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158 Cards in this Set

  • Front
  • Back
A normal serum Sodium level is
135 - 145 mEq/L
A normal serum Potassium level is
3.5 - 5.0 mEq/L
A normal serum Calcium level is
9 - 11 mg/dl
in Hyponatremia serum Sodium levels are
< (less than) 135 mEq/L
in Hypernatremia serum Sodium levels are
> (greater than) 147mEq/L
in Hypokalemia serum Potassium levels are
< (less than) 3.5 mEq/L
in Hyperkalemia serum Potassium levels are
> (greater than) 5.1 mEq/L
List 7 sources of Potassium
1. Bananas, citrus fruit, melons
2. Raisins
3. Dark green leafy vegetables
4. Potatoes
5. All bran cereal
6. Salt-Substitutes
7. Dried beef (e.g. Jerky)
in Hypocalcemia serum Calcium levels are
< (less than) 8.5 mg/dl
in Hypercalcemia serum Calcium levels are
> (greater than) 11mg/dl
List 3 sources of Calcium
1. Dairy Products
2. Fortified fruit juice
3. Dark green leafy vegetables
List 6 sources of Sodium
1. Table salt, seasonings & spices
2. Processed food
3. Canned Soda
4. Potatoes & white vegetables
5. Sardines & Herring fish
6. Cold cuts
When recieving Thiazide or Loop Diuretics, consume foods
high in potassium
When recieving Potassium-sparing diuretics avoid foods
high in potasium
Thiazide Diuretics act by (2)
1. Blocking Na+ absorption
2. Increasing K+ and H2O output.
Do not administer Atenolol (Tenormin) if pulse is
1. less than 60 bpm
Atenolol (Tenormin) can mask
Tachycardia that occurs with hypoglycemia
Atenolol (Tenormin) side effects (6)
1. fatigue
2. Weakness
3. Bradycardia
4. Hypotension
5. Decreased sexual desire or ability
6. Increased cold sensitivity
Atenolol (Tenormin) acts by
slowing HR & conduction
Chlorothiazide (Diuril) should not be administered to
lactating women
Chlorothiazide (Diuril) absorption is increased when
taken with food
Chlorothiazide (Diuril) taken with caffeine
increases diuresis
Chlorothiazide (Diuril) taken with large amounts of licorice
may increase hypokalemia effects
Chlorothiazide (Diuril) decreases the effectiveness of
antidiabetic drugs
Chlorothiazide (Diuril) is contraindicated in patients with (2)
1. Severe renal dysfunction
2. Anuria
Normal B/P
<120/80
Prehypertension
120 - 139 / 80 - 89
Stage 1 hypertension
140 - 159 / 90 - 99
Stage 2 hypertension
>160 / > 100
What kind of drugs are used for prehypertension?
None. Lifestyle modifications are encouraged.
What kinds of drugs are used for stage 1 hypertension?
Thiazide type diuretics mostly
Which kind of diuretics cause ototoxicity?
Loop Diuretics
Diuretics reduce the renal excretion of
Lithium

*Lithium levels must be monitored as toxicity may occur
Hydrochlorothiazide is contraindicated in patients with (3 Things)
1. Anuria
2. Prior sensitivity to thiazides
3. Prior sensitivity to sulfonamides
Hydrochlorothiazide should be taken with
orange juice (promotes adequate potassium intake)
Hydrochlorothiazide may increase serum levels of (6)
1. glucose
2. triglycerides
3. Uric acid
4. BUN
5. Creatinine
6. Calcium

*Watch patient for signs of metabolic imbalances
Hydrochlorothiazide may decrease serum levels of (3 things)
1. Potassium
2. Sodium
3. Chloride

*Watch patient for signs of metabolic imbalances.
Enalapril can produce "first dose phenomenon" of
profound hypotension

*Ensure that the effect diminishes with continued therapy.
To avoid first dose phenomenon with Enalapril
administer the first dose at bedtime
patients on Enalapril should not consume (2)
1. Electrolyte fortified nutritional snacks or sports drinks
2. salt sustitutes
The therapeutic advantage of potassium - sparing diuretics is that
diuresis can be obtained without affecting blood K+ levels
Spinorolactone (Aldactone) Potential Nursing Diagnosis
Disturbed body image (gynecomastia in males, hirsutism in females), related to anti-estrogen effects of drug.
Spinorolactone (Aldactone) is contraindicated in patients with (3)
1. Anuria
2. Worsening decreased kidney function
3. Acute renal insufficiency
rules regarding weighing for patients on Spinorolactone (Aldactone) (List 4)
1. weigh daily or weekly (depending on schedule recommended by healthcare provider)
2. same scale
3. same time
4. same amount of clothing
regarding weight results of patients on Spinorolactone (Aldactone), report changes of (2 things)
>3lbs if weighing daily
>5lbs if weighing weekly
patients on Spinorolactone (Aldactone) must avoid foods high in
potassium
Spinorolactone (Aldactone) causes the following sexual changes (6)
1. Decreased libido
2. Hirsutism in females
3. Gynecomastia in males
4. Impotence
5. Irregular menses, amenorrhea, post menopausal bleeding
6. Deepening of voice in females
Regarding pulse, patients on Cardiac Glycoside Therapy must (3 things)
1. Count pulse for 1 full min
2. Record pulse with every dose.
3. Contact healthcare provider if pulse is less than 60 or greater than 100 bpm
Why should Lasix be used with caution in the elderly?
They are more susceptible to dehydration & electrolyte imbalances from the drug.
With Lasix, check weight
Daily
With Lasix, report weight changes that are
greater or less that 2lbs in 24hrs.
Lasix is contraindicated in patients with
A history or hypersensitivity to the drug or sulfonimines.
When on Lasix, patients can avoid dizziness by
changing position slowly
Lasix dose should be scheduled (2)
1. In the morning
2. No later than 6pm if two- times-a-day dose is ordered.

*Avoids Nocturia
Increased risk for Lasix toxicity occurs in patients with (List 3)
1. Liver Disease
2. Cirrhosis
3. Ascities
Beta-blockers affect blood glucose levels by
lowering them

*Finger-stick blood glucose levels should be checked regularly

*Report signs of hypoglycemia
Beta-blockers affect cardiac output by
lowering it

*exercise or exertion should be started slowly

*Determine tolerance to increased activity
Patients on beta-blockers should report consistent fasting blood glucose levels below
70mg/dl
Target organs affected by untreated hypertension are
1. Heart
2. Brain
3. Retina
4. Kidneys
Emotions that decrease B/P are
1. Depression
2. Lethargy
Removal of excess fluid in the body results in (3 things)
1. Decreased cardiac preload
2. Decreased cardiac output
3. Decreased total peripheral resistance
Side effects of Thiazide Diuretics are (5)
1. Hypokalemia
2. Hyponatremia
3. Hyperglycemia
4. Hyperuricemia
5. Rash
Side effects of Loop Diuetics are (6)
1. Hypotension
2. Hypokalemia
3. Fatigue
4. Hearing loss
5. Dehydration
6. Dry Mouth
ACE Inhibitors usually end in
-pril
Osmotic Diuretics are used to treat (2)
1. Intra cranial pressure
2. Severe renal failure
An example of an Osmotic diuretic is
Mannitol
Beta-blockers often end in
-lol
Drug that can be used for hypertensive emergencies during labor and delivery
Nitroprusside IV
Is extremely light sensitive and only stable for 24hrs
Nitroprusside IV
The following occurs in Left-sided heart failure
1. Blood accumulation in left ventricle.
2. Hypertrothy of left ventricle
3. Blood backs up into lungs
4. Cough and SOB results
The following occurs in Right-sided heart failure
1. Blood backs up into veins
2. Peripheral edema & organ engorgement occurs.

*Less common than L-sided failure
A positive Inotropic effect results in
increased force of contraction
A negative Inotropic effect results in
decreased force of contractions
A positive Chronotropic effect results in
increased HR
A negative Chronotropic effect results in
decreased HR
A positive dromotropic effect results in
increased rate of electrical conduction
A negative dromotropic effect results in
decreased rate of electrical conduction
ACE Inhibitors must not be administered if the following CBC result is seen
Neutrophil count below 1000/mm3
Digoxin will not work until
therapetic dose is achieved
Cardiac Glycoside toxicity can be treated with
Digibind

*Neutralizes Digoxin
Max dose for Nifedipine is
180mg/day
Max dose for Enalapril is
40mg/day
Max dose for Doxazosin is
16mg/day
Max dose for Hydralzine is
300mg/day
The orthostatic hypotension caused by Chlorothiazide could result in the Potential Nursing Diagnosis
Risk for falls
Chlorothiazide when taken by patients with gout results in
hyperuricemia without symptoms
Chlorothiazide interferes with the excretion of
Uric acid and may lead to hyperuricemia

*pay particular attention to patients who already have gout.
Chlorothiazide administered with amphotericin B or corticosteroids results in
increased hypokalemic effects
What kind of drug is Lisinopril (Prinivil) and what is it prescribed for?
1. ACE Inhibitor
2. Hypertension & Heart Failure
ACE Inhibitors block Aldosterone secretion resulting in
1. Sodium loss
2. Potassium retention
When caring for a client receiving triamterene (Dyrenium), the nurse places priority on which nursing intervention?
Monitoring electrolytes for hyperkalemia
Nitroglycerin relieves chest pain by
Dilating arteries and veins
The nurse recognizes that the ability of organic nitrates to dilate coronary arteries is most effective for treating
Vasospastic or variant angina
The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias.
Cardioversion; defibrillation
The nurse recognizes the action of beta blockers for treatment of dysrhythmias is
Negative chronotropic effect

*meaning decreased HR
When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be
The client will avoid use of caffeine during therapy.
The nurse adjusts the care plan of a client of Asian descent who is receiving propranolol to include increased monitoring of
Heart rate

*Studies show lack of drug-metabolizing enzyme (mephenytoin hydroxylase) causes Asians to metabolize propranolol more quickly than do Caucasians. The nurse should assess for high early buildup and overdose.
What type of drug is Nifedipine (Procardia) and what is it prescribed for?
1. calcium channel blocker
2. Hypertension
What kind of drug is Enalapril (Vasotec) and what is it prescribed for?
1. ACE inhibitor
2. Hypertension
What kind of drug is Doxazosin (Cardura) and what is it prescribed for?
1. Adrenergic blocker
2. Hypertension and benign prostatic hyperplasia.
What kind of drug is Hydralazine (Apresoline) and what is it prescribed for?
1. Direct-acting vasodilator
2. Hypertension
What kind of drug is isosorbide dinitrate (Isordil) and what is it prescribed for?
1. Vasodilator
2. angina
What kind of drug is digoxin (Lanoxin) and what is it prescribed for?
1. Cardiac glycoside
2, Used to increase the strength of cardiac contractions, thereby alleviating symptoms of heart failure.
What kind of drug is milrinone (Primacor) and what is it prescribed for?
1. Phosphodiesterase inhibitor
2. heart failure
What kind of drug is Furosemide (Lasix) and what is it prescribed for?
1. Loop diuretic
2. acute heart failure
What kind of drug is carvedilol (Coreg) and what is it prescribed for?
1. Beta-adrenergic blocker
2. Used to treat heart failure by lowering heart rate and blood pressure.
What kind of drug is nitroglycerin (Nitrostat) and what is it prescribed for?
1. organic nitrate
2. angina and MI
What kind of drug is atenolol (Tenormin) and what is it prescribed for?
1. Beta-adrenergic blockers
2. used to treat angina and hypertension, and to prevent MI
What kind of drug is diltiazem (Cardizem) and what is it prescribed for?
1. Calcium channel blocker
2. angina, dysrhythmia, and hypertension
What kind of drug is metoprolol (Lopressor) and what is it prescribed for?
1. Beta-adrenergic blocker
2. MI, angina, and dysrhythmia
What kind of drug is reteplase (Retevase) and what is it prescribed for?
1. Thrombolytic
2. used to dissolve blood clots, especially after an MI
What kind of drug is verapamil (Calan) and what is it prescribed for?
1. Calcium channel blocker
2. dysrhythmia and angina
What kind of drug is propranolol (Inderal) and what is it prescribed for?
1. Beta-adrenergic blocker
2. dysrhythmia, hypertension, angina, and migraine headaches
What kind of drug amiodarone (Cardarone) is and what is it prescribed for?
1. Potassium channel blocker
2. atrial dysrhythmia and ventricular tachycardia
What kind of drug is quinidine (Quinidex) and what is it prescribed for?
1. Sodium channel blockers
2. dysrhythmia
What kind of drug is norepinephrine (Levarterenol)and what is it prescribed for?
1.Vasoconstrictor
2. used to increase blood pressure and cardiac output in acute shock and cardiac arrest
What kind of drug is epinephrine (Adrenalin) and what is it prescribed for?
1. Vasoconstrictor
2. acute anaphylactic shock
What kind of drug is dopamine (Dopastat, Inotropin) and what is it prescribed for?
1. cardiotonic agent
2. stimulates beta-adrenergic receptors used to treat shock
What kind of drug is normal serum albumin (Albuminar, Albutein, and others) and what is it prescribed for?
1. Fluid replacement agent
2. colloid fluid replacement
What kind of drug is atorvastatin (Lipitor) and what is it prescribed for?
1. HMG-CoA reductase inhibitor (Statin)
2. hyperlipidemia
What kind of drug is cholestyramine (Questran) and what is it prescribed for?
1. Bile acid resin
2. hyperlipidemia
What kind of drug is gemfibrozil (Lopid) and what is it prescribed for?
1. Fibric acid agent
2. hyperlipidemia
What serum level of Digitalis indicates toxicity?
above 2.0 ng
How often should the nurse monitor vital signs for the patient that has just recieved Nitroprusside (Nitropress) for a blood pressure as high as 220/110
every 5-15 minutes

*Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely
Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects, and instructs the client to immediately report:
Increased shortness of breath and orthopnea

*reflect signs of congestive heart failure
risk for digitalis toxicity is increased by
hypokalemia
'digitalize' means to
gradually increase Digoxin levels until heart tissue is saturated and symptoms of HF subside.
side effects of digitalis therapy include
anorexia, nausea and vomiting
The major action of cardiac glycosides is that
they have a positive inotropic effect.

*HR & afterload decreases
cardiac glycosides are used in the treatment of
atrial fibrillation
Phosphodiesterase inhibitors act by
increasing the force of
myocardial contraction

*increase cardiac output
Cardiac glycosides act by
increasing the force of
myocardial contraction

*increase cardiac output
Diuretics should be discontinued before the nurse initially administers
ACE inhibitors

*prevents severe hypotension
metabolic symptoms of shock are (4)
1. Low temperature
2. Low urine output
3. Acidosis
4. Thirst
Respiratory symptoms of shock are (2)
1. Rapid breathing
2. Shallow respirations
Cardiovascular symptoms of shock are (4)
1. Thready Pulse
2. Tachycardia
3. Low cardiac output
4. Low blood pressure
Neurologic symptoms of shock are (4)
1. Restlessness
2. Confusion
3. Anxiety
4. Lethargy
anaphylactic shock results from
an acute allergic reaction
hypovolemic shock results from
loss of blood volume
cardiogenic shock results from
failure of the heart to pump sufficient blood to tissues
neurogenic shock results from
vasodilation due to overstimulation of the parasympathetic or understimulation of the sympathetic nervous system.
septic shock results from
multiple organ dysfunction due to pathogenic organisms in the blood.
Septic shock is often a precursor to (2)
1. acute respiratory distress syndrome (ARDS)
2. disseminated intravascular coagulation (DIC)
shock generally results when
there is inadequate blood flow to meet body’s needs
Colloids act by
drawing molecules from body’s cells and tissues into blood vessels

*Oncotic pressure
Crystalloids are
intravenous solutions that contain electrolytes
Crystalloids act by (2)
1. replacing lost fluids and electrolytes
2. increasing urine output
Signs and Symptoms
specific to Anaphylaxis are
1. Periorbital edema
2. Urticaria (Hives)
3. Wheezing
4. Difficult breathing
Treatment of Anaphylaxis is as follows
1. Give oxygen immediately.
2. Antihistamine to prevent release of histamine.
3. Bronchodilator to relieve shortness of breath.
4. Corticosteroids to suppresses inflammation.
Most common cause of Acute Renal Failure is
hypoperfusion
An elevated blood level of homocysteine is a risk factor for
1. Heart disease
2. Stroke
Patients on Heparin therapy should avoid all
contact sports
signals indicating bleeding in patients recieving anticoagulant therapy are
1. an increase in HR followed by low B/P or a subnormal temperature.
2. flu-like symptoms (dizziness, chills, weakness, paleness)
3. Excessive bruising
Patients recieving Alteplase should have vital signs monitored every
15 mins during 1st hr of infusion, then every 30 mins during remainder of infusion.
Patients have increased risk of bleeding for 2-4 days after infusion of
Alteplase
Immediately discontinue Amniocaproic Acid (Amicar) therapy if
patient develops muscle weakness or reddish brown urine.

*indicates myopathy and myoglobinuria
response to Epoetin Alfa is minimal if there are deficient blood levels of
iron, folic acid and vitamin B12
use of IV nitrates puts the patient at risk for
severe hypotension secondary to vasodilation

*a baseline B/P should be obtained prior to administration