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59 Cards in this Set

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An elderly client is admitted to the ICU with acute chest pain. A lidocaine (xylocaine) drip is started because of sinus tachycardia and frequent PVCs. Client becomes restless and dioriented. Why?
Confusion is a common SE of lidocaine therapy.

R: Lidocaine has very low margin of safety. Confusion and drowsiness are frequent side effects of lidocaine therapy. As blood levels of lidocaine rise, clients tend to become apprehensive. SE and Adverse responses caused by lidocaine affect mainly CNS and cardiovascular.
What statement by a client would demonstrate to the nurse an understanding of how thrombolytic agents work? This med:
Uses my body's natural clot dissolving system.

R: Thrombolytics activate the fibrinolytic system of the body by activating plasminogen which is converted to plasmin- the body's natural clot dissolving substance.
Metolazone (Mykrox) would prompt the nurse to asses the client taking digoxin for S&S of toxicity because..?
Diuretic-induced hypokalemia can increase the sensitivity of the myocardium to digitalis glycosides.
A nurse can anticipate diuresis will occur when a client is taking lisinopril (Zestril) because?
Zestril is an antihypertensive ACE inhibitor: its action is to block the formation of angiotensin II. When this happens, diuresis and vasodilation occur, which will decrease blood volume and peripheral resistance, causing lowered bp.
The nurse would include follow-up eye exams in the teaching plan for a client discharged with a prescription for amiodarone (Cordarone) because?
Routine follow-up eye exams should be done to monitor for corneal microdeposits which appear in the majority of adults treated with cordarone. These microdeposits can lead to symptoms such as visual halos or blurred vision.
The physician orders labetalol (trandate) for a client to treat severe hypertension secondary to a pheochromocytoma. the nurse recognizes this drug to be a potent antihypertensive because of its action as?
An alpha- and beta-adrenergic blocker

R: nonselective beta-adrenergic blocker, blocks stimulation of beta-1 and beta-2 receptor sites as well as alpha-adrenergic receptors. This drug is extremely potent AntiHyp. agent.
It is important to advise a client taking aliskiren (Tekturna) to not use it if pregnant/or want to become pregnant because?
Aliskiren (Tekturna) may cause damage or death to the fetus. It should not be used during pregnancy. clients should be advised to call the health care provider is pregnancy is suspected.
Which info is least important for the nurse to include in a teaching plan for the client receiving Nitrolglycerin 0.4 mg SL Q5 minutes x 3 PRN angina?

monitor pulse rate daily
Activate emergency med system after 3 doses
place tab under tongue every 5 min
Store in orginal glass container, air tight
Monitor pulse rate daily, this med is prescribed on an as needed basis
Client is discharged on oral flecainide (Tambocor). Why would taking pulse daily and reporting irregularities be an appropriate instruction to pt?
Major life-threatening side effects of Tambocor therapy is arrhythmias, client should be taught to monitor the pulse daily (before getting out of bed) and report any evidence of palpitations or skipped beats to physician.
Client is admitted in hypertensive crisis due to a pheochromocytoma. The physician orders nitroprusside (nitropress) IV at 3 mcg/kg/min. In addition to the routine assessments, why would obtaining an infusion pump for the Nitropress be important?
Nitropress is a potent vasodilator with immediate onset of action, it must be administered via an infusion pump to ensure an accurate dosage rate.
"This drug is not habit-forming, so i dont have to worry about addiction." is an accurate statement for a pt taking nitroglcerin tablets because?
Nitroglycerin tablets are not habit-forming and can be taken as needed. It should be stressed to the client, however that if chest pain becomes severe or is not relieved, the doc needs to be notified.
"I have to stop eating canned veggies and sandwich meats such as bologna." suggests the client understands instructions given about hydralazine (apresoline) because?
Understand dietary modifications necessary to decrease the intake of sodium (salt). hydralazine (Apresoline) adverse side effect is sodium retention.
What health history finding would the nurse know to be a contraindication for the admin of any thrombolytic agent?
Colon resection a week ago.

R: a surgical procedure within the last 10 days is a contraindication for thrombolytic therapy. The risk of major bleeding at the surgical site outweighs the benefits of giving a thrombolytic.
When counseling a client taking isosorbide dinitrate (isordil) for angina, which following side effects can the nurse anticipate will occur least often?

weakness, headache, hypotension, bradycardia
Bradycardia does not result from use of isordil, a vasodilator. Its caused by meds which affect conduction pathways in the heart (beta-adrenergic blockers)
After direct current cardioversion, the physician is unable to determine whether client's rhythm, a wide QRS tachycardia, is of ventricular or atrial origin. In situations like this, the nurse knows it's best to administer?:
Proocainamide (pronestyl) should be used in the setting of a wide QRS tachycardia in which origin of arrhythmia is unknown. Procainamide has both atrial and ventricular aniarrhythmic properties.
"If i miss a dose, i should eliminate it and not take two in one day" is an appropriate statement for digoxin (lanoxin) use because?:
Clients do not need to catch up on doses. If dosage is missed, then it should be eliminated and the correct schedule resumed as soon as possible
A client taking which of the following antiarrhythmic drugs is most likely to complain to the nurse of developing an unusual taste sensation?

cordarone (amiodarone)
Propafenone (rhythmol)
Quinidine (quinora)
Propranolol (inderal)
Propafenone (Rythmol)
A sign of digoxin (lanoxin) toxicity is?:
Yellow-green halos

also nausea, vomiting, anorexia, diarrhea, arrhythmias and irrritability
When administering the second dose of reteplase to the client with an acute myocardial infarction, the nurse should prepare to administer the dose:
Thirty minutes after the first dose

R: second bolus is given 30 minutes after initiation of the first bolus injection. Each bolus is administered IV over 2 minutes.
Discharge teaching for a client taking captopril (capoten) would include notifying the doc if a cough or sore throat develops.
Capoten is an ACE inhibitor, a serious side effect is renal damage or neutropenia. Neutropenia can be life-threatening because of the risk of infection, the client should notify the physician if a cough, sore throat or fever develops.
Which EKG finding would the nurse expect not to find in the client with toxicity from a digitalis glycoside?
Altered Q wave, which is an indication of myocardial damage. You would expect to find altered P waves though.
Physician prescribes procainamide (Pronestyl) 500 mg P.O every six hrs as maintenance therapy after a client's ventricular arrhythmia was corrected. What is an adverse reaction associated with use of this drug?

hypokalemia, thrombocytopenia, hyperglycemia, hypertension
Thrombocytopenia because pronestyl can cause leukopenia and thrombocytopenia. Client should notify if unusual bleeding or bruising occurs.. Leukopenia(sore throat, mouth, or gums). Discontinue if problems occur.
A client takes a nitroglycerin (nitrostat) tablet at the onset of anginal pain. The chest pain is relieved, but the client complains of a sudden pounding headache. The nurse is aware that the headache represents?
An expected adverse reaction, due to vasodialation of cerebral blood vessels.
A physician prescribes tocainide (tonocard) P.O. for a client who has occasional to frequen premature ventricular contractions (PVCs). The nurse should teach the client to report which side effect when taking tonocard?

double vision, petechiae, dry mouth, photosensitivity
Petechiae. Potential life-threatening side effects of tocainide therapy are leukopenia, neutropenia, and thrombocytopenia. Client should be instructed to notify the physician if unusal bleeding or bruising occurs (petechiae, hematuria, melena, or epistaxis)
Nurse can anticipate reduced dosage of lidocaine (xylociane) to be ordered for a client with:

diabetes mellitus, copd, chf, hypertension
CHF- others would be elderly, weighing less than 50 kg or those with chf, renal, hepatic disease
Which food type should nurse include in teaching plan of daily diet needs to reduce electrolyte loss when taking furosemide (lasix)?

red meats, milk, dried fruit, grains
Dried fruit- also avocados, broccoli, cantaloupe, grapefruit, lima beans, nuts, bananas, peaches, potatoes, prunes, spinach, tomatoes are potassium-rich foods. Lasix cause loss of potassium, along with sodium, chloride, magnesium, and calcium
Which diagnostic study should the nurse monitor most closely while a client is taking captopril (Capoten)?
creatinine, hemoglobin/hct, urinalysis, serum glucose
Creatinine

R: capoten should be used cautiously in clients with renal impairment becuae of the frequent side effects of proteinuria. Renal failure can also occur: creatinine, BUN, and electrolyte levels should be monitored periodically.
Client admitted with hypertension, is taking furosemide (lasix) 40 mg P.O. twice a day. Which intervention, if included in the plan of care, would require further clarification by the nurse?

monitor I&O
Limit fluid intake to 1000 mL in 24 hrs
Orthostatic bp checks every 8hr
Daily weights before bfast
Limit fluid intake to 1000 mL in 24 hrs

R: needs to be discussed further. Lasix, potent diuretic, can cause dehydration. Limiting fluid intake may contribute to this problem.
Which problem would the nurse expect to develop in the client taking triamterene (dyrenium) and an ACE inhibitor?
Arrhythmia

R: ACE inhibitors in combo with potassium sparing diuretics may lead to significant increases in serum potassium. Clients could be at risk for developing cardiac arrhythmia secondary to hyperkalemia.

So ELECTROLYTE DISTURBANCE
Because a client is taking atenolol (tenormin), which of the following interventions is most critical for the nurse to include in the plan of care?

change positions slowly
monitor I&Os
Admin one hr before or 2 hr after meals
do not give if apical pulse is less than 60 bpm
Do not give if apical pulse is less than 60 bpm

R:Beta-blocker, on major side effect is bradycardia. The nurse must take the apical pulse prior to admin.
A client has been taking atenolol (Tenormin) for two months for treatment of hypertension and reports having no energy or enthusiasm. The client states, "I just want to sleep all the time. Life holds no interest for me." The nurse recognizes these statements to be indicative of what SE of Tenormin?
Depression

other SE of the CNS are memory loss, mental changes, nightmares, drowsiness, dizziness, fatigue, and weakness
A client is taking nadolol (Corgard) 80 mg P.O. daily for treatment of hypertension. during follow up app 6 months later, client exhibits hypertension, agitation, and tachycardia. why?
Nadolol withdrawal.

R: Beta-adrenergic blocker withdrawal could be rebound hypertension, tachycardia, or angina. Client should not discontinue abruptly after chronic therapy, hypersensitivity to catecholamines may have developed.
A client receiving propafenone (rythmol) develops sob and bibasilar crackles. Nurse should initially be prepared to: Discontinue propafenone therapy, admin loop diuretic, monitor for prolonged qt intervals, increase dose
Discontinue therapy

If CHF develops or worsens, propafenone should stop. Drug can be started at lower does only after adequate cardiac compensation has been established.
client is taking methyldopa (aldomet) 500 mg P.O. every eight hours. When monitoring the client, which side effect would the nurse be least likely to observe?

headache,sedation,tachycardia,weakness
Tachycardia
Correct side effect would be bradycardia. Methyldopa is a vasodilator and lowers bp/slows pulse
After several days of furosemide (Lasix) therapy, a client begins to complain of muscle weakness, drowsiness, abdominal cramping, and nausea. The nurse is aware that the most likely explanation for these manifestations is?
Hypokalemia

R: lasix causes increased excretion of potassium in the urine. The manifestations that the client describes are typical of hypokalemia.
When preparing to admin a transdermal nitroglycerin to a client, the nurse should:
apply nitroglycerin patch to clean, dry, hairless skin.
In addition to prophylactic use of nitrates, which of the following activities can the nurse encourage the client to perform without increasing the risk of an angina attack?
Walking a treadmill

R: clients w/sedentary lifestyle should be encouraged to establish a regular program of aerobic exercise (walk, jog, swim, bike)
Along w/liver enzymes, which additional lab test result should nurse monitor in client taking oral amiodarone (cordarone)?
Triiodothyronine (T3), thyroxine (T4)

R: amiodarone inhibits the peripheral conversion of thyroxine (T4) and t3 and cause increase thyroxine levels
What side effects should the nurse monitor for in the client receiving an IV infusion of adenosine?

tachycardia, hypertension, hypoxia, dyspnea
Dyspnea, adenosine admin IV can cause bronchoconstriction and dyspnea

adenosine slows conduction time through A-V node and can interrupt reentry pathways through a-v node resulting in a decrease in HR, not tachycardia
"IF i get ru quad discomfort, i should start a low fat diet." This statement made by the client receiving procainamide (pronestyl) extended release tabs indicates a potential knowledge deficit?
Client should notify physician immediately if ru quad discomfort develops. Death from liver failure can result.
A client with hypertension is being treated with chlorothiazide (Diuril) 500 mg P.O. twice a day. In taking the clients med history, the nurse notes that the client is a diabetic and has been taking chlorpropamide (Diabinese) 250 mg P.O. daily. Potential interaction may result in?
Hyperglycemia, thiazides such as diuril may decrease effectiveness of diabinese resulting in hyperglycemia. Could require increased antidiabetic medication.
A client has had an episode of ventricular tachycardia and a normal cardiac rhythm is successfully restored with cardioversion. The nurse knows the treatment for prevention of another episode of ventricular tachycardia includes administration of:
atropine, lidocaine hydrochloride (xylocaine), beta-blockers, dobutamine (dobutrex)
Xylocaine reduces ventricular excitability
To evaluate effectiveness of prazosin (Minipress) the nurse should expect to monitor for:
decreased bp
decreased weight
increased hr
increased urine output
Decreased bp, the effect of prazosin is most pronounced on the diastolic bp. bp is lowered in supine and standing positions.
Client is to be discharged on digoxin (lanoxin) 0.125 mg P.O. daily. Which of the following would the nurse include in clients teaching?

take it before rising in am
monitor pulse daily prior to taking
discontiniue the lanoxin if pulse is 60 bpm
eat diet high in bran fiber and Ca+
MOnitor pulse daily prior to lanoxin.

do not take if less than 60 or greater than 100
Six days after staring antihypertensive therapy that includes spironolactone (aldactone) a client calls to report palpitations/skipped hb. Nurse tells client to:
Report to the clinic to see the physician.

R: potassium sparing diuretic used in management of hypertension, nurse should be alert for hyperkalemia: fatigue, muscle weakness, paresthesia, cardiac arrhythmias.
The nurse would anticipate hyperkalemia to most likely develop in the client taking which of the following meds?

enalapril (vasotec)
digoxin (lanoxin)
Isosorbide dinitrate (isordil)
Furosemid (Lasix)
Enalapril (Vasotec), its an ACE inhibitor, suppresses rennin0angiotensin-aldosterone system by inhibiting conversion of angiotenstin I to angiotensi II. Decreased vasopresser activity and aldosterone secretion can result in increases of serum potassium.
Procainamide (Procan SR) may effect which lab value?

platelet count, potassium, blood urea nitrogen BUN, t3/t4
Platelet count

R: CBC should be monitored weekly during first months of therapy because procainamide can cause decreased platelet counts due to quinidine-platlet complexes which cause platelet destruction.
which assessment finding could be manifestation of a potentially life-threatening side effect of thrombolytic therapy?

decreased level of consciousness
Blood oozing from IV sites
Rash
Tachycardia
Decreased LOC

R: alert you to potential life threatening complication of cerebral hemorrhage.
A client admitted with a myocardial infarction MI two days ago, develops paroxysmal atrial tachycardia (PAT). doc orders quinidine sulfate (quinora) 300 mg every 3 hrs until arrhythmia is terminated. which baseline data should the nurse obtain prior to starting the quinora?

serum creatinine, q-t interval, abdominal girth, cardiac ejection fraction
q-t interval

R: quinidine acts to depress automaticity, resulting in prolongation of the Q-T interval (total time for ventricular depolarization and repolarization). BAseline data documenting the q-t interval is important.
A client is taking furosemid (lasix) 60 mg P.O. twice a day. The nurse is teaching the client methods to decrease the incidence of orthostatic hypotension. Which of the following statements made by the client to the nurse would require further discussion?
I should eat foods high in sodium to prevent dehydration.
A nurse is aware that clients who take anitarrhythmics are at increased risk for heart failure because these medications
Decrease cardiac output, most antiarrhythmics exert a negative inotropic effect upon the heart: they decrease myocardial contractility or cardiac output. This is the major reason why clients are at risk for heart failure.
Two most common side effects reported by clients taking the angiotensin receptor blockers (ARB), candesartan are:

constipation/diarrhea
Arthralgia/myalgia
Headache/dizziness
Nausea/vomiting
Headache/dizziness
A client with asthma has recently been diagnosed with hypertension. which of the following drugs would cause the nurse to question the order if prescribed?

valsartan (diovan)
Hydralazine (apresoline)
Methyldopa (Aldomet)
Nadolol (Corgard)
Nadolol (Corgard)

R: contraindicated in clients w/bronchial asthma, sinus bradycardia, cardiogenic shock, overt cardiac failure
Client has an order for a lidocaine (xylocaine) drip 2 g in 500 mL 5W at 2 mg/min on a volumetric pump after recieving a lidocaine bolus of 100 mg. The nurse knows the expected outcome of therapy is to:
Decrease number of premature ventricular contractions.
Most potentially life-threatening side effect of captopril (Capoten)?

rash, fever, dry cough, tachycardia
Fever: indication of inflammatory/infectious process in body. Capoten can cause neutropenia, so lowered immune system.
" I can stop taking the drug after my bp returns to normal" is an incorrect statement for client on felodipine (Plendil) to control blood pressure because?
Hypertensive is a chronic condition, should not be stopped with return on normal bp
Client has recently been medicated with enalaprilat (Vasotec) IV. Which of the following initial actions by the nurse is most appropriate?

monitor bp
assess pulse rate
advise client to rise slowly
monitor lab results
monitor bp

R: evaluates effectiveness of drug, enalaprilat injection is for hypertension, can occur w/15 min of administration
Client with history of angina is to take isosorbide dinitrate (isordil) 10 mg P.O. every six hours. When the client asks how the drug works, the nurse's reply is based upon understanding that primary action of isordil is to?:

Dilate coronary blood vessels, reduce cardiac preload/afterload, decrease myocardial circulation
Reduce cardiac P/A

R: potent vasodilator of venous and arterial systems. if arterioles are dilated, blood is moved out easily with less cardiac effort and venous system dilated, less blood blood return to the heart.
When doing client teaching, the nurse should offer which of the following precautions to a client who is taking clonidine (Catapres)?

check bp daily, be weaned off drug, or include more salt in your diet
You will need to be weaned off

R: catapres, like all central acting sympatholytics, should not be stopped abruptly. Therapy should be discontinued gradually by reducing the dosage over two to four days to avoid rebound hypertension, restlessness, and anxiety