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54/64 Unit 1 > Cardiovascular Pharmacology & Delegation > Flashcards

Cardiovascular Pharmacology & Delegation Flashcards

1
Q

The transference of responsibility and authority of an activity to a competent individual

A

Delegation

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2
Q

The individual who accepts responsibility for the work

A

Delegate

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3
Q

The individual who assigns the task but still remains accountable for the outcome

A

Delegator

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4
Q

The active support of an issue that has importance

A

Advocacy

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5
Q

When is it acceptable for a nurse to delegate nursing activities to another nurse?

A

As long as the second nurse is free

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6
Q

Rights of delegation

A

Right: task, circumstance, person, direction, supervision

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7
Q

Right of delegation by which the delegator must ensure that the task can be delegated according to facility procedures and state regulations

A

Right task

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8
Q

Right of delegation by which the delegator must determine that the task addresses the patient’s needs and contributes to a desired outcome

A

Right circumstances

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9
Q

Right of delegation by which the delegator makes sure that the delegate has the right experience and skills to carry out the task

A

Right person

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10
Q

Right of delegation in which the delegator must provide a clear, concise description of the task along with its limits, objectives and expectations, and ensures the instructions are understood

A

Right direction

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11
Q

Right of delegation in which the delegator must monitor and evaluate the delegate’s performance and give feedback when necessary

A

Right supervision

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12
Q

Tasks that can be delegated to UAP

A

Vital signs, I&O, patient transfers and ambulation, bathing, feeding, weighing

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13
Q

Tasks that cannot be delegated to UAP

A

Assessment, interpreting data, making NSG diagnosis, care planning, evaluation, care of invasive lines, inserting NG tube, patient education, care of any unstable patient

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14
Q

Principles for delegating to UAP

A

Nurse must assess patient prior to delegating, patient must be medically stable, task should be considered routine (not skill), task should have predictable outcome, nurse is responsible for assessing UAP’s ability/knowledge

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15
Q

Delegation benefits to the nurse

A

Time management (more time spent on complex care)

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16
Q

Delegation benefits to delegate

A

Allows learning of new skills and increase confidence

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17
Q

Delegation benefits to manager

A

Unit functions at higher and more cost-efficient way

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18
Q

Legal case by which patient with cognitive deficits was left unattended in the bathtub and drowned. Both UAP and nurses were liable

A

Ferry v. State of Oklahoma (2007)

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19
Q

Legal case by which nurse documented completion of care without evaluation (falsifying records)

A

Williams vs. West Virginia Board of Examiners (2004)

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20
Q

Class of medications that increase sodium excretion and vasodilate arterial blood vessels

A

Diuretics

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21
Q

Diuretics decrease

A

Preload

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22
Q

Diuretics preferred in patients with adequate renal function

A

Thiazide diuretics (HCTZ)

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23
Q

Diuretics that can be used in patients with reduced renal function

A

Loop diuretics

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24
Q

Side effects of thiazide and loop diuretics

A

Hypokalemia, hyponatremia, postural hypotension

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25
Q

Examples of thiazide diuretics

A

Hydrochlorothiazide (HCTZ), Metolazone (Zaroxoyln), and chlorothiazide (Diuril)

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26
Q

Examples of loop diuretics

A

Furosemide (Lasix) and bumetanide (Bumex)

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27
Q

Diuretics contraindicated in patients with hyperkalemia and renal failure

A

Potassium sparing

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28
Q

Example of potassium sparing diuretic

A

Spironolactone

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29
Q

Nursing consideration for thiazide and loop diuretics

A

Not to be used in patients with sulfa allergy

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30
Q

Goal of all diuretics

A

Increase urinary output

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31
Q

Medication given to treat or prevent shock following a serious injury, blood loss, surgery, or burns by increasing blood plasma

A

Albumin

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32
Q

Class of medications that reduces preload and afterload through arterial and venous dilation and inhibition of angiotensin

A

ACE inhibitors

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33
Q

Side effects of ACE inhibitors

A

Angioedema, Cough, Hyperkalemia, Acute Kidney Injury

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34
Q

Nursing implications for ACE inhibitors

A

Hold if rising creatinine, hold 3 days prior to open heart surgery

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35
Q

T or F: it is OK to use ARBs if allergic to ACE inhibitors

A

True (ARBs are less likely to cause cough, hyperkalemia, or angioedema)

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36
Q

Side effect of ARBs

A

Hypotension

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37
Q

Examples of ARBs

A

Irbesartan (Avapro), Losartan (Cozaar), Valsartan (Diovan)

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38
Q

When calcium is blocked, HR is _________

A

Reduced

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39
Q

Calcium Channel blockers reduce

A

Afterload through vasodilation

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40
Q

Side effects of calcium channel blockers

A

Hypotension, bradycardia, heart block, lower extremity edema

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41
Q

Examples of calcium channel blockers

A

Amlodipine (Norvasc), Verapamil, Nifedipine (Procardia), Cardizem

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42
Q

Alpha blockers lower BP by

A

Vasodilation

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43
Q

Beta blockers lower BP by

A

Decreasing HR and CO

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44
Q

Alpha 1 and 2 receptors affect

A

Vasculature

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45
Q

Beta 1 receptors affect

A

Heart, vasculature

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46
Q

Beta 2 receptors affect

A

Bronchial smooth muscle

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47
Q

Antagonist effect of Alpha 1 and 2 receptors

A

Vasodilation

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48
Q

Antagonist effect of Beta 1 receptors

A

Vasodilation

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49
Q

Antagonist effect of Beta 2 receptors

A

Bronchoconstriction

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50
Q

Vasculature refers to

A

Arteries, arterioles, and veins

51
Q

Beta ___ receptors are cardioselective, and Beta ___ receptors are non-cardioselective

A

1; 2

52
Q

Side effects of Alpha 1 blockers

A

Orthostatic hypotension, nausea, headache

53
Q

Examples of alpha 1 blockers

A

Doxazosin (Cardura) and Terazosin (Hytrin)

54
Q

Class of medications that diminish the effects of epinephrine and other stress hormones, reducing HR

A

Beta Blockers

55
Q

Side effects of beta blockers

A

Bradycardia, decreased AV conduction, reduced contractility

56
Q

Examples of nonselective beta blockers

A

Propranolol, sotalol, nadolol, carvedilol

57
Q

What beta blocker also has alpha blocking activity?

A

Carvedilol

58
Q

Examples of cardioselective beta blockers

A

Metoprolol (Lopressor), Esmolol (Brevibloc), and Atenolol (Tenormin)

59
Q

Beta blockers that can be used in patients with asthma

A

Low dose CARDIOSELECTIVE beta blockers

60
Q

Class of medications that relax and dilate blood vessels

A

Vasodilators

61
Q

Side effects of vasodilators

A

Flushing, orthostatic hypotension, dizziness/lightheadedness, reflex tachycardia

62
Q

Examples of vasodilators

A

Hydralazine, sodium nitroprusside nipride, nitroglycerin

63
Q

Vasodilator safe to use in kidney patients

A

Hydralazine

64
Q

Nursing implications for sodium nitroprusside nipride

A

Monitor thiocyanate levels because this medication can cause cyanide toxicity after 3 days

65
Q

S/S of cyanide toxicity

A

Blurred vision, confusion, seizures

66
Q

Nursing implications for nitroglycerin

A

Patient should be seating when inhaling or taking SL nitrated because they can drastically drop BP

67
Q

Class of medications that dilates veins, arteries, and arterioles

A

Nitrates

68
Q

Examples of nitrates

A

Nitroglycerin, isosorbide, ranolazine

69
Q

Class of medications that cause vasoconstriction and increase afterload

A

Vasopressors

70
Q

Examples of vasopressors

A

Norepi (Levophed), Epi, phenylephrine, dopamine, vasopressin

71
Q

Nursing implications for vasopressors

A

Always use a central line if available

72
Q

Effectiveness of vasopressors is decreased with severe _________

A

Acidosis

73
Q

Nursing implications for epinephrine

A

Monitor BG (epi raises BG)

74
Q

Vasopressors that can be used in patients with tachycardia because it has no effect on HR

A

Phenylephrine (Neosynephrine)

75
Q

Medication that has a positive inotropic effect and decreases HR and AV conduction allowing for more ventricular filling

A

digoxin (cardiac glycoside)

76
Q

Side effects of digoxin

A

N/V, dizziness, bradycardia

77
Q

Digoxin toxicity

A

Visual disturbance (halo effect), arrythmias (AV heart block, Vfib)

78
Q

Nursing implications for digoxin

A

Monitor levels due to narrow therapeutic range, monitor HR and hold if less than 60 bpm

79
Q

__________ increased the risk for digoxin toxicity

A

Hyperkalemia

80
Q

Positive inotropic medications increase

A

Contractility

81
Q

Examples of positive inotropic medications

A

Dopamine, dobutamine, primacor

82
Q

Adverse effects of dobutamine

A

Increase HR, arrhythmias, hypotension

83
Q

Abnormality in the rhythm of the heartbeat

A

Arrhythmia

84
Q

Medications used to suppress abnormal rhythms of the heart

A

Antiarrhythmics

85
Q

Types of antiarrhythmics

A

Tachyarrhythmics, bradyarrhythmics

86
Q

Examples of tachyarrhythmics

A

Amiodarone, cardizem, lidocaine, adenosine

87
Q

Medication that slows HR and can convert back to sinus rhythm

A

Amiodarone

88
Q

Amiodarone caution

A

Pulmonary fibrosis liver failure

89
Q

Reversal agent for cardizem

A

Calcium

90
Q

Lidocaine toxicity

A

Mouth/tongue numbness, dizziness, confusion, visual/auditory disturbances, drowsiness, seizures

91
Q

Lidocaine toxicity intervention

A

Lipid emulsion infusion

92
Q

Nursing implications for adenosine

A

Have patient attached to or close to crash cart just to be safe

93
Q

Examples of bradyarrhythmias

A

Atropine, isoproterenol

94
Q

Medication that increases HR and improves AV conduction by blocking parasympathetic influences on the heart

A

Atropine

95
Q

Side effects to be aware of with isoproterenol

A

Tachyarrhythmias, MI, and hypotension

96
Q

Class of medications that prevent formation of new clots and extension of clots already present

A

Anticoagulants

97
Q

Examples of anticoagulants

A

Heparin, enoxaparin (Lovenox), warfarin (Coumadin)

98
Q

Reversal agent for Coumadin

A

Vitamin K

99
Q

Nursing implications for Coumadin

A

Labs required at least once a month OR once a week if not within therapeutic range

100
Q

Examples of Direct Oral Anticoagulants (DOAC)

A

Rivaroxaban (Xarelto), apixaban (Eliquis)

101
Q

Xarelto education

A

Must be taken with at least 300 calories or can decrease absorption

102
Q

Nursing implications for novel anticoagulants or DOACs

A

Need renal/liver function test for dosing, no routine lab monitoring

103
Q

The only DOAC with reversal agent

A

Dabigatran (Pradaxa) —> direct thrombin inhibitor

104
Q

heparin nursing considerations

A

Risk for HIT, hold 4-6 hrs before any invasive procedure

105
Q

Lovenox nursing consideration

A

Hold for invasive procedures

106
Q

Coumadin nursing considerations

A

3-5 days to take effect, hold for days prior to any invasive procedure, MANY food/drug interactions

107
Q

Side effects of anticoagulants

A

Bleeding (educate patient to not abruptly discontinue these meds because of risk for bleeding and clots)

108
Q

Examples of antiplatelets

A

Aspirin, clopidogrel (Plavix), Prasugrel (Effient), ticagrelor (Brilinta)

109
Q

Prasugrel caution

A

Can increase risk of bleeding in adults over 75

110
Q

Prasugrel contraindications

A

Stroke, CVA

111
Q

Do not give ASA doses over ___ mg/day because it reduces effectiveness of drug and shortness of breath can be side effect

A

100

112
Q

DOAC hold time before procedure

A

48 hours

113
Q

Anti-platelets hold time before procedure

A

5-7 days

114
Q

Class of medications that dissolve blood clots

A

Fibrinolytics

115
Q

Examples of fibrinolytics

A

Alteplase/tPA (Activase) and streptokinase (Streptase)

116
Q

Nursing implications for fibrinolytics

A

Bed rest, monitor neuro status closely

117
Q

Signs of intracranial hemorrhage

A

Fall in GCS, neurologic deterioration (limb weakness, speech disturbances), new onset headache, N/V, rise in BP

118
Q

Signs of anaphylaxis

A

Marked hypotension, acute onset of SOB and/or wheeze, facial swelling

119
Q

Medications that reduce cholesterol, LDL, and triglycerides, and increase HDLs

A

Anti-lipid medications

120
Q

Why are anti-lipid medications important in acute coronary syndrome (ACS)?

A

For their anti-inflammatory and plaque stabilizing properties

121
Q

Side effects of Anti-lipid medications

A

Elevated LFTs, Rhabdomyolysis, Myalgias

122
Q

Examples of Anti-lipid medications

A

Pravastatin, atorvastatin, simvastatin, rosuvastatin

123
Q

Nursing implications for -statins

A

Use caution with liver failure

124
Q

Medications that cause QT prolongation

A

Antibiotics (quinolones, macrolides), antipsychotics (haldol, risperdal), reglan, zofran

54/64 Unit 1 (9 decks)

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