Cardiology Homework Qs Flashcards
A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. Which concern would prompt the nurse to ask the health care provider about potassium supplements?
A. Digoxin causes significant potassium depletion.
B. The liver destroys potassium as digoxin is detoxified.
C. Lasix requires adequate serum potassium to promote diuresis.
D. Digoxin toxicity occurs rapidly in the presence of hypokalemia.
D. Digoxin toxicity occurs rapidly in the presence of hypokalemia.
Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases
cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low.
Digoxin does not affect potassium excretion. Furosemide causes potassium excretion.
Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes
diuresis and consequent potassium loss regardless of the serum potassium level.
A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to drink a glass of orange juice every day?
A. Maintaining potassium levels
B. Preventing increased sodium levels
C. Limiting the medications’ synergistic effects
D. Correcting the associated dehydration
A. Maintaining potassium levels
Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia.
A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately?
A. Potassium level of 3.1 mEq/L.
B. Sodium level of 132 mEq/L.
C. Calcium level of 8.6 mg/dL.
D. Magnesium level of 1.2 mEq/L.
A. Potassium level of 3.1 mEq/L.
Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can effect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.
The nurse is caring for a client prescribed furosemide and digoxin for the treatment of heart failure. The client reports seeing halos and bright lights. Which laboratory result would be anticipated?
A. Low sodium level
B. Low digitalis level
C. Low potassium level
D. Low serum osmolality
C. Low potassium level
Clients with heart failure who take digoxin are commonly given diuretics. Hypokalemia can increase the risk of digitalis toxicity. Digitalis toxicity may also develop in the presence of hypomagnesemia. Clients with dig toxicity would have elevated digoxin levels. Sodium would likely be normal. The serum osmolality would likely be normal or high in a client on a diuretic.
The nurse is providing care for a client admitted to the hospital with a diagnosis of digoxin toxicity. The client reports more than usual urine output over the previous 48 hours because of the prescribed diuretic. Which assessment finding does the nurse anticipate?
A. Muscle weakness or cramping
B. Blood in the urine
C. Hypertension
D. Tinnitus
A. Muscle weakness or cramping
Symptoms of hypokalemia include muscle weakness and cramping. The digoxin toxicity will not cause blood in the urine, or tinnitus or hypertension.
An 80-year-old client who is taking digoxin reports nausea, vomiting, abdominal cramps and halo vision. Which laboratory result should the nurse evaluate first?
A. Potassium levels
B. Blood pH
C. Magnesium levels
D. Blood urea nitrogen
A. Potassium levels
Nausea, vomiting, abdominal cramps and halo vision are classic signs of digitalis toxicity. The most common cause of digitalis toxicity is a low potassium level.
A nurse is preparing to administer morning medications to a client with heart failure. The morning lab values are: sodium 142 mEq/L (142 mmol/L), potassium 2.9 mEq/L (2.9 mmol/L), digoxin level 1.4 ng/mL. Which of the following medications should the nurse not administer until after speaking with the health care provider?
A. Spironolactone
B. Carvedilol (Coreg)
C. Digoxin (Lanoxin)
D. Ferrous sulfate
C. Digoxin (Lanoxin)
Because the potassium levels are low (normal is 3.5 to 5 mEq/L or 3.5 to 5 mmol/L), the nurse should not give the digoxin; hypokalemia can predispose a person to digoxin toxicity.
The nurse is preparing to administer digoxin to a client with recurring atrial fibrillation. Which laboratory value should be of highest concern for the nurse?
A. Hemoglobin 9.4 g/dL
B. Serum potassium 3.1 mEq/L
C. Serum creatinine 1.9 mg/dL
D. B-type natriuretic peptide 140 pg/mL
B. Serum potassium 3.1 mEq/L
Although all of the lab values are outside of normal range, the low potassium level (normal range 3.5-5.0 mEq/L) should be of highest concern for the client at this time.
A client recently diagnosed with heart failure has been prescribed digoxin and furosemide. Which of the following foods should the nurse teach the client to eat at least one serving a day?
A. Blueberries
B. Wheat cereal
C. Tomato juice
D. Pear nectar
C. Tomato juice
Of the food choices, tomato juice is the highest in potassium. To reduce the risk of potassium depletion, the client should be encouraged to drink at least 1/2 cup of tomato juice every day which is about 400 mg of potassium.
A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?
A. “I can walk a mile a day.”
B. “I’ve had a backache for several days.”
C. “I am urinating more frequently.”
D. “I feel nauseated and have no appetite.”
D. “I feel nauseated and have no appetite.”
Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
A. Check the client’s vital signs.
B. Request a dietitian consult.
C. Suggest that the client rests before eating the meal.
D. Request an order for an antiemetic.
A. Check the client’s vital signs.
It is possible that the client’s nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity.
The client with hypokalemia reports nausea, vomiting, and seeing a yellow light around objects. Which of the client’s medications is the likely cause of the client’s symptoms?
A. Digoxin
B. Furosemide
C. Propranolol
D. Spironolactone
A. Digoxin
These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia.
A client who takes multiple medications complains of severe nausea, and the client’s heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of which medication?
A. Digoxin
B. Captopril
C. Furosemide
D. Morphine sulfate
A. Digoxin
Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances.
The nurse is providing discharge medication teaching to a client who will be taking furosemide and digoxin after discharge from the hospital. Which information is important for the nurse to include in the teaching plan?
A. Maintenance of a low-potassium diet
B. Avoidance of foods high in cholesterol
C. Signs and symptoms of digoxin toxicity
D. Importance of monitoring output
C. Signs and symptoms of digoxin toxicity
The risk of digoxin toxicity increases when the client is receiving digoxin and furosemide, a loop diuretic; loop diuretics can cause hypokalemia, which potentiates the effects of digoxin, leading to toxicity.
Digoxin is prescribed for a client with heart failure. The nurse will assess for signs and symptoms that indicate digoxin toxicity? Which of the following is NOT a sign or symptom of digoxin toxicity?
A. Nausea
B. Yellow vision
C. Irregular pulse
D. Increased urine output
D. Increased urine output
Increased urine output is an expected effect of improved cardiac output.
A child being treated with cardiac medications developed vomiting, bradycardia, anorexia, and dysrhythmias. The nurse understands which medication toxicity is responsible for these symptoms?
A. Digoxin
B. Nesiritide
C. Dobutamine
D. Spironolactone
A. Digoxin
Digoxin helps improve pumping efficacy of the heart, but an overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias.
A nurse is preparing to administer prescribed maintenance dose of digoxin to a client who has heart failure. Which action should the nurse to take?
A. Withhold the medication if the heart rate is above 100/min
B. Instruct the client to eat foods that are low in potassium
C. Measure apical pulse rate for 30 seconds before administration
D. Evaluate the client for nausea, vomiting, and anorexia
D. Evaluate the client for nausea, vomiting, and anorexia
Digoxin is used to decrease heart rate and should be held if the heart rate is less than 60 beats per minute. When administering digoxin, the nurse should measure the client’s apical pulse for a full minute. A client with heart failure who is prescribed digoxin should be assessed for digoxin toxicity.
A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?
A. Withholding the medication if the heart rate is above 100/min
B. Instructing the client to eat foods that are low in potassium
C. Measuring apical pulse rate for 30 seconds before administration
D. Evaluating the client for nausea, vomiting, and anorexia
D. Evaluating the client for nausea, vomiting, and anorexia
Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity. The nurse should measure the apical pulse rate for 1 min.
The nurse is reviewing medication instructions with a client who is taking digoxin. The nurse should reinforce to the client to report which of the following side effects?
A. Rash, dyspnea, edema
B. Nausea, vomiting
C. Hunger, dizziness, diaphoresis
D. Polyuria, thirst, dry skin
B. Nausea, vomiting
Common manifestations of digoxin toxicity include nausea, vomiting and fatigue.
An infant with congenital heart disease is prescribed digoxin and furosemide upon discharge. Which sign would the nurse instruct the parents to be alert for?
A. Difficulty feeding with vomiting
B. Cyanosis during periods of crying
C. Daily naps lasting more than 3 hours
D. A pulse rate faster than 100 beats/min
A. Difficulty feeding with vomiting
Vomiting and feeding issues are early signs of digoxin toxicity.
The nurse is monitoring a 6-year-old child for toxicity precipitated by digoxin. Which sign of digoxin toxicity would the nurse monitor for?
A. Oliguria
B. Vomiting
C. Tachypnea
D. Splenomegaly
B. Vomiting
Vomiting is a sign of digoxin toxicity in children.
A health care provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of acute digoxin toxicity?
A. Vomiting
B. Urticaria
C. Photophobia
D. Respiratory distress
A. Vomiting
Nausea, vomiting, anorexia, and abdominal pain are early indications of acute toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin.
One week after being hospitalized for an acute myocardial infarction, a client reports nausea and loss of appetite. Which of the client’s prescribed medications would be withheld and the health care provider notified?
A. Digoxin
B. Propranolol
C. Furosemide
D. Spironolactone
A. Digoxin
Toxic levels of digoxin stimulate the medullary chemoreceptor trigger zone, resulting in anorexia, nausea, and vomiting.
The nurse is reviewing medication instructions with parents of an infant receiving digoxin and spironolactone. Which parental response indicates instructions have been understood?
A. Activity should be restricted.
B. Orange juice should be given daily.
C. Vomiting should be reported to the health care provider.
D. Anti-inflammatory medications should be avoided.
C. Vomiting should be reported to the health care provider.
Vomiting is a classic sign of digoxin toxicity, and the health care provider must be notified.
A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention?
A. Heartburn.
B. Headache.
C. Constipation.
D. Vomiting.
D. Vomiting.
Vomiting, anorexia, and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse
A nurse in a clinic is caring for a client who has a prescription for digoxin. Which of the following statements indicates the client is experiencing digoxin toxicity?
A. “I am gaining weight.”
B. “I am constipated.”
C. “My vision seems yellow.”
D. “My tongue is red and beefy.”
C. “My vision seems yellow.”
Blurred and yellow vision is an indication of digoxin toxicity. Weight loss & diarrhea may occur while on digoxin.
When teaching a client about digoxin, which symptom will the nurse include as a reason to withhold the digoxin?
A. Fatigue
B. Yellow vision
C. Persistent hiccups
D. Increased urinary output
B. Yellow vision
Digoxin toxicity is a common and dangerous effect. Visual disturbances, most notably yellow vision, may be evidence of digoxin toxicity.
A client has been receiving digoxin. The client calls the clinic and complains of ‘yellow vision.’ Which response would the nurse provide?
A. ‘This is related to your illness rather than to your medication.’
B. ‘This is an expected side effect; you will become accustomed to it over time.’
C. ‘This side effect is only temporary. You should continue the medication.’
D. ‘The medication may need to be discontinued. Come to the clinic this afternoon.’
D. ‘The medication may need to be discontinued. Come to the clinic this afternoon.’
Yellow vision indicates digoxin toxicity; the medication should be withheld until the health care provider can assess the client and check the digoxin blood level.
A client who takes furosemide and digoxin reports to the nurse that everything looks yellow. Which response by the nurse is most appropriate?
A. ‘This is related to your heart problems, not to the medication.’
B. ‘I will hold the medication until I consult with your health care provider.’
C. ‘It is a medication that is necessary, and that side effect is only temporary.’
D. ‘Take this dose, and when I see your health care provider, I will ask about it.’
B. ‘I will hold the medication until I consult with your health care provider.’
The response ‘I will hold the medication until I consult with your health care provider’ is a safe practice because yellow vision indicates digitalis toxicity.
Which response would a nurse give to a client who takes furosemide and digoxin and reports that everything looks yellow?
A. “This is related to your heart problems, not to the medication.”
B. “I will hold the medication until I consult with your health care provider.”
C. “It is a medication that is necessary, and that side effect is only temporary.”
D. “Take this dose, and when I see your health care provider, I will ask about it.”
B. “I will hold the medication until I consult with your health care provider.”
The response “I will hold the medication until I consult with your health care provider” is a safe practice because yellow vision indicates digitalis toxicity.
Which clinical finding indicates that a client taking digoxin may have developed digoxin toxicity?
A. Constipation
B. Decreased urination
C. Cardiac dysrhythmias
D. Metallic taste in the mouth
C. Cardiac dysrhythmias
The development of cardiac dysrhythmias is often a sign of digoxin toxicity.
When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing action is important to include when planning care?
A. Administer the digoxin 1 hour after the client’s morning insulin.
B. Monitor the client for cardiac dysrhythmias.
C. Monitor for increased risk of hyperglycemia.
D. Increase digoxin dosage if insulin requirements are increased.
B. Monitor the client for cardiac dysrhythmias.
The speed of conduction is decreased when digoxin is given, and this can result in a variety of cardiac dysrhythmias.
A client is prescribed furosemide and digoxin for heart failure. The nurse should monitor the client for which potential adverse drug effect?
A. Pulmonary hypertension
B. Acute arterial occlusion
C. Acute kidney injury
D. Cardiac dysrhythmias
D. Cardiac dysrhythmias
Digoxin is a cardiac glycoside, or positive inotrope that increases myocardial contractility. Potassium ions compete with digoxin and a low potassium level can cause digoxin toxicity, leading to lethal cardiac dysrhythmias.
A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take?
A. Offer the client a light snack.
B. Measure the client’s blood pressure.
C. Measure the client’s apical pulse.
D. Weigh the client.
C. Measure the client’s apical pulse.
The nurse should hold the medication and notify the provider if the client’s heart rate is below 60/min or if a change in heart rhythm is detected.
Which assessment will the nurse conduct before administering digoxin to a client?
A. Apical heart rate
B. Radial pulse
C. Difference between carotid and radial pulses
D. Difference between apical and radial pulses
A. Apical heart rate
Because digoxin slows the heart rate, the apical pulse should be counted for 1 minute before administration. If the apical rate is below a preset parameter (usually 60 beats/minute), digoxin should be withheld because its administration may further decrease the heart rate.
A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication?
A. Potassium
B. Hemoglobin
C. Creatinine
D. Blood urea nitrogen
A. Potassium
During therapy, the nurse should closely monitor the client’s potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias.
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin?
A. Observe respiratory rate and depth.
B. Assess the serum potassium level.
C. Obtain the client’s blood pressure.
D. Monitor the serum glucose level.
B. Assess the serum potassium level.
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin.
The client diagnosed with heart failure is prescribed oral digoxin. What is the priority nursing assessment for this medication?
A. Monitor serum electrolytes and creatinine
B. Measure apical pulse prior to administration
C. Maintain accurate intake and output ratios
D. Monitor blood pressure every 4 hours
B. Measure apical pulse prior to administration
Digoxin is an antiarrhythmic and an inotropic drug. It works to increase cardiac output and slow the heart rate. The priority assessment is to measure the apical pulse for one minute prior to administering the drug.
The home care nurse is reviewing the medical record of a new client with a history of chronic obstructive pulmonary disease, atrial fibrillation and gout. After reviewing the client’s medication list, for which medication should the nurse arrange to monitor blood levels?
A. Beclomethasone
B. Digoxin
D. Allopurinol
E. Montelukast
B. Digoxin
It is necessary to monitor blood levels for digoxin to prevent toxicity.
The nurse is preparing to administer digoxin to a client admitted for acute decompensated heart failure. Which action is the priority before giving this drug?
A. Monitor oxygen saturation on room air
B. Assess the client’s weight and compare to the baseline
C. Auscultate the lungs for crackles in the bases
D. Assess the apical pulse for a full minute
D. Assess the apical pulse for a full minute
Digoxin, a cardiac glycoside, is used to slow the heart rate and increase the force of contraction. The priority for the nurse is to count the client’s apical pulse for one full minute, even if the heart rhythm is regular.
A client receives a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator. The client’s apical pulse rate is 44 beats/minute. The nurse concludes that the decreased heart rate is caused by which medication?
A. Diuretic/furosemide
B. Vasodilator/nitroglycerin
C. ACE inhibitor/ “ace” to -pril
D. Cardiac glycoside/digoxin
D. Cardiac glycoside/digoxin
A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate.
A client with heart failure is to receive digoxin. Which therapeutic effect is associated with this medication?
A. Reduces edema
B. Increases cardiac conduction
C. Increases rate of ventricular contractions
D. Slows and strengthens cardiac contractions
D. Slows and strengthens cardiac contractions
Digoxin improves cardiac function by increasing the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect).
Which nursing intervention is NOT important when caring for clients receiving intravenous (IV) digoxin?
A. Monitor the heart rate closely.
B. Check the blood levels of digoxin.
C. Administer the dose over 1 minute.
D. Monitor the serum potassium level.
C. Administer the dose over 1 minute.
Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock.
Digoxin is prescribed for a client. Which therapeutic effect of digoxin would the nurse expect?
A. Decreased cardiac output
B. Decreased stroke volume of the heart
C. Increased contractile force of the myocardium
D. Increased electrical conduction through the atrioventricular (AV) node
C. Increased contractile force of the myocardium
Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart.
A client with left ventricular heart failure and supraventricular tachycardia is prescribed digoxin 0.25 mg daily. Which changes would the nurse NOT expect to find if this medication is therapeutically effective?
A. Diuresis
B. Tachycardia
C. Decreased edema
D. Decreased pulse rate
B. Tachycardia
Because of digoxin’s inotropic and chronotropic effects, the heart rate will decrease.
A client is given a loading dose of digoxin and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. Which responses would the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved?
A. Resolution of heart failure symptoms
B. Decreased anginal episodes
C. Conversion of atrial fibrillation
D. Decreased blood pressure
A. Resolution of heart failure symptoms
Digoxin improves cardiac output to improve heart failure symptoms. Digoxin is not an antianginal medication; if it decreases angina as a result of controlling heart failure, it is a secondary effect. Digoxin may be given to control a rapid ventricular response to atrial fibrillation, but it does not convert the rhythm. Digoxin has a negligible effect on blood pressure; therefore it is not an antihypertensive medication.
The nurse is caring for a client diagnosed with heart failure who will begin treatment with digoxin. Which therapeutic effect would the nurse expect to find after administering this medication?
A. Decreased chest pain with decreased blood pressure
B. Increased heart rate with increased respirations
C. Improved respiratory status with increased urinary output
D. Diaphoresis with decreased urinary output
C. Improved respiratory status with increased urinary output
Digoxin (Lanoxin), a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. The other findings are related to adverse, not therapeutic, effects related to digoxin or are not typically seen at all with digoxin.
The nurse provides medication discharge instructions to a client who received a prescription for digoxin. Which statement by the client leads the nurse to conclude that the teaching was effective?
A. ‘I will avoid foods high in potassium.’
B. ‘I must increase my intake of vitamin K.’
C. ‘I should adjust the dosage according to my activities.’
D. ‘It will be important to check my pulse rate daily.’
D. ‘It will be important to check my pulse rate daily.’
Checking the pulse rate daily is necessary for monitoring cardiac function; digoxin slows and strengthens the heart rate. Digoxin should be withheld, and the health care provider notified, if the pulse rate falls below a predetermined rate (e.g., 60 beats per minute).
hich advice will the nurse include when teaching a client about digoxin for left ventricular failure?
A. Sleep flat in bed.
B. Follow a low-potassium diet.
C. Take the pulse three times a day.
D. Report increasing fatigue.
D. Report increasing fatigue
Treatment with digoxin should improve fatigue associated with heart failure; if fatigue increases, it may reflect complications of therapy.
A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer?
A. Fab antibody fragments
B. Flumazenil
C. Acetylcysteine
D. Naloxone
A. Fab antibody fragments
Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.
The nurse is caring for a client who received digoxin-specific immune fab. Which finding indicates the treatment is having the intended effect?
A. Increased heart rate
B. Decreased potassium levels
C. Decreased blood pressure
D. Increased serum digoxin levels
A. Increased heart rate
The goal of treatment is to lower digoxin levels and treat symptomatic digoxin toxicity, specifically cardiac dysrhythmias including bradycardia.
Effective treatment of dysrhythmia should raise blood pressure.
The nurse administers a parenteral preparation of potassium slowly to avoid which complication?
A. Metabolic acidosis
B. Cardiac arrest
C. Seizure activity
D. Respiratory depression
B. Cardiac arrest
Too rapid an administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest.
Which medication is unsafe to administer as an intravenous (IV) bolus?
A. Saline flush
B. Potassium chloride
C. Naloxone
D. Adenosine
B. Potassium chloride
Potassium chloride given as an IV bolus can cause cardiac arrest.
A nurse is assessing a client receiving intravenous potassium chloride. The client verbalizes pain to the IV site. The site appears swollen and is warm to touch. Which action does the nurse perform?
A. Decrease the rate of the infusion
B. Apply ice to the IV access site
C. Inform the client that this is an expected finding
D. Discontinue the IV catheter
D. Discontinue the IV catheter
The nurse should discontinue the IV catheter. The client’s symptoms are indicative of phlebitis, inflammation of the vein.
The inpatient hospital nurse is caring for a client with hypokalemia. The health care provider prescribed a potassium intravenous (IV) infusion of 40 mEq potassium chloride in 250 mL normal saline to be infused over 4 hours. The nurse receives the infusion from the pharmacy. Which action should the nurse take next?
A. Confirm patency of the peripheral venous access device and start the infusion
B. Notify the health care provider of the inappropriate dose of the prescribed IV potassium
C. Ask another nurse to verify the prescription, IV solution and serum potassium level
D. Ask another nurse to witness the addition of the prescribed potassium to the IV solution
C. Ask another nurse to verify the prescription, IV solution and serum potassium level
Since potassium chloride is considered a high alert medication, especially when given IV, having two nurses verify the order and IV bag is recommended.
Which information will the nurse include when teaching a client about potassium chloride effervescent tablets?
A. Chew the tablet completely.
B. Take the medication with food.
C. Take the medication at bedtime.
D. Use warm water to dissolve the tablet.
B. Take the medication with food.
Eating food when taking the medication will decrease gastrointestinal irritation. Side effects of this medication include abdominal cramps, diarrhea, and ulceration of the small intestine.
A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCL) 20 mEq extended release PO daily. Which of the following instructions should the nurse provide about the new prescription?
A. Take the extended release tablets on an empty stomach.
B. Add an antacid if the medication causes indigestion.
C. Take the extended release tablets whole.
D. Expect urinary output to decrease while on this medication.
C. Take the extended release tablets whole.
The nurse should teach the client that extended release tablets should be taken whole and should not be broken, crushed, or chewed.
Which teaching would a nurse give to a client with a prescription for potassium supplements?
A. To report any abdominal distress
B. To use salt substitutes to season food
C. To take the medication on an empty stomach
D. To increase the dosage if muscle cramps occur
A. To report any abdominal distress
Potassium supplements can cause gastrointestinal ulceration and bleeding.
Potassium supplements are prescribed for a client receiving diuretic therapy. Which client statement indicates that the teaching about potassium supplements is understood?
A. ‘I will report any abdominal distress.’
B. ‘I should use salt substitutes with my food.’
C. ‘The medication must be taken on an empty stomach.’
D. ‘The dosage is correct if my urine output increases.’
A. ‘I will report any abdominal distress.’
Potassium supplements can cause gastrointestinal ulceration and bleeding.
The nurse is discharging a client on oral potassium replacement. Which of the following statements requires further teaching by the nurse?
A. “I can still take my nonsteroidal anti-inflammatory medications occasionally for my arthritis pain.”
B. “I will continue to use salt substitutes to flavor my food.”
C. “I will take my furosemide first thing in the morning.”
D. “I will read the food labels for added potassium.”
B. “I will continue to use salt substitutes to flavor my food.”
Salt substitutes are made using potassium. As the client is taking potassium supplements, they should avoid salt substitutes to prevent hyperkalemia from occurring.
A nurse is preparing to administer potassium chloride (KCL) to a client who is receiving diuretic therapy. The nurse reviews the client’s serum potassium level results and discovers the client’s potassium level is 3.2 mEq/L. Which of the following actions should the nurse take?
A. Give the ordered KCL as prescribed.
B. Omit the KCL dose and document that it was not given.
C. Hold the prescribed dose and notify the provider of the serum potassium level.
D. Call the lab to verify the client’s results.
A. Give the ordered KCL as prescribed.
The client’s serum potassium level is below the recommended reference range. The nurse should administer the KCL as prescribed.
A nurse is caring for a client who has a prescription for potassium chloride (KCL) 20 mEq PO daily. The nurse reviews the client’s most recent laboratory results and finds the client’s potassium level is 5.2 mEq/L. Which of the following actions should the nurse take?
A. Give the ordered KCL as prescribed.
B. Omit the KCL dose and document it was not given.
C. Call the prescribing physician and inform her of the client’s serum potassium level results.
D. Call the lab to verify the client’s results.
C. Call the prescribing physician and inform her of the client’s serum potassium level results.
As a potassium level of 5.2 mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the client’s serum potassium level.
Which assessment would be brought to the health care provider’s attention before administration of intravenous potassium chloride?
A. Progressively worsening muscle weakness
B. Poor tissue turgor with tenting
C. Urinary output of 100 mL during the previous 8 hours
D. Oral fluid intake of 300 mL during the previous 12 hours
C. Urinary output of 100 mL during the previous 8 hours
Decreased urinary output may result in the retention of potassium, causing hyperkalemia.
Intravenous (IV) potassium is prescribed for a client with a diagnosis of hypokalemia. Which statement about administration of IV potassium is accurate?
A. Oliguria/not able to urinate enough, is an indication for withholding IV potassium.
B. Rapid infusion of potassium prevents burning at the IV site.
C. Clients with severe deficits should be given IV push potassium.
D. Average IV dosage of potassium should not exceed 60 mEq in 1 hour.
A. Oliguria/not able to urinate enough, is an indication for withholding IV potassium.
Potassium chloride should not be given unless renal flow is adequate; otherwise, the potassium chloride will accumulate in the body, causing hyperkalemia.
Which reason would an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium be prescribed for a client with a nasogastric (NG) tube set to low intermittent suction?
A. Prevent constipation
B. Prevent dehydration
C. Prevent vomiting
D. Prevent electrolyte imbalance
D. Prevent electrolyte imbalance
When clients do not receive nutrients or fluids by mouth and have a loss of electrolytes through the removal of gastric secretions via an NG tube, electrolyte imbalance is a primary concern.
Which food would the nurse encourage a client to eat while receiving treatment to prevent hypokalemia?
A. Broccoli
B. Oatmeal
C. Fried rice
D. Canned carrots
A. Broccoli
Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup.
When the nurse is administering intravenous potassium to a client with hypokalemia, which finding is most important to communicate to the health care provider?
A. U waves on cardiac monitor
B. QRS duration of 0.28 seconds
C. Decreased bowel sounds
D. Weakened grip strength
B. QRS duration of 0.28 seconds
Widening of the Q waves is a potentially fatal manifestation of hyperkalemia (because it may lead to cardiac arrest) and would be communicated rapidly to the health care provider so that the infusion can be stopped and the potassium level can be rechecked.
The nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective?
A. Pruritus decreases.
B. Mental status improves.
C. Sodium decreases to 137 mEq/L (137 mmol/L).
D. Potassium decreases to 4.2 mEq/L (4.2 mmol/L).
D. Potassium decreases to 4.2 mEq/L (4.2 mmol/L).
This resin exchanges sodium ions for potassium in the large intestine to lower the serum potassium level; 4.2 mEq/L (4.2 mmol/L) is in the expected range for potassium.
A nurse is reviewing the laboratory report of a client and identifies a serum potassium level of 6.8 mEq/L. Which of the following medications should the nurse plan to administer?
A. Lactulose
B. Sevelamer
C. Sodium polystyrene
D. Darbepoetin alfa
C. Sodium polystyrene
Sodium polystyrene is used for the treatment of hyperkalemia., It removes excess potassium by ion exchange through the bowel.
Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective?
A. ‘I should take the medicine three times a day.’
B. ‘I will be sure to take my pulse after I have exercised.’
C. ‘It will be important to avoid activities that can cause angina.’
D. ‘I should take one tablet before attempting activity that has caused angina.’
D. ‘I should take one tablet before attempting activity that has caused angina.’
The response about taking one tablet before activity that has caused angina indicates that the client understands the nurse’s teaching. Taking a nitroglycerin tablet before such an activity probably will prevent an episode of angina
Which instructions about the use of nitroglycerin to prevent angina will the nurse provide to a client?
A. ‘At the point when pain first occurs, place two tablets under the tongue.’
B. ‘Place one tablet under the tongue before activity, and swallow another if pain occurs.’
C. ‘Before physical activity, you know will cause angina, place one tablet under the tongue, and repeat the dose in 5 minutes if pain occurs.’
D. ‘Place one tablet under the tongue when pain occurs and use an additional tablet after the attack to prevent recurrence.’
C. ‘Before physical activity, you know will cause angina, place one tablet under the tongue, and repeat the dose in 5 minutes if pain occurs.’
Anginal pain, which can be anticipated during certain activities, may be prevented by dilating the coronary arteries immediately before engaging in the activity.
A nurse is teaching a client with stable angina about newly prescribed SL nitroglycerin. Which statement should the nurse include in the teaching?
A. “Take this medication after each meal and at bedtime.”
B. “Take one tablet with food.”
C. “Take one tablet immediately when you experience chest pain.”
D. “Take this medication with 8 ounces of water.”
C. “Take one tablet immediately when you experience chest pain.”
When teaching a client about SL nitroglycerin, the nurse should instruct the client to take one tab and place it under their tongue immediately when experiencing chest pain.
A client with angina has been instructed about the use of sublingual nitroglycerin. Which statement by the client indicates the need for additional teaching?
A. “I’ll call the health care provider if pain continues after three tablets five minutes apart.”
B. “I will rest briefly right after taking one tablet.”
C. “I understand that the medication should be kept in the dark bottle.”
D. “I can swallow two or three tablets at once if I have severe pain.”
D. “I can swallow two or three tablets at once if I have severe pain.”
Clients must understand that just one sublingual tablet should be taken at a time.
A client has a prescription for a sublingual nitroglycerin tablet. Which technique will the nurse teach the client to use?
A. Place the pill inside the cheek and let it dissolve.
B. Place the pill under the tongue and let it dissolve.
C. Chew the pill thoroughly and then swallow it.
D. Swallow the pill with a full glass of water.
B. Place the pill under the tongue and let it dissolve.
Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood.
The nurse is preparing a teaching plan for a client prescribed nitroglycerin sublingual. Which would the nurse include in the teaching?
A. ‘Place the tablet under the tongue.
B. ‘It takes 30 to 45 minutes for the nitroglycerin to achieve its effect.’
C. ‘If dizziness occurs, take a few deep breaths and lean the head back.’
D. ‘To facilitate absorption, drink a large glass of water after taking the medication.’
A. ‘Place the tablet under the tongue.
Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Clients are instructed to place the tablet under the tongue and let it dissolve.
Which information would the nurse include when preparing a teaching plan for a client prescribed sublingual nitroglycerin?
A. “Place the tablet under the tongue or between the cheek and gums.”
B. “It takes 30 to 45 minutes for the nitroglycerin to achieve its effect.”
C. “If dizziness occurs, take a few deep breaths and lean the head back.”
D. “To facilitate absorption, drink a large glass of water after taking the medication.”
A. “Place the tablet under the tongue or between the cheek and gums.”
Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Clients are instructed to place the tablet under the tongue or between the cheek and gums and let it dissolve.
A nurse at a provider’s office receives a phone call from a client who reports nausea and unrelieved chest pain after taking a nitroglycerin tablet 5 min ago. Which of the following is an appropriate response by the nurse?
A. Tell the client to take an antacid.
B. Instruct the client to call 911.
C. Tell the client to take another nitroglycerin tablet in 15 min.
D. Advise the client to come to office
B. Instruct the client to call 911.
The nurse should instruct the client to call 911 for transportation to the emergency department because the client is having unstable angina or an acute myocardial infraction.
A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching?
A. “I’ll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart.”
B. “I’ll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period.”
C. “I’ll dial 911 when I have pain and then take the nitroglycerin tablets.”
D. “I’ll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.”
D. “I’ll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.”
If 1 nitroglycerin tablet does not relieve the client’s pain, he should access emergency services and then take 2 more tablets at 5-min intervals if he still has pain.
A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take?
A. Administer another nitroglycerin tablet.
B. Initiate a peripheral IV.
C. Call the Rapid Response Team.
D. Obtain an ECG.
A. Administer another nitroglycerin tablet.
Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain.
A client with midsternal pain presents to the emergency department. Vital signs are stable. Which form of nitroglycerin would the nurse anticipate giving initially?
A. Oral capsule
B. Sublingual spray
C. Intravenous solution
D. Transdermal patch
B. Sublingual spray
Nitroglycerin spray provides prompt relief of symptoms. The nurse administers one to two sprays, up to a maximum of three sprays, onto or under the tongue every 5 minutes until pain is relieved.
Which instruction would the nurse include in a teaching plan for nitroglycerin patches?
A. ‘Apply the patch on a distal extremity.’
B. ‘Remove a previous patch before applying the next one.’
C. ‘Massage the area gently after applying the patch to the skin.’
D. ‘Apply a warm compress to the site before attaching the patch.’
B. ‘Remove a previous patch before applying the next one.’
Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose.
The nurse is teaching a client with stable angina about their new prescription for nitroglycerin transdermal patch. Which instructions should the nurse NOT include.
A. Apply the patch to a hairless area of the body
B. Notify your provider for persistent dizziness or any fainting episode
C. Apply a second patch with chest pain
D. Rotate the application area
C. Apply a second patch with chest pain
The nurse is providing discharge education to a client diagnosed with coronary artery disease. The client is prescribed to use a nitroglycerin transdermal patch at home. Which statement by the client indicates a correct understanding of safe medication administration?
A. “I will remove the old patch and cleanse the area before applying a new patch.”
B. “This drug can lead to hypertension. So, I will monitor my blood pressure at home.”
C. “I will keep a record of chest pain occurrences now that I have this patch.”
D. “I can place this patch on broken skin. It will absorb better.”
A. “I will remove the old patch and cleanse the area before applying a new patch.”
The client should be taught to remove the previous patch before applying the new patch and to properly label the tube of nitroglycerin paste and keep it out of the reach of children
A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching?
A. “I should measure the dosage on the supplied paper.”
B. “I should leave the patch in place until it is time for the next dose.”
C. “I should get up slowly when I stand.”
D. “I might have a headache when I first start taking this medication.”
B. “I should leave the patch in place until it is time for the next dose.”
Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance.
The nurse is preparing to apply nitroglycerin ointment. Before applying the ointment, which action will the nurse take?
A. Assess the client’s pulse rate.
B. Prepare the site with an alcohol swab.
C. Shave the client’s chest in the area for application.
D. Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount.
D. Use the dose measuring application paper and spread the ointment in a thin layer to the prescribed amount.
The nurse would use the dose measuring application paper supplied with the ointment and spread in a thin layer to the prescribed amount and place side down on the desired skin.
A nurse is providing teaching to a client who has stable angina and a new prescription for nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include?
A. Take 1 capsule at the onset of anginal pain.
B. Stop taking the medication if side effects are troublesome.
C. Take the medication with meals.
D. Swallow the capsules whole.
D. Swallow the capsules whole.
The client should swallow the capsules whole and not chew or crush them or place them under the tongue.
A client presents to the emergency department with chest pain. A myocardial infarction is suspected, and 500 mL of 5% dextrose in water (D 5W) with 50 mg of nitroglycerin intravenously (IV) has been prescribed. The nurse will monitor the client for which common side effect of nitroglycerin?
A. Bradycardia
B. Hypotension
C. Nausea and vomiting
D. Leg cramps
B. Hypotension
The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure; orthostatic hypotension can occur.
A nurse has administered sublingual nitroglycerin to a client in the emergency department. Which clinical finding indicates an adverse response to the medication?
A. Persistent chest pain
B. Orthostatic hypotension
C. Decreased heart rate
D. Labored breathing
B. Orthostatic hypotension
Decreased blood pressure when changing positions is an unexpected response to nitroglycerin. The nurse should instruct the client to lay down and elevate the feet to promote venous return.
he nurse working in an intensive care unit is caring for a client diagnosed with acute angina. The client is receiving an intravenous infusion of nitroglycerin. What is the priority assessment for this client?
A. Heart rate
B. Neurologic status
C. Urine output
D. Blood pressure
D. Blood pressure
The client’s blood pressure should be evaluated every 15 minutes until stable, and then every 30 minutes to every hour thereafter.
The nurse on a cardiac unit is caring for a client who is receiving nitroglycerin intravenously for unstable angina. During administration of the medication, which assessment is the priority?
A. Respiratory rate
B. Cardiac enzymes
C. Cardiac rhythm
D. Blood pressure
D. Blood pressure
Nitroglycerin is a drug that is used to provide relief from myocardial chest pain and treat hypertensive emergencies. Nitroglycerin causes vasodilation.
A client with a myocardial infarction receives intravenous nitroglycerin to relieve pain. The nurse will assess which medication side effect?
A. Nausea
B. Delirium
C. Bradycardia
D. Hypotension
D. Hypotension
The major action of intravenous nitroglycerin is venous and then arterial dilation, leading to a decrease in blood pressure and resulting in decreased cardiac workload.
Which instruction would the nurse include when teaching the client about sublingual nitroglycerin?
A. ‘Once the tablet is dissolved, spit out the saliva.’
B. ‘Take tablets 3 minutes apart up to a maximum of five tablets.’c
C. ‘Common side effects include headache and low blood pressure.’
D. ‘Once opened, the tablets should be refrigerated to prevent deterioration.’
C. ‘Common side effects include headache and low blood pressure.’
The primary side effects of nitroglycerin are headache and hypotension.
The nitrate isosorbide dinitrate is prescribed for a client with angina. Which instruction should the nurse include in this client’s discharge teaching plan?
A. Quit taking the medication if dizziness occurs.
B. Do not get up quickly. Always rise slowly.
C. Take the medication with food only.
D. Increase your intake of potassium-rich foods.
B. Do not get up quickly. Always rise slowly.
An expected side effect of nitrates is orthostatic hypotension and the nurse should instruct the client to prevent it by rising slowly.
Which client statement indicates understanding of the side effects of nitroglycerin ointment?
A. ‘I may experience a headache.’
B. ‘Confusion is a common adverse effect.’
C. ‘A slow pulse rate in an expected side effect.’
D. ‘Increased blood pressure readings may occur initially.’
A. ‘I may experience a headache.’
The most common side effect of nitroglycerin is a headache
A nurse in a provider’s clinic is assessing a client who takes sublingual nitroglycerin for stable angina. The client reports getting a headache each time he takes the medication. Which of the following statements should the nurse make?
A. “Take only one dose of nitroglycerin to reduce the risk of getting a headache.”
B. “There’s nothing that can be done to relieve the headaches that nitroglycerin causes.”
C. “Try taking a mild analgesic to relieve the headache. This is a common side effect.”
D. “We will ask the provider to prescribe a different medication for you.”
C. “Try taking a mild analgesic to relieve the headache. This is a common side effect.”
Headache is a common side effect of nitroglycerin. The nurse should suggest conservative measures, such as taking aspirin, acetaminophen, or some other mild analgesic, to manage the headache.
The nurse is providing discharge instructions to a client with a prescription for sublingual nitroglycerin. The nurse should inform the client to prepare for this most common side effect?
A. Headache
B. Depression
C. Dry mouth
D. Anorexia
A. Headache
Nitroglycerin is a potent vasodilator and a headache is the most common side effect.
A client’s dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement?
A. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol).
B. Administer the 40 mg of Imdur and then contact the healthcare provider.
C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol).
D. Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.
C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol).
Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.
Which pain characteristic would the nurse expect to observe when a client is experiencing anginal pain?
A. Unchanged by rest
B. Precipitated by light activity
C. Described as a knifelike sharpness
D. Relieved by sublingual nitroglycerin
D. Relieved by sublingual nitroglycerin
Relief by sublingual nitroglycerin is a classic reaction because it causes vasodilation of peripheral veins and arteries, thereby decreasing oxygen demand by decreasing preload.
Sublingual nitroglycerin has been prescribed for a client with unstable angina. Which client response indicates that nitroglycerin is effective?
A. Pain subsides as a result of arteriole and venous dilation.
B. Pulse rate increases because the cardiac output has been stimulated.
C. Sublingual area tingles because sensory nerves are being triggered.
D. Capacity for activity improves as a response to increased collateral circulation.
A. Pain subsides as a result of arteriole and venous dilation.
Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved?
A. Client states chest pain is relieved.
B. Client’s pulse decreases from 120 to 90.
C. Client’s systolic blood pressure decreases from 180 to 90.
D. Client’s SaO2 level increases from 92% to 96%.
A. Client states chest pain is relieved
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.
The nurse is monitoring a client who is taking prescribed nitroglycerin for angina. Which finding indicates the medication has a therapeutic effect?
A. The client blood pressure is 150/80 mm/Hg.
B. The client heart rate is 110.
C. The client reports a decrease in chest pressure.
D. The client reports a headache.
C. The client reports a decrease in chest pressure.
Nitroglycerin acts to decrease myocardial oxygen consumption. Dilatation of the veins reduces the amount of blood returning to the heart (preload), so the chambers have a smaller volume to pump resulting in decreased oxygen needs. Decreased oxygen demand reduces pain caused by dilating coronary blood flow.
Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The nurse advises the client to anticipate pain relief will begin within which period of time?
A. 1 to 3 minutes
B. 4 to 5 seconds
C. 30 to 45 seconds
D. 10 to 15 minutes
A. 1 to 3 minutes
The onset of action of sublingual nitroglycerin tablets is rapid (1–3 minutes); duration of action is 30 to 60 minutes.
The nurse has administered sublingual nitroglycerin. Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin?
A. Relief of anginal pain
B. Improved cardiac output
C. Decreased blood pressure
D. Ease in respiratory effort
A. Relief of anginal pain
Cardiac nitrates relax smooth muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain
Which client response indicates to the nurse that a vasodilator medication is effective?
A. Absence of adventitious breath sounds
B. Increase in the daily amount of urine produced
C. Pulse rate decreases from 110 to 75 beats/minute
D. Blood pressure changes from 154/90 to 126/72 mm Hg
D. Blood pressure changes from 154/90 to 126/72 mm Hg
Vasodilation will lower the blood pressure.
Which criterion is an indicator that the nitroglycerin sublingual tablets have lost their potency?
A. Sublingual tingling is experienced.
B. The tablets are more than 3 months old.
C. The headache is less severe.
D. Onset of relief is delayed.
B. The tablets are more than 3 months old.
Nitroglycerin tablets are affected by light, heat, and moisture. Loss of potency can occur after 3 months, reducing the medication’s effectiveness in relieving pain.
The nurse is teaching a client who has a new prescription for sublingual nitroglycerin. Which point should the nurse emphasize?
A. Take the medication at the same time each day
B. Rest in bed for an hour after taking medication
C. Carry the nitroglycerine with you at all times
D. Keep the medication bottle in the refrigerator
C. Carry the nitroglycerine with you at all times
The medication should be kept in its original dark-colored glass container. Nitroglycerin should be carried by the client at all times so it can be used when anginal pain occurs.
Which instructions will the nurse give a client for whom nitroglycerin tablets are prescribed?
A. Limit the number of tablets to four per day.
B. Discontinue the medication if a headache develops.
C. Increase the number of tablets if dizziness is experienced.
D. Ensure that the medication is stored in its original dark container.
D. Ensure that the medication is stored in its original dark container.
Nitroglycerin is sensitive to light and moisture, so it must be stored in a dark, airtight container.
A client who had a myocardial infarction receives a prescription for a nitroglycerin patch. Which statement would the nurse identify as the purpose of the nitroglycerin patch?
A. Decreased heart rate lowers cardiac output.
B. Increased cardiac output increases oxygen demand.
C. Decreased cardiac preload reduces cardiac workload.
D. Peripheral venous and arterial constriction increases peripheral resistance.
C. Decreased cardiac preload reduces cardiac workload.
Nitroglycerin reduces cardiac workload by decreasing the preload of the heart by its vasodilating effect.
The health care provider prescribes isosorbide dinitrate 10 mg for a client with chronic angina pectoris. The client asks the nurse why the isosorbide dinitrate is prescribed. How will the nurse respond?
A. ‘It prevents excessive blood clotting.’
B. ‘It suppresses irritability in the ventricles.’
C. ‘It decreases cardiac oxygen demand.’
D. ‘The inotropic action increases the force of contraction of the heart.’
C. ‘It decreases cardiac oxygen demand.’
Isosorbide dinitrate dilates peripheral veins and arteries thus decreasing preload and decreasing oxygen demand.
A client with acute myocardial infarction is admitted to the coronary care unit. Which medication should the nurse administer to lessen the workload of the heart by decreasing the cardiac preload and afterload?
A. Nitroglycerin.
B. Propranolol
C. Morphine.
D. Captopril
A. Nitroglycerin.
Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.
Sodium nitroprusside is prescribed for a client with a blood pressure of 260/120 mm Hg. The nurse recalls that sodium nitroprusside decreases blood pressure by which mechanism?
A. Decreasing the heart rate
B. Increasing cardiac output
C. Increasing peripheral resistance
D. Relaxing venous and arterial smooth muscles
D. Relaxing venous and arterial smooth muscles
This medication decreases blood pressure by relaxing venous and arteriolar smooth muscles and is used for immediate reduction of blood pressure
A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching?
A. “Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain.”
B. “Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries.”
C. “You can store the bottle of tablets in your bathroom medicine cabinet.”
D. “Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart.”
D. “Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart.”
Nitroglycerin relaxes the blood vessels, which increases blood and oxygen supply to the heart.
A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide?
A. Bicarbonate
B. Carbon dioxide
C. Potassium
D. Phosphate
C. Potassium
Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client’s serum potassium level before administering it to prevent hypokalemia.
The nurse is observing a new graduate nurse preparing to administer bumetanide 4 mg orally to a client with heart failure. Which client finding requires the nurse to intervene immediately?
A. The client’s most recent serum potassium level is 2.9 mEq or mmol/L.
B. The client has crackles in both lung bases.
C. The client has 4+ pitting edema in both lower legs.
D. The client’s most recent blood pressure is 96/60 mmHg.
A. The client’s most recent serum potassium level is 2.9 mEq or mmol/L.
Prior to administration, the nurse should verify that the client’s potassium level is within normal range (3.5 to 5.0 mEq or mmol/L).
A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client’s potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action will the nurse take next?
A. Send another blood sample to the laboratory to retest the serum potassium level.
B. Notify the health care provider that the potassium level is above normal.
C. Notify the health care provider that the potassium level is below normal.
D. No action is required because the potassium level is within normal limits.
C. Notify the health care provider that the potassium level is below normal
The health care provider should be notified immediately because the client’s potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5–5.0 mmol/L).
A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the cause of the client’s low potassium level?
A. Furosemide
B. Nitroglycerin
C. Metoprolol
D. Spironolactone
A. Furosemide
Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis, which decreases potassium through excretion in the distal nephrons.
A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor?
A. Hypervolemia
B. Hypertension
C. Hypokalemia
D. Hypoglycemia
C. Hypokalemia
Hypokalemia is an adverse effect of furosemide.
The client is discharged from the hospital with a new prescription for furosemide. During a follow-up visit one week later, the nurse notes the following findings. Which finding is most important to report to the health care provider?
A. Constipation
B. Muscle cramps
C. Occasional lightheadedness
D. Increased urine production
B. Muscle cramps
Furosemide is a loop (potassium-wasting) diuretic. It can cause dehydration and hypokalemia, which can result in muscle cramps.
A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include?
A. “Take this medication before bedtime.”
B. “Monitor for leg cramps.”
C. “Avoid grapefruit juice.’
D. “Reduce intake of potassium-rich foods.”
B. “Monitor for leg cramps.”
Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness.
The nurse is caring for a client who has been taking furosemide for the past week. Which manifestation would indicate that the client may be experiencing a negative side effect?
A. Edema of the ankles
B. Gastric irritability
C. Weight gain of five pounds
D. Decreased appetite.
D. Decreased appetite.
Findings of hypokalemia include anorexia, fatigue, nausea, decreased gastrointestinal motility, muscle weakness and dysrhythmias.
Which sign of hypokalemia will the nurse monitor for in a client receiving furosemide?
A. Chvostek sign
B. Muscle weakness
C. Anxious behavior
D. Abdominal cramping
B. Muscle weakness
With hypokalemia, failure occurs in myoneural conduction and smooth muscle functioning, resulting in fatigue and muscle weakness.
A nurse is assessing a client who is taking chlorothiazide sodium. The nurse recognizes which of the following as a manifestation of hypokalemia?
A. Shallow respirations
B. Hypertensive crisis
C. Diarrhea
D. Hyperreflexia
A. Shallow respirations
A client’s shallow respirations are a sign of weakness in the accessory muscles of breathing, due to hypokalemia.
A client is receiving furosemide to relieve edema. The nurse will monitor the client for which adverse effect?
A. Hypernatremia
B. Elevated blood urea nitrogen
C. Hypokalemia
D. Increase in the urine specific gravity
C. Hypokalemia
Furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of Henle and causes depletion of electrolytes, such as potassium and sodium.
Furosemide has been prescribed as part of the medical regimen for a client with hypertension. Which client statement indicates a need for medication education?
A. ‘This can decrease my vitamin K level.’
B. ‘I will take the medication in the morning.’
C. ‘I will contact my health care provider if I notice muscle weakness.’
D. ‘I plan to take the medication even when my blood pressure is normal.’
A. ‘This can decrease my vitamin K level.’
Furosemide can produce hypokalemia, not vitamin K deficiency.
A client is given a prescription for bumetanide. The nurse will teach the client to watch for symptoms of which condition?
A. Hypokalemia
B. Hyperchloremia
C. Hypernatremia
D. Hypoglycemia
A. Hypokalemia
Bumetanide is a loop diuretic. Diuretic therapy that affects the loop of Henle increases urinary excretion of sodium, chloride, and potassium. As a result, clients are at risk for hypokalemia, hyponatremia, and hypochloremia.
After the nurse provides education about hydrochlorothiazide, the client will agree to notify the health care provider regarding the development of which symptom?
A. Insomnia
B. Nasal congestion
C. Increased thirst
D. Generalized weakness
D. Generalized weakness
Generalized weakness is a symptom of significant hypokalemia, which may be a sequela of diuretic therapy.
A nurse is teaching a client who has a new prescription for bumetanide. Which of the following instructions should the nurse include in the teaching?
A. “Report changes in hearing.”
B. “Avoid foods high in potassium.”
C. “Take the prescribed second dose at nighttime.”
D. “Limit your fluid intake to no more than 1.5 L a day.”
A. “Report changes in hearing.”
High-ceiling loop diuretics can cause ototoxicity. Concurrent use of aminoglycosides, such as gentamycin, increases the risk of ototoxicity.
The nurse is administering 40 mg of furosemide intravenously. Which sensation reported by the client would the nurse consider when determining that it is being administered too quickly?
A. Full bladder
B. Buzzing ears
C. Fast heartbeat
D. Numb arms and legs
B. Buzzing ears
Rapid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ears), loss of hearing, and ear pain.
A nurse is assessing a client with heart failure who is taking prescribed torsemide. Which clinical finding indicates effectiveness of the medication?
A. Symmetrical pulses bilaterally
B. Full strength to bilateral extremities
C. Intact whisper test
D. Absence of peripheral edema
D. Absence of peripheral edema
Torsemide is a loop diuretic used in the treatment of hypertension and fluid overload. The expected therapeutic response of torsemide is a decrease in fluid retention evidenced by the absence of peripheral edema.
A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The health care provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. Which nursing action will best evaluate the effectiveness of the furosemide in managing the client’s condition?
A. Performing daily weights
B. Auscultating breath sounds
C. Monitoring intake and output
D. Assessing for dependent edema
B. Auscultating breath sounds
Although the lessening of a client’s dependent edema reflects effectiveness of furosemide therapy, it is the client’s improving pulmonary status that is the best indicator of how furosemide improves the client’s condition.
Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema?
A. Furosemide
B. Chlorothiazide
C. Spironolactone
D. Acetazolamide
A. Furosemide
Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium; is available for intravenous administration; and is more effective than chlorothiazide, spironolactone, and acetazolamide.
The nurse is providing discharge instructions to an older adult client with heart failure. The client asks, “What is the purpose for taking the furosemide?” How should the nurse respond?
A. It will help with decreasing fluid buildup in your lungs.
B. It will help with reducing the risk for an irregular heart rhythm.
C. It will protect your kidneys from chronic damage.
D. It will reverse the damage to your heart muscle.
A. It will help with decreasing fluid buildup in your lungs.
These drugs enhance the renal excretion of sodium and water by reducing circulating blood volume, decreasing preload, and reducing systemic and pulmonary congestion, i.e., decreased fluid buildup in the lungs.
A client is receiving hydrochlorothiazide. Which physiological alteration will the nurse monitor to best determine the effectiveness of the client’s hydrochlorothiazide therapy?
A. Blood pressure
B. Decreasing edema
C. Serum potassium level
D. Urine specific gravity
A. Blood pressure
Diuretics promote urinary excretion, which reduces the volume of fluid in the intravascular compartment, thus lowering blood pressure. The measure of blood pressure is the best determination of effectiveness because it is a direct measure of the desired outcome.
A nurse is caring for a client whose serum potassium level is 5.3 mEq/L. Which of the following scheduled medications should the nurse plan to administer?
A. Lisinopril
B. Digoxin
C. Furosemide
D. Potassium iodide
C. Furosemide
Furosemide results in loss of potassium from the nephron as part of its diuretic effect. This medication can be given when a client has an elevated potassium level and can lower the potassium level. For this client, the depletion of potassium is a beneficial effect.
Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema?
A. Furosemide
B. Chlorothiazide
C. Spironolactone
D. Acetazolamide
A. Furosemide
Furosemide acts on the loop of Henle by increasing the excretion of chloride and sodium; is available for intravenous administration; and is more effective than chlorothiazide, spironolactone, and acetazolamide.
Hypertension develops in a school-age child with acute glomerulonephritis. Which medication would the nurse anticipate providing teaching for?
A. Digoxin
B. Furosemide
C. Diazepam
D. Phenytoin
B. Furosemide
Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal tubule, increasing urine output and thereby decreasing blood pressure.
A school-age child is admitted with hypertensive acute glomerulonephritis. Which medication would the nurse anticipate being prescribed initially in addition to hydralazine?
A. Digoxin
B. Alprazolam
C. Phenytoin
D. Furosemide
D. Furosemide
Furosemide is a loop diuretic that is recommended for the treatment of acute glomerulonephritis
A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include?
A. Take aspirin if headaches develop.
B. Eat foods that contain plenty of potassium.
C. Expect some swelling in the hands and feet.
D. Take the medication at bedtime.
B. Eat foods that contain plenty of potassium.
Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits.
A client was prescribed furosemide. The nurse would instruct the client to include which food in the diet?
A. Liver
B. Apples
C. Cabbage
D. Bananas
D. Bananas
Bananas have a significant amount of potassium. Bananas: 450 mg; cabbage: 243 mg; liver: 73.6 mg; apples: 100 to 120 mg.
Which instruction would the nurse include when teaching about hydrochlorothiazide given to a client diagnosed with a transient ischemic attack (TIA) related to hypertension?
A. “Resume regular eating habits.”
B. “Drink a protein supplement daily.”
C. “Avoid eating foods high in insoluble fiber.”
D. “Increase the intake of potassium-rich foods.”
D. “Increase the intake of potassium-rich foods.”
The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide.
A client diagnosed with a transient ischemic attack (TIA) related to hypertension is discharged with a prescription of hydrochlorothiazide. Which instruction would the nurse include when teaching about this medication?
A. ‘Resume regular eating habits.’
B. ‘Drink a protein supplement daily.’
C. ‘Avoid eating foods high in insoluble fiber.’
D. ‘Increase the intake of potassium-rich foods.’
D. ‘Increase the intake of potassium-rich foods.’
The client must increase the dietary intake of potassium because of potassium loss associated with hydrochlorothiazide.
Which instruction regarding nutrition will the nurse give a client discharged after a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension who is on a regimen that includes chlorothiazide?
A. “Eat more dark green, leafy vegetables such as spinach.”
B. “Substitute a potassium-based salt substitute for table salt.”
C. “Return to previous eating habits.”
D. “Increase intake of dairy products.”
A. “Eat more dark green, leafy vegetables such as spinach.”
The client should increase the dietary intake of potassium because of potassium loss associated with chlorothiazide. Leafy green vegetables are high in potassium and should be encouraged.
A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide?
A. Weigh weekly to monitor therapeutic effect.
B. Take the medication on an empty stomach.
C. Take the medication early in the day.
D. Muscle pain is an expected adverse effect.
C. Take the medication early in the day.
The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia.
The nurse is discharging a client from the hospital who has a new prescription for furosemide. Which of the following client statements indicates an understanding of the teaching?
A. “I should eat a diet low in potassium while taking this medication.”
B. “I should limit my fluid intake while taking this medication.”
C. “My blood pressure will increase while I am taking this medication.”
D. “I need to limit my sun exposure and wear sunscreen while on this medication.”
D. “I need to limit my sun exposure and wear sunscreen while on this medication.”
Limiting sun exposure and wearing sunscreen are appropriate while taking furosemide due to the adverse effect of photosensitivity.
A health care provider prescribes furosemide for a client with hypervolemia. The nurse recalls that furosemide exerts its effects in which part of the renal system?
A. Distal tubule
B. Collecting duct
C. Glomerulus of the nephron
D. Loop of Henle
D. Loop of Henle
Furosemide acts in the ascending limb of the loop of Henle in the kidney.
Which principle explains how loop diuretics promote diuresis?
A. Osmosis
B. Filtration
C. Diffusion
D. Active transport
A. Osmosis
Loop diuretics inhibit the reabsorption of sodium and water in the ascending loop of Henle. The increased sodium load in the distal tubule causes the passive transfer of water from the glomerular filtrate to urine through the process of osmosis.
Which mechanism of action explains how hydrochlorothiazide increases urine output?
A. Increases the excretion of sodium
B. Increases the glomerular filtration rate
C. Decreases the reabsorption of potassium
D. Increases renal perfusion
A. Increases the excretion of sodium
Hydrochlorothiazide inhibits sodium reabsorption in the nephrons, causing increased excretion of sodium, which increases urine excretion.
A health care provider prescribes a diuretic for a client with hypertension. Which mechanism of action explains how diuretics reduce blood pressure?
A. They facilitate vasodilation.
B. They promotes smooth muscle relaxation.
C. They reduce the circulating blood volume.
D. They block the sympathetic nervous system.
C. They reduce the circulating blood volume.
Diuretics decrease blood volume by blocking sodium reabsorption in the renal tubules, thus promoting fluid loss and reducing arterial pressure.
A nurse is providing instructions to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?
A. Furosemide
B. Hydrochlorothiazide
C. Metolazone
D. Spironolactone
D. Spironolactone
Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia.
A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. The nurse will monitor the client for which adverse medication effect?
A. Bruising
B. Tachycardia
C. Hyperkalemia
D. Hypoglycemia
C. Hyperkalemia
Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse would monitor the client for signs and symptoms of hyperkalemia.
Which medication requires the nurse to monitor the client for signs of hyperkalemia?
A. Furosemide
B. Metolazone
C. Spironolactone
D. Hydrochlorothiazide
C. Spironolactone
Spironolactone is a potassium-sparing diuretic; hyperkalemia is an adverse effect.
A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications?
A. Do not add salt to foods during preparation.
B. Refrain for eating foods high in potassium.
C. Restrict fluid intake to 1000 ml per day.
D. Increase intake of milk and milk products.
B. Refrain for eating foods high in potassium.
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes, which generally contain potassium chloride that can lead to hyperkalemia.
A nurse is providing dietary instructions to a client who is taking prescribed amiloride. Which information will the nurse include in the teaching?
A. Avoid eating foods that are rich in potassium such as bananas
B. It is important to control high-sodium foods such as canned soups
C. Eat plenty of foods that contain calcium such as milk
D. Choose foods that are high in iron content such as shellfish
A. Avoid eating foods that are rich in potassium such as bananas
Amiloride is a potassium-sparing diuretic used in the treatment of edema, hypertension, and potassium loss caused by other diuretic medications.
A client with cirrhosis of the liver has been taking chlorothiazide. The provider adds spironolactone to the client’s medication regimen to prevent which condition?
A. Hyponatremia
B. Hypokalemia
C. Ascites
D. Peripheral neuropathy
B. Hypokalemia
The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss.
The nurse is administering spironolactone for a client diagnosed with cirrhosis of the liver and ascites. Which electrolyte should the nurse anticipate to be spared when giving this medication?
A. Sodium
B. Phosphate
C. Potassium
D. Albumin
C. Potassium
Spironolactone is a potassium-sparing diuretic.
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement?
A. Verify both prescriptions with the healthcare provider.
B. Report the medication interactions to the nurse manager.
C. Hold the ACE inhibitor and give the new prescription.
D. Transcribe and send the prescription to the pharmacy.
A. Verify both prescriptions with the healthcare provider.
The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels.
The nurse is admitting a client to the hospital with findings of liver failure and ascites. A health care provider (HCP) orders spironolactone. The nurse understands that the pharmacological effects of the medication, are which of the following?
A. Combines safely with antihypertensives
B. Depletes potassium reserves
C. Promotes sodium and chloride excretion
D. Increases aldosterone levels
C. Promotes sodium and chloride excretion
Spironolactone is considered a diuretic, that is indicated for individuals with hypertension, edema, congestive heart failure and potassium loss.
The nurse is assessing a postpartum client who is taking labetalol. Which client report should the nurse identify as a potential adverse effect of the medication?
A. Nausea
B. Ankle edema
C. Abdominal pain
D. Dizziness
D. Dizziness
The mechanism of action for labetalol is to vasodilate, which could lead to a decrease in blood pressure. A client with a sudden drop in blood pressure could report dizziness.
The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication?
A. Headache
B. Tachycardia
C. Constipation
D. Hypotension
D. Hypotension
Atenolol competitively blocks stimulation of beta-adrenergic receptors within vascular smooth muscles, which lowers the blood pressure.
The health care provider has written a new order to give metoprolol tartrate 25 mg twice a day by mouth. In assessing the client prior to administering the medications, which finding should the nurse report to the health care provider?
A. Urine output of 50 mL/hour
B. Respiratory rate of 16
C. Blood pressure of 84/56
D. Heart rate of 76 BPM
C. Blood pressure of 84/56
Both medications decrease the heart rate. Metoprolol (Lopressor)affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60 to 100 BPM and systolic BP greater than 100 mm Hg) in order to safely administer both medications.
The nurse is providing information to a client about propranolol. Which statement by the client indicates the teaching has been effective?
A. “I should expect to feel nervousness during the first few weeks.”
B. “I can have a heart attack if I stop this medication suddenly.”
C. “I could have an increase in my heart rate for a few weeks.”
D. “I may experience seizures if I stop the medication abruptly.”
B. “I can have a heart attack if I stop this medication suddenly.”
Suddenly discontinuing a beta blocker can cause angina, hypertension, dysrhythmias, or even a myocardial infarction (i.e., heart attack).
A primary health care provider prescribes atenolol 20 mg by mouth four times a day. Which information is important for the nurse to include in the discharge teaching plan for this client?
A. Drink alcoholic beverages in moderation.
B. Avoid abruptly discontinuing the medication.
C. Increase the medication if chest pain develops.
D. Report a pulse rate less than 70 beats/minute.
B. Avoid abruptly discontinuing the medication.
An abrupt discontinuation of atenolol may cause an acute myocardial infarction.
A client with hypertension has received a prescription for metoprolol. Which information will the nurse include when teaching this client about metoprolol?
A. Do not abruptly discontinue the medication.
B. Consume alcoholic beverages in moderation.
C. Report a heart rate of less than 70 beats per minute.
D. Increase the medication dosage if chest pain occurs.
A. Do not abruptly discontinue the medication.
Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction.
A nurse is admitting a client who is having an exacerbation of his asthma. When reviewing the provider’s orders, the nurse recognizes that clarification is needed for which of the following medications?
A. Propranolol
B. Theophylline
C. Montelukast
D. Prednisone
A. Propranolol
Medications that block beta-2 receptors, such as propanolol, are contraindicated in clients with asthma.
The nurse is caring for a client who has heart failure and a history of asthma. The nurse reviews the provider’s orders and recognizes that clarification is needed for which of the following medications?
A. Carvedilol
B. Fluticasone
C. Captopril
D. Isosorbide dinitrate
A. Carvedilol
Medications that block beta-2 receptors, such as carvedilol, are contraindicated in clients with asthma.
A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?
A. Asthma
B. Glaucoma
C. Depression
D. Migraines
A. Asthma
Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.
Propranolol is prescribed for a client with coronary artery disease (CAD). The nurse should consult with the health care provider (HCP) before giving this medication when the client reports a history of which condition?
A. Asthma
B. Deep vein thrombosis
C. Myocardial infarction
D. Peptic ulcer disease
A. Asthma
Non-cardioselective beta-blockers such as propranolol block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in clients with a history of asthma
A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication?
A. Paroxysmal nocturnal dyspnea
B. Supraventricular tachycardia
C. Malignant hypertension
D. Hyperglycemia
A. Paroxysmal nocturnal dyspnea
Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol and are often manifested by episodes of paroxysmal nocturnal dyspnea and orthopnea.
A 42-year-old male client diagnosed with hypertension tells the nurse he no longer wants to take the prescribed propranolol. Which client statement best explains the reason why he does not want to take this medication?
A. “I have difficulty falling asleep.”
B. “I’m having problems with my stomach.”
C. “I’m experiencing decreased sex drive.”
D. “I feel so tired all the time.”
C. “I’m experiencing decreased sex drive.”
propranolol may cause decreased sex drive, impotence or difficulty having an orgasm in men.
The nurse is providing discharge education to a client who will be starting daily atenolol for the treatment of hypertension. Which side effect is most important for the client to notify their health care provider about?
A. Decreased libido
B. Slow, irregular heart rate
C. Dizziness in the morning
D. Decreased exercise tolerance
B. Slow, irregular heart rate
The client should be taught to assess their heart rate and to notify the health care provider of any changes to the heart rate or rhythm.
The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately?
A. Headache, hypertension, and blurred vision.
B. Wheezing, hypotension, and AV block (cardiac arrythmia).
C. Vomiting, dilated pupils, and papilledema.
D. Tinnitus, muscle weakness, and tachypnea.
B. Wheezing, hypotension, and AV block (cardiac arrythmia).
Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output.
The nurse incorrectly administers carvedilol (Coreg) to a client with an order for benztropine (Cogentin). What is the priority nursing intervention after making this medication error?
A. Complete an incident report
B. Notify the nurse manager
C. Monitor the client’s blood pressure
D. Notify the health care provider
C. Monitor the client’s blood pressure
Because the nurse mistakenly administered a beta blocker medication, the priority intervention is to monitor the client for any adverse physiological response to the given drug. Carvedilol blocks alpha1 and beta receptors in blood vessels, causing dilation and a decrease in blood pressure.
The nurse administers a dose of metoprolol for a client. Which assessment is most important for the nurse to obtain?
A. Temperature.
B. Lung sounds.
C. Blood pressure.
D. Urinary output.
C. Blood pressure.
It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.
The nurse is preparing to administer metoprolol to a client with a history of hypertension. Which of the following data is the priority for the nurse to review prior to administration?
A. Potassium level
B. Most recent heart rate
C. Creatinine level
D. Respiratory rate
B. Most recent heart rate
Beta-blockers, such as metoprolol, can decrease heart rate and blood pressure, so the nurse should review these specific vital signs prior to administering the medication.
A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?
A. Heart rate 46/min
B. Oxygen saturation 95%
C. Respiratory rate 18/min
D. Blood pressure 160/94 mm Hg
A. Heart rate 46/min
The nurse should check the client’s heart rate prior to administering a beta-blocker. If the client’s heart rate is less than 50/min, the nurse should hold the medication and contact the provider.
The nurse is talking with a client who was admitted with an acute myocardial infarction due to coronary artery disease. The clients ask what the purpose for the prescribed carvedilol is. How should the nurse respond?
A. “A beta blocker will prevent postural hypotension.”
B. “Most people develop hypertension after a heart attack.”
C. “This drug will decrease the workload on your heart.”
D. “Beta blockers will help to increase your heart rate.”
C. “This drug will decrease the workload on your heart.”
One action of beta blockers is to decrease systemic vascular resistance by dilation of the arterioles. This is useful for clients with coronary artery disease and will reduce the risk of another MI or a sudden cardiac event.
A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response?
A. Depleting acetylcholine
B. Stimulating histamine release
C. Blocking the adrenergic response
D. Decreasing adrenal release of epinephrine
C. Blocking the adrenergic response
The beta-adrenergic blocking effect of atenolol decreases the heart’s rate and contractility; it may result in orthostatic hypotension and decreased cerebral perfusion, causing dizziness.
A client with hypertensive heart disease who had an acute episode of heart failure is to be discharged on a regimen of metoprolol and digoxin. Which outcome would the nurse anticipate when metoprolol is administered with digoxin?
A. Headaches
B. Bradycardia
C. Hypertension
D. Junctional tachycardia
B. Bradycardia
Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate.
Which action describes a therapeutic effect of atenolol?
A. Heart rate decreases
B. Cardiac output increases
C. Bronchospasm is relieved
D. Pulse oximetry improves
A. Heart rate decreases
Atenolol, a beta-blocker, slows the rate of sinoatrial (SA) node discharge and atrioventricular (AV) node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial oxygen consumption.
A beta blocker is prescribed for the client with persistent ventricular tachycardia. Which response indicates that the beta blocker is working effectively?
A. Decreased anxiety
B. Reduced chest pain
C. Decreased heart rate
D. Increased blood pressure
C. Decreased heart rate
A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart.
A client has primary open-angle glaucoma. Which ophthalmic preparation is indicated to manage this condition?
A. Tetracaine
B. Fluorescein
C. Timolol maleate
D. Atropine sulfate
C. Timolol maleate
A client is receiving metoprolol. Which potential effect will the nurse teach the client to expect?
A. Dizziness with strenuous activity
B. Acceleration of the heart rate after eating a heavy meal
C. Flushing sensations after taking the medication
D. Pounding of the heart
A. Dizziness with strenuous activity
Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart’s rate and contractility in response to exercise does not occur. This, combined with the medication’s hypotensive effect, may lead to dizziness.
A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication?
A. Ototoxicity
B. Tachycardia
C. Postural hypotension
D. Hypoglycemia
C. Postural hypotension
Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client’s blood pressure from a lying to sitting to standing position.
The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client’s blood pressure. Which instruction should the nurse provide the client regarding the new medication?
A. Take the medication at bedtime.
B. Report presence of increased bruising.
C. Check pulse before taking medication.
D. Rise slowly when getting out of bed or chair.
D. Rise slowly when getting out of bed or chair.
The client’s new medication is an angiotensin-converting enzyme (ACE) inhibitor, which has the side effect of orthostatic hypotension.
The nurse provides instruction when the beta-blocker (BB) atenolol is prescribed for a client with moderate hypertension. Which client statement indicates to the nurse that further teaching is needed?
A. ‘I must take the medication before going to bed.’
B. ‘This medication will make me feel drowsy.’
C. ‘I need to count my pulse before taking the medication.’
D. ‘I will move slowly when changing positions from sitting to standing.’
A. ‘I must take the medication before going to bed.’
This medication should be taken early in the morning to maximize its therapeutic effect.
Which is an appropriate nursing action when caring for a client taking benazepril for hypertension?
A. Assess for dizziness.
B. Assess for dark, tarry stools.
C. Administer the medication after meals.
D. Monitor the electroencephalogram (EEG).
A. Assess for dizziness.
Dizziness may occur during the first few weeks of therapy until the client adapts physiologically to the medication.
The nurse prepares discharge instructions for a client who will take enalapril for hypertension. Which instruction would the nurse include in the client’s teaching?
A. ‘Change to a standing position slowly.’
B. ‘This may color your urine green.’
C. ‘The medication may cause a sore throat for the first few days.’
D. ‘Schedule blood tests weekly for the first 2 months.’
A. ‘Change to a standing position slowly.’
Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. Like many antihypertensives, it can cause orthostatic hypotension.
A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse’s discharge instructions should include reporting which problem to the healthcare provider?
A. Weight loss.
B. Dizziness.
C. Muscle cramps.
D. Dry mucous membranes.
B. Dizziness.
Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness.
The nurse is reviewing prescribed medications with a client. Which information should the nurse reinforce about captopril?
A. Take the medication with meals.
B. Avoid using salt substitutes.
C. Restrict fluids to 1000 mL/day.
D. Avoid green leafy vegetables
B. Avoid using salt substitutes.
Captopril is used to treat hypertension and heart failure. Because it can cause an accumulation of serum potassium (i.e., hyperkalemia), clients should avoid the use of salt substitutes, which often contain potassium instead of sodium chloride.
A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide?
A. Do not use salt substitutes while taking this medication.
B. Take the medication with food.
C. Count your pulse rate before taking the medication.
D. Expect to gain weight while taking this medication.
A. Do not use salt substitutes while taking this medication.
Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.
A nurse is teaching a client who has a new prescription for captopril. Which of the following instructions should the nurse include in the teaching?
A. Monitor for a cough.
B. Hold medication for heart rate less than 60/min.
C. Take this medication with food.
D. Avoid grapefruit juice.
A. Monitor for a cough.
Captopril is an ACE inhibitor used to treat hypertension. The client should monitor and report a cough and dyspnea.
A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of following statements by the nurse indicates an understanding of the teaching?
A. “I should increase my intake of potassium-rich foods.”
B. “I should expect to have facial swelling when taking this medication.”
C. “I should take this medication with food.”
D. “I should report a cough to my provider.”
D. “I should report a cough to my provider.”
The client should report a cough to the provider. The provider should discontinue the medication for a persistent, irritating cough.
A client taking multiple medications for hypertension develops a persistent, hacking cough. Which antihypertensive medication class would the nurse identify as the likely cause of the cough?
A. Thiazide diuretics
B. Calcium channel blockers
C. Direct renin inhibitors
D. Angiotensin-converting enzyme (ACE) inhibitors
D. Angiotensin-converting enzyme (ACE) inhibitors
When ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to the common adverse effect sometimes referred to as an ACE cough.
A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report?
A. Dry cough
B. Swelling of the tongue
C. Nausea
D. Nasal congestion
B. Swelling of the tongue
When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat.
Captopril is prescribed for a client. Which effect would the nurse anticipate?
A. Increased urine output
B. Decreased anxiety
C. Improved sleep
D. Decreased blood pressure
D. Decreased blood pressure
Captopril is an angiotensin-converting enzyme (ACE) inhibitor antihypertensive. It does not have diuretic, sedative, or hypnotic properties.
A health care provider prescribes enalapril for a client. Which nursing action is important?
A. Assess the client for hypokalemia.
B. Monitor for adverse effects on renal function.
C. Monitor the client’s blood pressure during therapy.
D. Assess the client for hypoglycemia.
C. Monitor the client’s blood pressure during therapy.
Enalapril is an antihypertensive. A lowering of the client’s blood pressure reflects a therapeutic response and needs to be monitored regularly.
A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication?
A. Decreased blood pressure
B. Increase of HDL cholesterol
C. Prevention of bipolar manic episodes
D. Improved sexual function
A. Decreased blood pressure
Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure.
Which medication may be useful in managing hypertension in a child with acute glomerulonephritis?
A. Digoxin
B. Diazepam
C. Captopril
D. Phenytoin
C. Captopril
Captopril, an angiotensin-converting enzyme inhibitor antihypertensive, blocks the conversion of angiotensin I to the constrictor angiotensin II.
The nurse is caring for a client who is being treated for heart failure. After completing the medication reconciliation process, the nurse notes that the prescriber has added lisinopril 5mg orally bid. Which medication from the list below should the nurse question due to possible drug-to-drug interaction with lisinopril?
A. Metoprolol
B. Glipizide
C. Naproxen
D. Enoxaparin
C. Naproxen
Nonsteroidal anti-inflammatory (NSAIDs) drugs, such as naproxen, reduce the antihypertensive effects of angiotensin converting enzyme (ACE) inhibitors such as lisinopril. The use of NSAIDs and ACE inhibitors may also predispose patients to develop acute renal failure.
Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. The nurse will monitor the client for which adverse effect?
A. Constipation
B. Hyperkalemia
C. Hypertension
D. Change in visual acuity
B. Hyperkalemia
Hyperkalemia may occur with valsartan.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client’s laboratory results and notes that the client’s serum potassium level is 5.9 mEq/L. Which action should the nurse take first?
A. Withhold the scheduled dose.
B. Check the client’s apical pulse.
C. Notify the healthcare provider.
D. Repeat the serum potassium level.
A. Withhold the scheduled dose.
The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l).
A client with hypertension is prescribed an angiotensin II receptor blocker (ARB). Which instructions will the nurse provide about this medication?
A. ‘Monitor the blood pressure twice daily.’
B. ‘Stop treatment if a occasional cough develops.’
C. ‘Stop the medication if swelling of the mouth, lips, or face develops.’
D. We will draw labs daily on you while on this drug.
C. ‘Stop the medication if swelling of the mouth, lips, or face develops.’
The medication should be stopped if angioedema occurs, and the health care provider should be notified.
Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)?
A. Fluid volume deficit.
B. Risk for infection.
C. Risk for injury.
D. Impaired sleep patterns.
C. Risk for injury.
Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury
How would the nurse determine if a client is experiencing the therapeutic effect of valsartan?
A. Check a lipid profile.
B. Assess an apical pulse.
C. Measure urinary output.11
D. Check the blood pressure.
D. Check the blood pressure.
Angiotensin II receptor blockers (ARBs) are antihypertensive medications that lower the blood pressure.
Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan has been achieved?
A. Dependent edema reduced from +3 to +1.
B. Serum HDL increased from 35 to 55 mg/dL.
C. Pulse rate reduced from 150 to 90 beats/minute.
D. Blood pressure reduced from 160/90 mmHg to 130/80 mmHg.
D. Blood pressure reduced from 160/90 mmHg to 130/80 mmHg.
Valsartan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.
A nurse is assessing a client who started taking prescribed olmesartan 2 weeks ago. Which finding indicates an expected response to the medication?
A. Heart rate of 85 beats/min
B. Urinary output of 45 ml/hr
C. Blood pressure of 125/79 mmHg
D. Respiratory rate of 20 breaths/min
C. Blood pressure of 125/79 mmHg
Olmesartan is an angiotensin II receptor antagonist used in the treatment of hypertension. The expected outcome is to maintain the blood pressure within normal limits.
A nurse is reviewing a client’s medical history. The client has been newly diagnosed with hypertension and has been prescribed oral losartan as treatment. The nurse will clarify the use of losartan if which comorbidity is noted in the client’s medical record?
A. Renal stenosis
B. Hyperlipidemia
C. Atrial fibrillation
D. Diabetes
A. Renal stenosis
Losartan is contraindicated in clients with renal stenosis due to the risk of kidney injury.
A client who has been diagnosed with Raynaud’s disease and hypertension is prescribed nifedipine. For which side effect should the nurse monitor the client?
A. Cyanosis of the lips
B. Decreased urine output
C. Increased pain in fingers
D. Facial flushing
D. Facial flushing
Nifedipine is a calcium channel blocker (CCB) used in the treatment of Raynaud’s disease and hypertension by producing vasodilation. As a result of this vasodilating effect, facial flushing can occur.
Amlodipine is prescribed for a client with hypertension. Which response to the medication will the nurse instruct the client to report to the health care provider?
A. Blurred vision
B. Dizziness on rising
C. Difficulty breathing
D. Excessive urination
C. Difficulty breathing
Dyspnea may indicate development of pulmonary edema, which is a life-threatening condition.
Which advice would the nurse include in a teaching plan to reduce the side effects of diltiazem?
A. Lie down after meals.
B. Avoid dairy products in diet.
C. Take the medication with an antacid.
D. Change slowly from sitting to standing.
D. Change slowly from sitting to standing.
A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?
A. Hyperthermia
B. Hypotension
C. Ototoxicity
D. Muscle pain
B. Hypotension
Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.
A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?
A. Notify the client’s provider.
B. Check the client’s vital signs.
C. Fill out an occurrence form.
D. Administer the medication to the correct client.
B. Check the client’s vital signs.
The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client’s vital signs (especially the client’s blood pressure) to ensure that the client is not hypotensive as a result.
Which instruction will the nurse NOT include in a teaching plan for a client taking a calcium channel blocker such as nifedipine?
A. Report peripheral edema.
B. Expect temporary hair loss.
C. Avoid drinking grapefruit juice.
D. Change to a standing position slowly.
B. Expect temporary hair loss.
Hair loss does not occur.
The nurse is assisting a client who is taking amlodipine with meal planning. Which fluid selected by the client would require follow up by the nurse?
A. Black coffee
B. Grapefruit juice
C. Green tea
D. Chocolate Milk
B. Grapefruit juice
Grapefruit juice affects the metabolism of certain medications, such as amlodipine, and may cause toxicity if taken together.
A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication?
A. Milk
B. Orange juice
C. Coffee
D. Grapefruit juice
D. Grapefruit juice
Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism
Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be correct.
A. Alcohol
B. Grapefruit juice
C. Cheddar cheese
D. Summer sausage
E. Dark green vegetables
B. Grapefruit juice
A nurse is providing education to a client about newly prescribed diltiazem. Which statement will the nurse include in the teaching?
A. Skip the dose if your systolic blood pressure is less than 120 mmHg
B. Hold the dose if your heart rate is less than 50 beats/min
C. Call your healthcare provider if you experience any fever
D. Notify your healthcare provider if you notice any weight loss
B. Hold the dose if your heart rate is less than 50 beats/min
Diltiazem is a calcium channel blocker medication used in the treatment of hypertension and cardiac arrhythmias such as atrial flutter and fibrillation. Diltiazem can cause bradycardia. The nurse should instruct the client how to take their pulse and hold the dose if less than 50 beats/min.
A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective?
A. Increased urine output
B. Blood pressure of 88/60 mm Hg
C. Heart rate of 90 beats/minute
D. No longer complaining of gentle heart palpations
C. Heart rate of 90 beats/minute
Diltiazem hydrochloride’s purpose is to slow down the heart rate. SVT has a heart rate of 150 to 250 beats/minute. A heart rate of 110 beats/minute indicates that the diltiazem hydrochloride is having the desired effect
The nurse is preparing to administer diltiazem to a client with heart disease. Which action should the nurse take first?
A. Assess the client’s lung sounds and monitor for wheezing
B. Assess the client’s blood pressure and apical pulse
C. Assess the client’s urine output and potassium level
D. Auscultate the abdomen for bowel sounds
B. Assess the client’s blood pressure and apical pulse
Because the medication can lead to hypotension and bradycardia, it is essential to assess the client’s blood pressure and apical pulse prior to administration.
A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include?
A. “Limit your fluid intake to meal times.”
B. “Do not take this medication on an empty stomach.”
C. “Increase your daily intake of dietary fiber.”
D. “You can expect swelling of the ankles while taking this medication.”
C. “Increase your daily intake of dietary fiber.”
The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil.
A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect?
A. Blurred vision
B. Orthostatic hypotension
C. Muscle weakness
D. Urinary retention
C. Muscle weakness
Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness.
Which instructions will the nurse NOT include in the teaching plan for a client who will be taking simvastatin?
A. Increase dietary intake of potassium.
B. Avoid prolonged exposure to the sun.
C. Schedule regular ophthalmic examinations.
E. Contact your health care provider for unexplained muscle pain.
A. Increase dietary intake of potassium.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client?
A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms.
B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping.
C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect.
D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.
C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect.
Myopathy, suggested by the leg pain and weakness, is a serious and potentially life-threatening complication of Lipitor, and should be evaluated immediately by the healthcare provider.
Which clinical indicator would the nurse monitor to determine if the client’s simvastatin is effective?
A. Heart rate
B. Triglycerides
C. Blood pressure
D. International normalized ratio (INR)
B. Triglycerides
Therapeutic effects of simvastatin include decreased levels of serum triglycerides, low-density lipoprotein (LDL), and cholesterol.
A health care provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which advice is important for the nurse to teach when the client initially takes the medication?
A. Take the medication with breakfast.
B. Have liver function tests every 6 months.
C. Wear sunscreen to prevent photosensitivity reactions.
D. Inform the health care provider if you wish to become pregnant.
D. Inform the health care provider if you wish to become pregnant.
Simvastatin is a teratogen that is contraindicated in pregnancy because it is capable of causing fetal damage.
A nurse is teaching a client who is taking atorvastatin daily. Which of the following statements by the client indicates an understanding of the teaching?
A. “I will avoid drinking grapefruit juice.”
B. “I should take this medication without food.”
C. “I should expect my stools to turn clay-colored.”
D. “It is not necessary to have routine lab tests done.”
A. “I will avoid drinking grapefruit juice.”
Grapefruits and grapefruit juice can reduce metabolism of atorvastatin, which increases the risk for toxicity
A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include?
A. “You should expect brown-colored urine.”
B. “You should avoid grapefruit juice.”
C. “You should monitor for ringing in the ears.”
D. “You should take the medication in the morning.”
B. “You should avoid grapefruit juice.”
Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin.
A nurse is teaching about necessary baseline examinations with a female client who is to start taking atorvastatin. Which of the following baseline examinations should the nurse include in the teaching?
A. Liver function tests
B. Hearing test
C. Papanicolaou test
D. Dental examination
A. Liver function tests
The nurse should inform the client that statins such as atorvastatin can cause liver damage and should not be taken by clients who have a history of liver disease. The client should undergo baseline liver function testing before beginning therapy, and every 6 to 12 months thereafter.
