Active Learning Exercise

Question 1

Lidocaine
Amiodarone - used for afib
Digoxin
Priority AE: bradycardia
Priority nursing: check HR prior to admin

Answer 1

Lower HR/HR/antiarrhythmics

Question 2

Metoprolol - used for afib
Diltiazem - used for afib
Priority AE: indication for med - why taking med then prioritize off of that
Priority nursing: indication

Answer 2

HR &BP

Question 3

HCTZ
Captopril
Losartan
Nitroprusside
Priority AE: hypotension - primary affect of the drug
Priority nursing: check BP prior to admin meds

Answer 3

BP

Question 4

Start IV
Place client on continuous telemetry monitoring
Assess allergies, current medications, past medical history
Baseline head-to-toe assessment
Obtain IV infusion pump

Answer 4

The emergency room (ER) nurse is caring for a client who presented to the ER after a syncopal episode. After a 12-lead EKG and evaluation by the ER physician, it was discovered the client had developed new-onset atrial fibrillation with rapid ventricular rate. VS: HR 186; BP 164/82; RR 16; O2 sat 96% RA; temp. 98.3F The ER physician has prescribed a loading dose of intravenous amiodarone. What interventions should the nurse perform to prepare to administer this medication?

Question 5

Amiodarone 150 mg/100 mL - Loading dose for amiodarone (rapid infusion)

Answer 5

Using your nursing drug guide, which medication should the nurse expect the ER physician to order first?

Question 6

Intravenous

Answer 6

Two hours later, the nurse obtains lab results for the client. The client’s potassium level is 2.8 mmol/L. The nurse plans to initiate the electrolyte replacement protocol from the standing orders. The client has converted to NSR and VS are stable. Physical assessment is within normal limits. The client is NPO. What route should the nurse administer the potassium replacement?

Question 7

Check y-site compatibility. The nurse can administer 2 infusions through one IV. An order will need to be obtained to start a second IV for the third infusion.
Amiodarone and potassium chloride are compatible
Potassium chloride and furosemide are compatible
Amiodarone and furosemide are NOT compatible and CANNOT be run through the same IV line

Answer 7

As the nurse prepares to administer the potassium chloride, the primary care provider prescribes a furosemide continuous intravenous infusion. How should the nurse plan to administer the amiodarone, furosemide, and potassium chloride?

Question 8

The nurse is caring for a client who is taking an antihypertensive. Which client complaint could be attributed to this medication?
1.Constipation
2.Epistaxis
3.Dizziness
4.Hematuria

Answer 8

Answer: 3
Rationale: Hypotension is a common AE among all antihypertensives. Common manifestations of hypotension include dizziness, falls/fainting, and fatigue.

Question 9

The nurse knows which intravenous medications require telemetry monitoring for administration? Select all that apply.
A.Amiodarone
B.Nitroprusside
C.Diltiazem
D.Lidocaine
E.Digoxin

Answer 9

Answer: A, C, D, E
Rationale: Antiarrhythmic medications require telemetry monitoring. Nitroprusside does not affect heart rhythm.

Question 10

The nurse is planning care for a client taking captopril. The nurse should plan for which outcome?
1.Limited bleeding events
2.Absence of blood clots
3.Lack of bradycardia
4.Blood pressure with normal limits

Answer 10

Answer: 4
Rationale: Captopril is an antihypertensive and the goal is to maintain a normal blood pressure.

Question 11

The nurse is reviewing a medication list for a client. The nurse is most concerned when the client is prescribed which combination of medications?
A.Warfarin and St. John’s Wart
B.Nitroglycerin (SL) and captopril
C.Furosemide and metoprolol
D.Amiodarone and rivaroxaban

Answer 11

Answer: A
Rationale: Although nitro and captopril can both lower BP, it is common for those with HTN to have a hx of MI/angina. Although furosemide and metoprolol can both lower BP, they are indicated in the tx of HF. Amiodarone and aspirin can be safely given together.

Question 12

Masks s/s hypoglycemia in diabetic patients

Answer 12

Metoprolol

Question 13

AE: hyperkalemia

Answer 13

Captopril

Question 14

AE: hypokalemia

Answer 14

Hydrochlorothiazide

Question 15

AE: peripheral edema

Answer 15

Diltizem

Question 16

Drug-drug: beta2-agonist

Answer 16

Metoprolol

Question 17

Requires blood monitoring

Answer 17

Digoxin

Question 18

Monitor PTT

Answer 18

Heparin

Question 19

Route: SQ every 12 hours

Answer 19

Enoxparin

Question 20

Monitor INR

Answer 20

Warfarin

Question 21

Indication: Prevention for CV events

Answer 21

Clopidogrel

Question 22

Indication: ischemic stroke

Answer 22

Alteplase

Question 23

Unstable angina

Answer 23

The nurse is caring for a client with diabetes mellitus type 2, hypertension, and myocardial infarction s/p stents x 2 (two years ago). The client is currently hospitalized for an infected diabetic ulcer. When the nurse answers the client’s call light, the client has just finished showering and is complaining of shortness of breath, nausea, and 7/10 pain in his chest. What is the client experiencing?

Question 24

Nitroglycerin sublingual tablet

Answer 24

What medication should the nurse prepare to administer?

Question 25

Blood pressure and pain

Answer 25

What 2 assessments should the nurse prioritize after administration of the medication?

Question 26

Administer a second dose of nitroglycerin

Answer 26

The nurse reassess the client after 5 minutes and the client continues to complain of 7/10 chest pain. The client’s blood pressure is 118/76. What should the nurse do next?

Question 27

Place 1 tab under the tongue every 5 minutes as needed up to 3 tablets
If chest pain dose not resolve after 2 tabs, call 911
Stay seated until chest pain resolves (risk fall, hypotension)
Store in a cool, dry place and dark colored container
Refill medication when it expires

Answer 27

After the second dose of nitroglycerin, the client’s chest pain is unresolved. The nurse calls the rapid response team, and the client is brought to the cath lab for stent placement. The following day the nurse is preparing to discharge the client. What discharge instructions should the nurse provide regarding nitroglycerin sublingual tablets?