E4 Questions Flashcards
A patient is ordered to receive digoxin (Lanoxin) to treat congestive heart failure. The nurse is most concerned about which assessment finding?
a. Heart rate 56 beats/min
b. BP 138/90 mm Hg
c. RR 18 breaths/min
d. 1+ pitting edema of the lower extremities
Answer: A Heart rate 56 beats/min
A baseline pulse rate for the patient should be obtained for future comparisons. Apical pulse should be taken for a full minute and should be greater than 60 beats/min. The prescriber should be notified if the patient’s pulse is less than 60 beats per minute.
A patient has angina pectoris. The patient’s BP is 108/60 mm Hg. The nurse administers nitroglycerin 0.4 mg sublingual (SL). It is most important for the nurse to assess the patient for the development of
a. bradycardia.
b. hypotension.
c. bradypenia.
d. hypokalemia.
Answer: B hypotension
A side effect of nitroglycerin is hypotension owing to the vasodilation of blood vessels.
Another side effect is headache as well as N/V
S1 is the closing of which valves?
Atrioventricular
Mitral (biscupid)
Triscupid
S2 is the closing of Aortic and Pulmonic valves
You are working in the ER when a patient with palpitations and shortness of breath arrives.
What are some baseline assessments you will want to do?
General survey - color, distress, fatigue
Respiratory - oxygenation, rate, rhythm, effort, SOB?
CV - pain, distress, color, diaphoresis, clutching chest
Mental status - awake, alert, orientated
Then EKG, health history and current medications/supplements
Symptoms of a patient in atrial flutter
palpitations, SOB, anxiety and fatigue
What is a major contributor for developing afib
Hypertension, which is why treatment for the afib must also include managing BP
A patient has a history of systolic heart failure and A-V block. Which medication will the nurse expect to administer for the short-term relief of angina?
A. Atenolol (Tenormin)
B. Diltiazem (Cardizem)
C. Amlodipine (Norvasc)
D. Nitroglycerin (Nitrostat)
Correct D. Nitroglycerin (Nitrostat)
Administers sublingual nitroglycerin for angina in a patient with heart failure
Atenolol, diltiazem, and amlodipine are indicated in the treatment of angina; however, these medications are used for maintenance therapy.
Atenolol is contraindicated for patients with systolic heart failure
Amlodipine and diltiazem are contraindicated with A-V block.
A nurse is preparing to administer digoxin (Digitalis) to a patient. Which laboratory result is the nurse most concerned about?
a. Sodium 138 mEq/L
b. Potassium 3.0 mEq/L
c. Digitalis level 1.8 ng/mL
d. BNP 200 pg/mL
Answer: B Potassium 3.0 mEq/L
A low serum potassium level enhances the action of digoxin and can cause digitalis toxicity. CAUTION with K+ wasting diuretics
Normal serums:
K+ 3.5-5.0 mEq/L
Na+ 135-145 mEQ/L
BNP 100-300 pg/mL suggestive of heart failure
What is the therapeutic level of digoxin?
What are S&SX of digoxin toxicity?
Therapeutic range: 0.5-2.0 ng/mL
Toxicity: Bradycardia, diarrhea, nausea, vomiting, halos in vision, and headache
A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse implement? (Select all that apply.)
a. Checking the apical pulse rate before administration
b. Monitoring the patient’s serum digoxin level
c. Instructing patient to report pulse rate less than 60
d. Advising patient to avoid foods high in potassium
e. Always giving an antacid with digoxin to reduce GI distress
Answer: A, B, C
The apical pulse should be taken before digoxin administration and the drug withheld if the heart rate is less than 60. The patient’s serum digoxin level should be monitored and withheld if in toxic range. Patient should be advised to avoid taking antacids with digoxin because they decrease absorption.
When administering antianginal drugs, the nurses identifies which as the most common response?
a. Tachycardia
b. Bradypnea
c. Hypotension
d. Dry mouth
Answer: C Hypotension
The most common side effect of antianginal drugs is hypotension.
The nurse identifies which drug as a calcium channel blocker used for the treatment of dysrhythmias?
a. Diltiazem (Cardizem)
b. Esmolol (Brevibloc)
c. Flecainide (Tambocor)
d. Sotalol HCl (Betapace)
Answer: A Diltiazem (Cardizem)
- Diltiazem (Cardizem) is a calcium channel blocker used to treat dysrhythmias.
- Esmolol (Brevibloc) is a beta blocker.
- Flecainide (Tambocor) is a sodium channel blocker.
- Sotalol HCl (Betapace) is a beta blocker.
What is the priority nursing diagnosis for a patient with a dysrhythmia?
a. Alteration in cardiac output
b. Imbalance of fluid and electrolytes
c. Inadequate peripheral tissue perfusion
d. Ineffective breathing pattern
a. Alteration in cardiac output
Cardiac output affects all the other diagnoses; therefore, without adequate cardiac output, fluid balance, tissue perfusion, and breathing cannot be adequately maintained.
The nurse is caring for patient who is being treated with amiodarone. The nurse notes that the patient is experiencing a hacking cough. What is the nurse’s priority action?
a. Notify the provider regarding this symptom
b. Document the findings in the patient’s chart
c. Administer medication to help the patient rest
d. Administer the cough syrup that has been ordered
a. Notify the provider regarding this symptom
A most serious adverse effect of amiodarone is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli. The nurse will also document the findings; however, this is not the priority. Administering the medication or a cough syrup will not address the pulmonary toxicity that may accompany amiodarone and may make it worse.
A patient is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed?
a. Vitamin K
b. Protamine sulfate
c. Warfarin (Coumadin)
d. Aminocaproic acid (Amicar)
Answer: B Protamine sulfate
Vitamin K is the antidote for warfarin (Coumadin), an anticoagulant
aminocaproic acid (Amicar) is a plasminogen inactivator used to control excessive bleeding from hyperfibrinolysis, it promotes clotting
You have administered a thrombolytic. What signs & symptoms might indicate hemorrhage?
Initially increased HR, decreased Bp…if untreated, decreased HR, LOC
Monitor mouth and rectum for bleeding, IV sites, surgical sites, wounds, Foley catheter
A patient arrived in the emergency department 2 hours after an acute ischemic stroke. The patient is given an intravenous (IV) injection of alteplase tPA (Activase). It is most important for the nurse to monitor what? (Select all that apply.)
a. Bleeding
b. Vital signs
c. PT levels
d. Allergic reactions
e. Electrocardiogram
Answer: A, B, D, E
The nurse should monitor the patient receiving thrombolytics for adverse effects, such as bleeding, allergic reactions, and cardiac dysrhythmias. An increased heart rate with a decreased BP usually indicates blood loss from bleeding.
A patient manifests symptoms of a thrombolic stroke. The emergency department nurse is aware that thrombolytics need to be administered in this situation within how many hours of the onset of symptoms?
1 hour
2 hours
3 hours
4 hours
Answer: C. 3 hours
A thrombolytic drug should be administered within 3 hours of a thrombolic stroke, within 4 hours of AMI
*continue to monitor the guidelines, as this is changing!
Four patients are considered as potential candidates for thrombolytic therapy. Which patient is most likely to receive thrombolytic therapy?
a. The patient who recently used acetaminophen (Tylenol)
b. The patient with a history of severe hypertension
c. The patient who recently had spinal surgery
d. The patient with a history of warfarin (Coumadin) use
Answer: A
Acetaminophen (Tylenol) does not interfere with the coagulation system.
Contraindications/cautions for use of thrombolytics include a recent CVA, active bleeding, severe hypertension, recent history of traumatic injury, especially head injury, and anticoagulant therapy. The nurse should report if the patient takes aspirin or NSAIDs.
The nurse is caring for a patient who received alteplase tPA (Activase) for treatment of acute coronary syndrome. The patient starts to bleed. The nurse anticipates administration of which medication?
a. Protamine sulfate (protamine)
b. Vitamin K (phytonadione)
c. Warfarin (Coumadin)
d. Aminocaproic acid (Amicar)
Answer: D
Aminocaproic acid (Amicar) is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis.
The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath. Which baseline nursing assessments are priorities? (Select all that apply.)
a. ECG monitoring
b. Medication history
c. Oxygen saturation
d. Presence of chest pain, dyspnea, fatigue
e. Mental status
f. Sleep pattern
a. ECG monitoring
b. Medication history
c. Oxygen saturation
d. Presence of chest pain, dyspnea, fatigue
e. Mental status
A patient with suspected myocardial infarction is seen in the emergency department. The nurse is preparing to administer 325 mg of aspirin. The nurse will perform which action?
a. Administer an enteric-coated tablet.
b. Ask the patient to chew the tablet.
c. Give the tablet with a small sip of water.
d. Place the tablet under the patient’s tongue.
b. ask the patient to chew the tablet
“I don’t have aspirin. Can I chew Advil?”
NO!
Other NSAIDs can do far more harm than good
Increased mortality, HTN, heart failure, myocardial rupture!
Acebutolol (Sectral) belongs to what class of drugs?
Cardio-selective beta blocker
Cardio-selective d/t beta 1 blocking
Treat dysrhythmias (Class II)
The cardiac unit nurse is providing discharge education to a patient with stable angina. The patient has been prescribed nitroglycerin for treatment of the angina. Which statement by the patient indicates an accurate understanding of the education provided?
a. “I shouldn’t take the nitroglycerin for mild chest pain.“
b. “It mostly helps by increasing oxygen supply to my heart.“
c. “I should call 911 if the chest pain isn’t relieved after two doses of nitroglycerin.“
d. “The nitroglycerin works on my veins, causing them to open wider.”
D. “The nitroglycerin works on my veins, causing them to open wider.”
Nitroglycerin, a nitrate, acts directly on vascular smooth muscle to promote vasodilation and acts predominantly on veins, but also affects arteries. It should be taken when chest pain begins; the patient should not wait for it to become more severe. The main effect of nitroglycerin is through decreasing cardiac oxygen demand, not increasing oxygen supply.
A Nitroglycerin drip is ordered for your patient to control his chest pain. The concentration is 100 mg in 250 mL D5W. The order is to begin the infusion at 20 mcg/min. What is the rate you would begin the infusion on the infusion pump?
________ mL/h
mL/h = 250mL/100mg x 20mcg/min x 60min/h x mg/1000mcg =
3 mL/h
A patient is experiencing both atrial and ventricular dysrhythmias. The nurse anticipates administration of which medication?
a. Adenosine
b. Amiodarone
c. Atropine
d. Epinephrine
Answer: B Amiodarone
Amiodarone is used for the treatment of atrial and ventricular dysrhythmias, including PVCs
Adenosine is used for the treatment of PSVT
Atropine is used for the treatment of symptomatic bradycardia Epinephrine is used for the treatment of cardiac arrest
Amiodarone: What are some important nursing assessments and interventions r/t side effects?
If side effect bradycardia occurs, slow the infusion rate, abruptly ceasing may lead to fatal dysrhythmias!
Treat hypotension with fluids, vasopressors
Treat bradycardia with pacemaker if indicated
Teach patients to report cough, may need to discontinue!
PVCs, Vtach, Vfib
Profound bradycardia
Torsades de pointes
Anaphylactic shock
Opioid overdose
Hypoxemia
PSVTs
MATCHED WITH
Magnesium sulfate
Atropine sulfate
Lidocaine
Epinephrine
Oxygen
Adenosine
Naloxone
PVCs, Vtach, Vfib - lidocaine
Profound bradycardia - atropine
Torsades de pointes - magnesium
Anaphylactic shock - epinephrine
Opioid overdose - naloxone
Hypoxemia - oxygen
PSVTs - adenosine
What s&sx will you see with hypovolemic shock?
Anxiety, Increased respirations, Increased HR (initially)
Initially increased BP:
Remember Bp is a combination of HR, stroke volume, and peripheral resistance
HR goes up, because the demand for 02 is increasing as tissue is not being perfused
Peripheral resistance is increased as a protective mechanism
Monitor EtC02 to help determine if 02 exchange is occurring
A patient presents to the emergency department with severe respiratory distress, hives, and edema after being stung on the face by a bee. Which are accurate nursing assessments of the situation? (Select all that apply)
a. Hypotension and bronchospasm will progress rapidly if treatment is delayed.
b. The patient is suffering from anaphylactic shock.
c. Epinephrine and diphenhydramine are the drugs of choice as first-line agents.
d. Prompt treatment with drug therapy will prevent this syndrome from occurring again.
Answer: A, B, C
Treatment will not prevent anaphylaxis from occurring again. All other statements are true.
Monitor electrolytes
Extravasation of dopamine
Treat metabolic acidosis
Increased intracranial pressure
Angina pectoris
Give within 4 hours of AMI
MATCHING
Thrombolytic
Nitroglycerin
Phentolamine
Furosemide
Sodium Bicarbonate
Mannitol
Monitor electrolytes - furosemide
Extravasation of dopamine - phentolamine
Treat metabolic acidosis - sodium bicarbonate
Increased intracranial pressure - mannitol
Angina pectoris - nitroglycerin
Give within 4 hours of AMI - thrombolytic
Which finding indicates that administration of glucagon has been effective? The patient experiences
a. an improvement in level of consciousness.
b. an elevation in respiratory rate.
c. suppression of heart rate.
d. reduction in blood pressure.
Answer: A an improvement in level of consciousness
Glucagon is used for treatment of patients with severe hypoglycemia. An improved level of consciousness indicates elevation of blood sugar. A blood sugar analysis should also be obtained.
When administering an intravenous infusion of Rituximab (Rituxan), it is most important for the nurse to
a. restrict the patient’s intake of fluids.
b. premedicate the patient with morphine.
c. stay with the patient during the first 15 minutes of the infusion.
d. assess the patient for the development of ototoxicity.
Answer: C stay with the patient during the first 15 minutes of the infusion.
Rationale: Infusion reactions are common with infusion of Rituximab (Rituxan). Resuscitation equipment should be nearby. The nurse should stay with the patient for the first 15 minutes of the infusion and monitor vital signs every 15 to 30 minutes during the infusion and for 1 hour after the infusion is complete. The patient should be well-hydrated before, during, and after therapy;
The nurse identifies which statement about targeted therapy for cancer as being true? Targeted therapies for cancer
a. are more general in their mechanisms and effects than traditional cancer chemotherapy.
b. exert their effects by damaging the DNA of nearly any cell.
c. require a specific molecular target as the recipient of their effects.
d. require fewer tests on cancer cells to determine if the therapy will be effective.
Answer: C require a specific molecular target as the recipient of their effects.
Rationale: Targeted therapies require a specific molecular target as the recipient of their effects. Targeted therapies are more specific in their mechanisms and effects than traditional cancer chemotherapy agents. More tests are required on cancer cells to determine whether or not targeted therapy will be effective. Targeted therapies exert their effect on specific components of specific cells, not all cells.
