Exam 3 Flashcards
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9 questions over diuretics
7 questions over HTN
9 questions over blood coags
How do the drugs learned work to reduce blood pressure?
Decrease volume:
— diuretic (hydrochlorothiazide)
— inhibits RAAS (lisinopril, Losartan)
Decreases resistance:
Vasodilation (Nitroprusside, diltaziem, metoprolol)
Inhibits RAAS (lisinopril, Losartan)
What is the most important nursing assessment prior to administering an antihypertensive drug?
BP
What problems can result from taking an antihypertensive drug?
Hypotension, falls
How will the nurse evaluate the effectiveness of an antihypertensive drug?
Goal systolic is 120
Goal diastolic is 80
Avoid hypotension!
Patients may need multiple antihypertensive drugs to control BP
When reviewing the medication orders for a client prescribed penicillin, the nurse notes that the client is also prescribed warfarin. What possible effect may occur as the result of an interaction between these drugs?
A. The penicillin will cause an enhanced anticoagulant effect on warfarin
B. The penicillin will cause the anticoagulant effect of warfarin to decrease
C. The warfarin will reduce the anti-infective action of the penicillin
D. The warfarin will increase the effectiveness of penicillin
A
The nurse is teaching a client about their prescribed atorvastatin. What information should the nurse include?
A. This medication can affect your blood’s ability to clot so you will need routine blood tests
B. Grapefruit juice should be avoided as drinking grapefruit juice while taking this med will cause toxic levels
C. Be sure to rise slowly from lying or sitting positions as this drug can cause low BP when changing positions
D. Take your pulse before taking this medication to ensure it is at least 60 bpm
B
The nurse is caring for a client with DVT. The nurse knows which medications may be used to treat a DVT? SATA
A. Digoxin
B. Heparin
C. Alteplase
D. Clopidogrel
E. Warfarin
F. Enoxaparin
G. Rivaroxaban
B. Heparin
E. Warfarin
F. Enoxaparin
G. Rivoroxaban
Digoxin = used for HF
Alteplase = acute clot lysis in the case of arterial clot in MI or stroke
Clopidogrel = antiplatelet to prevent MI or stroke
The nurse is evaluating coagulation laps for a client prescribed a continuous IV heparin drip. Which lab value indicates heparin is having a therapeutic effect?
A. APTT 60 seconds
B. PT 20 seconds
C. International normalized ratio 2.5
D. Platelet count 30,000
A. Activated partial thromboplastin time 60 seconds
APTT is used for adjusting heparin therapy
A day shift nurse is giving hand-off report to an evening shift nurse. As the nurses are reviewing the calculations for a clients IV heparin drip rate, the nurse notice the pump was set incorrectly and the client has been getting double the amount of heparin needed. What should the nurses do FIRST?
A. Call the primary to report the error
B. Collect a blood sample so lab can run an APTT
C. Assess the client for signs of bleeding
D. Stop the heparin infusion
D. Stop the heparin infusion
The infusion should be stopped first, then assess the client for any signs of bleeding. Next call the provider, the provider will most likely order a STAT APTT
The nurse is caring for a client prescribed Amiodarone for the tx of chronic atrial fibrillation. The nurse plans for which goal?
A. HR less than 110 bpm
B. BP less than 120/80
C. INR 2.5
D. Total cholesterol 200
A
Amiodarone is an antidysrhythmic drug. The goal in afib is to keep HR less than 110 to avoid complications
The nurse is caring for a client with a dx of cerebral edema. Which medication does the nurse anticipate administering?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Mannitol
D. Mannitol
Mannitol is an osmotic diuretic and pulls fluid from the cells and interstitial spaces into the blood stream. It also works as a diuretic to pull fluid into the renal tubule for excretion
The med-surg nurse is assessing a client who has been prescribed furosemide for several days. What assessment data is most concerning for the nurse?
A. Potassium 2.3
B. Sodium 136
C. BP 100/64
D. HR 102
A. Potassium 2.3
Normal range = 3.5-5.0
Furosemide can further reduce potassium levels. Potassium supplements is needed. Potassium poses a higher risk
The nurse is caring for a client who is currently receiving a 0.45% sodium chloride infusion. What assessment finding suggests the client has received too much fluid?
A. JVD
B. BP 93/50
C. Capillary refill 2 seconds
D. Urine output 980 in 24 hours
B. BP 93/50
A hypotonic fluid will cause water to leave the vascular space and move into the cells. Hypotension may occur. JVD occurs when the vascular space is overloaded.
Hypotonic fluid = more fluid into cells and out of vascular space; CELLS SWELL
Hypertonic fluid = less fluid into cells and more into the vascular space; CELLS SHRINK
When reviewing a clients mediation list, the nurse knows that which medications may be used to treat constipation? SATA
A. Loperamide
B. Polyethylene glycol
C. Docusate
D. Bisacodyl
E. Ondansetron
B, C, D
If too much of an isotonic fluid is administered to a patient, how will this cause imbalance?
The vascular space becomes overfilled with fluid (fluid overload). There is no change in cell size
The ER nurse is caring for a patient admitted with dehydration. The pt’s BP is 122/78. How does dehydration cause imbalance?
Cells are dehydrated by vascular volume
What will happen if too much hypotonic fluid is administered?
The cells will SWELL
The nurse is caring for a client with cerebral edema. How does this condition affect the cells and vascular space?
Cells SWELL
What happens when too much hypertonic fluid is administered?
Vascular space overload. The cells will shrink too much, all fluid in the vascular space
