Cardiovascular Drugs Ati

Front 1

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?

Back 1

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.

Front 2

What statement by a client would demonstrate to the nurse an understanding of how thrombolytic agents work? This med:

Back 2

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.

Front 3

Metolazone (Mykrox) would prompt the nurse to asses the client taking digoxin for S&S of toxicity because..?

Back 3

Diuretic-induced hypokalemia can increase the sensitivity of the myocardium to digitalis glycosides.

Front 4

A nurse can anticipate diuresis will occur when a client is taking lisinopril (Zestril) because?

Back 4

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.

Front 5

The nurse would include follow-up eye exams in the teaching plan for a client discharged with a prescription for amiodarone (Cordarone) because?

Back 5

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.

Front 6

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?

Back 6

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.

Front 7

It is important to advise a client taking aliskiren (Tekturna) to not use it if pregnant/or want to become pregnant because?

Back 7

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.

Front 8

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

Back 8

Monitor pulse rate daily, this med is prescribed on an as needed basis

Front 9

Client is discharged on oral flecainide (Tambocor). Why would taking pulse daily and reporting irregularities be an appropriate instruction to pt?

Back 9

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.

Front 10

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?

Back 10

Nitropress is a potent vasodilator with immediate onset of action, it must be administered via an infusion pump to ensure an accurate dosage rate.

Front 11

"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?

Back 11

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.

Front 12

"I have to stop eating canned veggies and sandwich meats such as bologna." suggests the client understands instructions given about hydralazine (apresoline) because?

Back 12

Understand dietary modifications necessary to decrease the intake of sodium (salt). hydralazine (Apresoline) adverse side effect is sodium retention.

Front 13

What health history finding would the nurse know to be a contraindication for the admin of any thrombolytic agent?

Back 13

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.

Front 14

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

Back 14

Bradycardia does not result from use of isordil, a vasodilator. Its caused by meds which affect conduction pathways in the heart (beta-adrenergic blockers)

Front 15

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?:

Back 15

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.

Front 16

"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?:

Back 16

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

Front 17

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)

Back 17

Propafenone (Rythmol)

Front 18

A sign of digoxin (lanoxin) toxicity is?:

Back 18

Yellow-green halos

also nausea, vomiting, anorexia, diarrhea, arrhythmias and irrritability

Front 19

When administering the second dose of reteplase to the client with an acute myocardial infarction, the nurse should prepare to administer the dose:

Back 19

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.

Front 20

Discharge teaching for a client taking captopril (capoten) would include notifying the doc if a cough or sore throat develops.

Back 20

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.

Front 21

Which EKG finding would the nurse expect not to find in the client with toxicity from a digitalis glycoside?

Back 21

Altered Q wave, which is an indication of myocardial damage. You would expect to find altered P waves though.

Front 22

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

Back 22

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.

Front 23

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?

Back 23

An expected adverse reaction, due to vasodialation of cerebral blood vessels.

Front 24

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

Back 24

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)

Front 25

Nurse can anticipate reduced dosage of lidocaine (xylociane) to be ordered for a client with:

diabetes mellitus, copd, chf, hypertension

Back 25

CHF- others would be elderly, weighing less than 50 kg or those with chf, renal, hepatic disease

Front 26

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

Back 26

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

Front 27

Which diagnostic study should the nurse monitor most closely while a client is taking captopril (Capoten)?
creatinine, hemoglobin/hct, urinalysis, serum glucose

Back 27

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.

Front 28

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

Back 28

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.

Front 29

Which problem would the nurse expect to develop in the client taking triamterene (dyrenium) and an ACE inhibitor?

Back 29

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

Front 30

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

Back 30

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.

Front 31

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?

Back 31

Depression

other SE of the CNS are memory loss, mental changes, nightmares, drowsiness, dizziness, fatigue, and weakness

Front 32

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?

Back 32

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.

Front 33

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

Back 33

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.

Front 34

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

Back 34

Tachycardia
Correct side effect would be bradycardia. Methyldopa is a vasodilator and lowers bp/slows pulse

Front 35

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?

Back 35

Hypokalemia

R: lasix causes increased excretion of potassium in the urine. The manifestations that the client describes are typical of hypokalemia.

Front 36

When preparing to admin a transdermal nitroglycerin to a client, the nurse should:

Back 36

apply nitroglycerin patch to clean, dry, hairless skin.

Front 37

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?

Back 37

Walking a treadmill

R: clients w/sedentary lifestyle should be encouraged to establish a regular program of aerobic exercise (walk, jog, swim, bike)

Front 38

Along w/liver enzymes, which additional lab test result should nurse monitor in client taking oral amiodarone (cordarone)?

Back 38

Triiodothyronine (T3), thyroxine (T4)

R: amiodarone inhibits the peripheral conversion of thyroxine (T4) and t3 and cause increase thyroxine levels

Front 39

What side effects should the nurse monitor for in the client receiving an IV infusion of adenosine?

tachycardia, hypertension, hypoxia, dyspnea

Back 39

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

Front 40

"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?

Back 40

Client should notify physician immediately if ru quad discomfort develops. Death from liver failure can result.

Front 41

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?

Back 41

Hyperglycemia, thiazides such as diuril may decrease effectiveness of diabinese resulting in hyperglycemia. Could require increased antidiabetic medication.

Front 42

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)

Back 42

Xylocaine reduces ventricular excitability

Front 43

To evaluate effectiveness of prazosin (Minipress) the nurse should expect to monitor for:
decreased bp
decreased weight
increased hr
increased urine output

Back 43

Decreased bp, the effect of prazosin is most pronounced on the diastolic bp. bp is lowered in supine and standing positions.

Front 44

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+

Back 44

MOnitor pulse daily prior to lanoxin.

do not take if less than 60 or greater than 100

Front 45

Six days after staring antihypertensive therapy that includes spironolactone (aldactone) a client calls to report palpitations/skipped hb. Nurse tells client to:

Back 45

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.

Front 46

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)

Back 46

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.

Front 47

Procainamide (Procan SR) may effect which lab value?

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

Back 47

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.

Front 48

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

Back 48

Decreased LOC

R: alert you to potential life threatening complication of cerebral hemorrhage.

Front 49

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

Back 49

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.

Front 50

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?

Back 50

I should eat foods high in sodium to prevent dehydration.

Front 51

A nurse is aware that clients who take anitarrhythmics are at increased risk for heart failure because these medications

Back 51

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.

Front 52

Two most common side effects reported by clients taking the angiotensin receptor blockers (ARB), candesartan are:

constipation/diarrhea
Arthralgia/myalgia
Headache/dizziness
Nausea/vomiting

Back 52

Headache/dizziness

Front 53

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)

Back 53

Nadolol (Corgard)

R: contraindicated in clients w/bronchial asthma, sinus bradycardia, cardiogenic shock, overt cardiac failure

Front 54

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:

Back 54

Decrease number of premature ventricular contractions.

Front 55

Most potentially life-threatening side effect of captopril (Capoten)?

rash, fever, dry cough, tachycardia

Back 55

Fever: indication of inflammatory/infectious process in body. Capoten can cause neutropenia, so lowered immune system.

Front 56

" 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?

Back 56

Hypertensive is a chronic condition, should not be stopped with return on normal bp

Front 57

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

Back 57

monitor bp

R: evaluates effectiveness of drug, enalaprilat injection is for hypertension, can occur w/15 min of administration

Front 58

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

Back 58

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.

Front 59

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

Back 59

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