Pharm Ch 22 24 25 Eoc Qs

Front 1

What special nursing considerations are important when administering adenosine to a patient who is experiencing PSVT that has not responded to treatment with calcium channel blockers?

Back 1

Keep in mind that adenosine is contraindicated in patients with second- or third-degree heart block, sick sinus syndrome, atrial flutter or fibrillation, or ventricular tachycardia, as well as in those with a known hypersensitivity to it. It has a very short half-life of less than 10 seconds, so it must be given intravenously with a fast IV push. Monitor the patient closely because this drug commonly causes asystole for a few seconds. Monitor for therapeutic results: return to sinus rhythm.

Front 2

Mrs. L. is about to be discharged home and will be taking quinidine for the treatment of ventricular ectopy. What instructions are important for her to understand before her discharge?

Back 2

If the quinidine is in capsule form, it must not be crushed or chewed. It is important to inform the patient that the medication should not be discontinued even if symptoms do not recur. If GI distress occurs, she should take this medication with food. She may notice a "pill" in her stools but needs to know that it is just the waxy matrix that held the medication, and the medication has been absorbed. If she notices a weight gain of 2 pounds per 24 hours or 5 pounds per week, the physician should be notified.

Front 3

Many precautions are associated with the use of amiodarone (Cordarone). Discuss problems about which you would warn a patient taking this drug, especially in the summer in hot climates. What serious adverse effects may occur?

Back 3

Amiodarone increases the sensitivity of one's skin to sunlight, and too much exposure could result in serious sunburn. Sunburn may even occur through window glass or thin cotton clothing. The use of this drug may also be associated with visual problems due to corneal microdeposits, resulting in visual halos, photophobia, and dry eyes. In addition, a very serious adverse effect is pulmonary toxicity, which is fatal in about 10% of the patients who take this drug. Watch for progressive dyspnea and cough, and report these symptoms immediately. Damage to the alveoli may result in pulmonary fibrosis.

Front 4

Primary hypertension has been diagnosed in a 53 year old woman, and the B-blocker carvedilol has been prescribed. Before initiating therapy, what past medical conditions should the nurse inquire about during the nursing assessment?

Back 4

Prior to initiating antihypertensive therapy with carvedilol, a nonselective β blocker, the nurse should assess the patient for the following contraindications: hypersensitivity, acute heart failure, concurrent use with monoamine oxidase inhibitors (MAOIs), severe mental depression, peptic ulcer, colitis, and severe liver or kidney disease. In addition, knowing that carvedilol is a nonselective β blocker, the nurse will assess for the presence of respiratory diseases such as asthma and for respiratory failure. Taking a nonselective β blocker with these respiratory conditions may result in bronchoconstriction due to the stimulation of β-2 receptors.

Front 5

A 78-yr-old woman has been admitted to the ER for the treatment of a possible acute MI and has another diagnosis of acute hypertensive crisis. One of the physician's orders is to start a sodium nitroprusside infusion. What is the purpose of using sodium nitroprusside?

Back 5

Sodium nitroprusside (Nipride) is a drug that causes vasodilation and a decrease in preload and afterload. Because it dilates arterioles, the peripheral resistance in the patient is decreased (increased vasodilation leads to decreased peripheral resistance and thus lower blood pressure) and, because it is also a venous dilator, it leads to a decrease in preload (venous dilation leads to pooling of blood and a decrease in the return of blood to the heart, or decreased preload). The parenteral intravenous infusion works immediately and effectively. This drug is indicated for those in hypertensive emergencies and not for other classifications of hypertension.

Front 6

A 63-yr-old African American man has a new diagnosis of stage 2 hypertension. He has been treated for type 2 diabetes for 2 years but admits that he does not follow his diet as he should. His urinalysis shows traces of protein, but his retinal examination shows no defects. What drug therapy would you expect to see ordered for this patient? What is the treatment goal for this patient?

Back 6

The 2-year history of diabetes and the possibility of renal disease as indicated by the presence of protein in the urine (which will have to be investigated further) means that this patient has "compelling indications." According to the JNC-VII recommendations, stage 2 hypertension with the presence of compelling indications would indicate a two-drug combination with a thiazide-type diuretic plus one of the following: ACE inhibitor, ARB, or calcium channel blocker. These drugs are in addition to the drugs needed for the treatment of the diabetes. However, some research has suggested that there are differences in responses to specific blood pressure medications between African American and white patients. Calcium channel blockers and diuretics have been shown to be more effective in African Americans; β blockers and ACE inhibitors have been shown to be less effective in African Americans than in whites.
According to the JNC-VII report, the treatment goal for hypertension in the presence of compelling indications is less than 130/80 mm Hg.