. Increased myocardial contractility. 3. Decreased cardiac arrhythmias. 4. Decreased electrical conductivity in the heart/
What is 2. Rationale: Digoxin is a cardiac gylcoside with positive inotropic activity. This causes increased strength of myocardial contractions and increases output of LV. Digoxin does not dilate arteries. It can be used to treat arrhythmias and does increase electrical conductivity but these are not primary reasons for its use in patients with HF and pulmonary edema.
A client is scheduled for discharge and will be taking phenobarbital (Luminal) for an extended period. A nurse would place highest priority on teaching the client which of the following points that directly relates to client safety? 1. Take the medication only with meals 2. Take the medication at the same time each day 3. Use a dose container to help prevent missed doses 4. Avoid drinking alcohol while taking this medication
What is 4. Rationale: Phenobarbital is an anti-convulsant and hypnotic agent. The client should avoid taking any other CNS depressants such as alcohol while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication.
Alendronate (Fosamax) is prescribed to a client with osteoporosis. The nurse instructs the client to: 1) take at bedtime 2) take with breakfast 3) lie down for 30min after taking 4) take with a full glass of water after rising in the morning
What is take w/a full glass of water after rising in the morning. Rationale: This drug can cause GI side effects, esp, esophageal irritation, so lying down after taking is discouraged. Taking the drug on a completely empty stomach will increase absorption.
Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following: 1. Age greater than 60 years. 2. History of cerebral hemorrhage 3. History of heart failure. 4. Cigarette smoking.
What is 2. Rationale: History of cerebral hemorrhage is a contraindication to the administration of t-PA because the risk of hemorrhage may be further increased. The others are not contraindications.
Metroprolol is added to the pharmacologic therapy of a diabetic female patient with stage 2 hypertension initially treated with Furosemide and Ramipril (Altace). An expected therapeutic effect is: 1. Decrease in heart rate. 2. Lessening of fatigue. 3. Improvement in blood sugar levels. 4. Increase in urine output.
What is 1. Rationale: The effects of BB are decrease in heart rate, contractility and afterload. The client may have an increase in fatigue when starting the BB. They do not improve blood sugar or increase urine output.
A nurse is providing discharge instructions to a client receiving baclofen (Lioresal). Which of the following would be incl. in the teaching plan? 1) Restrict fluid intake 2) avoid the use of alcohol 3) notify the phys. if fatigue occurs 4) stop the medication if diarrhea occurs
What is avoid use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against depressant use because baclofen increases the activity of these agents. Constipation, rather than diarrhea, is an adverse effect of baclofen.
Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? 1. 5-10 min. 2. 30-60 min. 3. 2-4 hours. 4. 6-8 hours.
What is 1. Rationale: After an IV injection of furosemide, diuresis usually begins in about 5 minutes and reaches its peak at about 30 min. When given orally or IM, action begins more slowly and lasts longer.
A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following adverse effects of this drug? Select all that apply. 1. Dry mouth. 2. Hyperkalemia. 3. Impotence. 4. Pancreatitis. 5. Sleep disturbance.
What is 1, 3 and 5. Rationale: Clonidine is a central acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence and sleep disturbances are possible adverse effects. Hyperkalemia and pancreatitis are not anticipated with the use of this drug.
A nurse notes that a client with schizophrenia is receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches TV. The nurse determines that the client is experiencing: 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome
What is 2. Rationale: Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue.