Lilley Chapters 18-29 Flashcards
drugs that stimulate and mimic the actions of the sympathetic nervous system
adrenergic agonists
receptor sites for the sympathetic neurotransmitters norepinephrine and epinephrine
adrenergic receptors
bodily functions that are involuntary and result from the physiologic activity of the autonomic nervous system
autonomic functions
two divisions of the autonomic nervous system
sympathetic and parasympathetic
a branch of the peripheral nervous system that controls autonomic bodily functions
autonomic nervous system
Beta1-adrenergic receptors are located primarily in
the heart
Beta 2 adrenergic receptors are located in
the smooth muscle fibers of the bronchioles, arterioles, and visceral organs
substances that can produce a sympathetic response
catecholamines
an increase in heart rate
positive chronotropic effect
an increase in the conduction of cardiac electrical impulses through the atrioventricular node, which results in the transfer of nerve action potential from the atria to the ventricles.
positive dromotropic effect
an increase in the force of contraction of the heart muscle
positive inotropic effect
drugs used therapeutically that mimic the catecholamines epinephrine, norepinephrine, and dopamine
sympathomimetics/ adrenergic agonists
the space either between two adjacent nerve cell membranes or between a nerve cell membran and an effector organ cell membrane
synaptic cleft
The nurse caring for a patient who is receiving beta 1 agonist drug therapy needs to be aware that hes drugs cause which effect?
a. Increased cardiac contractility
b. decreased heart rate
c. bronchoconstriction
d. increased GI tract motility
A. increased cardiac contractility
During a teaching session for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for which condition?
a. rescue treatment of acute bronchospasms
b. prevention of bronchospasms
c. reduction of airway inflammations
d. long term treatment of sinus congestion
B. prevention of bronchospasms
For a patient receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate?
a. monitor the gravity drip infusion closely, and adjust as needed
b. assess the patient’s cardiac function by checking the radial pulse
c. assess the intravenous site hourly for possible infiltration
d. administer the drug by intravenous boluses according to the patient’s blood pressure
C. assess the intravenous site hourly for possible infiltration
A patient is receiving dobutamine for shock and is complaining of feeling more skipping beats than yesterday. What will the nurse do next?
a. monitor for other signs of a therapeutic response to the drug
b. titrate the drug to a higher dose to reduce the palpitations
c. discontinue the dobutamine immediately
d. assess the patient’s vital signs and cardiac rhythm.
D. assess the patient’s vital signs and cardiac rhythm
When a drug is characterized as having a negative chronotropic effect, the nurse knows to expect which effect?
a. reduced blood pressure
b. decreased heart rate
c. decreased etopic beats
d. increased force of cardiac contractions
B. decreased heart rate
The nurse is monitoring a patient who is receiving an infusion of a beta-adrenergic agonist. Which adverse effects may occur with this infusion?
a. mild tremors
b. bradycardia
c. tachycardia
d. palpitations
e. drowsiness
f. nervousness
A,C,D,F
The order reads: “Dopamine 3 mcg/kg/min IV” The solution available is 400mg in 250mL D5W, and the patient weighs 176 pounds. The nurse will set the IV infusion pump to run at how many mL/hour?
9mL/hr
decreased amount of oxygen delivered to the extremities, causing the feet or hands to turn blue
acrocyanosis
specific receptor site throughout the body for the endogenous sympathetic neurotransmitters norepinephrine and epinephrine
adrenergic receptors
drugs with a specific receptor affinity that mimic the body’s natural chemicals
agonists
paroxysmal (sudden) chest pain caused by myocardial ischemia
angina
drugs that bind to specific receptors and inhibit or block the response of the receptors
antagonists
irregular heart rhythms
dysrhythmias
the leaking of fluid from a blood vessel into the surrounding tissues, as in the case of an inflitrated intraveous infusion
extravasation
severe and sudden drop in blood pressure after the administration of the first dose of an alpha-adrenergic blocker
first dose phenomenon
the paradoxial action of some beta-blocking drugs that mimic the action of the sympathetic nervous system
intrinsic sympathomimetic activity
the chemical attraction of substance to lipid or fat molecules
lipopphilicity
a sudden drop in blood pressure when a person stands up
orthostatic hypotension
a vascular edrenal gland tumor that is usually benign but secretes E and NE, and thus often causes CNS stimulation and substantial blood pressure elevation
pheochromocytoma
a narrowing of small arteries that limits the amount of blood circulation to the extremities causing numbness of the nose, fingers, toes, and ears in response to cold temperatures or stress
Raynaud’s disease
drugs that inhibit the postganglionic functioning of the sympathetic nervous system
sympatholytics
When a patient has experienced extravasation of a peripheral infusion of dopamine, the nurse will inject the aplha blocker phentolamine (Regitine) into the area of extravasation and expect which effect?
a. vasoconstriction
b. vasodilation
c. analgesia
d. hypotension
B. vasodilation
When administering beta blockers, the nurse will follow which guideline for administration and monitoring?
a. the drug may be discontinued at any time
b. postural hypotension rarely occurs with this drug
c. tapering off the medication is necessary to prevent rebound hypertension
d. the patient needs to stop taking the medication at once if he/she gains 3-4 pounds in a week.
C. tapering off the medication is necessary to prevent rebound hypertension
The nurse providing teaching for a patient who has a new prescription for beta 1 blockers will keep in mind that these drugs may result in which effect?
a. tachycardia
b. tachypnea
c. bradycardia
d. bradypnea
C. bradycardia
A patient who has recently had a myocardial infarction has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to
a. cause vasodilations of the coronary arteries
b. prevent hypertension
c. increase conduction through the SA node
d. protect the heart from circulating catecholamines
D. protect the heart from circulating catecholamines
Before initiating therapy with a nonselective beta blocker, the nurse will assess the patient for a history of which condition?
a. hypertension
b. liver disease
c. pancreatitis
d. asthma
D. asthma
A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effects?
a. orthostatic hypotension
b. increased blood pressure
c. increased urine flow
d. headaches
e. bradycardia
A,C,D
the neurotransmitter responsible for transmission of nerve impulses to effector cells in the parasympathetic nervous system
acetylcholine
the enzyme responsible for the breakdown of acetylcholine
cholinesterase
a lack of muscle tone
atony
severe muscle weakness and respiratory paralysis due to excessive acetylcholine
Cholinergic crisis
a nerve receptor that is stimulated by acetylcholine
cholinergic receptor
the contraction of the pupil
miosis
cholinergic receptors located in ganglia of both the sympathetic and parasympathetic nervous systems
nicotinic receptors
The nurse is reviewing the use of bethanechol in a patient who is experiencing postoperative urinary retention. Which statement best describes the mechanism of action of bethaechol?
a. it causes decreased bladder tone and motility
b. it causes increased bladder tone and motility
c. it increases the sensation of a full bladder
d. it causes the sphincters in the bladder to become tighter
B. it causes increased bladder tone and motility
The family of a patient who has recently been diagnosed with Alzheimer’s disease is asking about the new drug prescribed to treat the disease. The wife says I’m so excited that there are drugs that can cure this disease! Which reply from the nurse is appropriate?
a. the sooner he starts the medicine, the sooner it can have this effect.
b. these effects won’t be seen for a few months
c. these drugs don’t cure AD. let’s talk about what the physician said to expect from drug therapy.
d. his response to this drug therapy will depend on how far along he is in the disease process.
C. These drugs don’t cure AD. Let’s talk about what the physician said to expect from drug therapy
The nurse is giving a dose of bethanechol to a postoperative patient. The nurse is aware that contraindications to bethanechol include:
a. bladder atony
b. peptic ulcer
c. urinary retention
d. hypothyroidism
B. peptic ulcer
A patient took an accidental overdose of a cholinergic drug while at home. He comes to the ED with severe abdominal cramping and bloody diarrhea. The nurse expects that which drug will be used to treat this patient?
a. atropine
b. physostigmine
c. bethanechol
d. phentolamine
A. atropine
The nurse is reviewing the orders for a newly admitted patient and sees an order for edrophonium. The nurse expects that this drug is ordered for which reason?
a. to reduce the symptoms and delay the onset of AD
b. to treat the symptoms of myasthenia gravis
c. to aid in the diagnosis of myasthenia gravis
d. to reverse the effects of nondepolarizing neuromuscular blocking drugs after surgery
C. to aid in the diagnosis of myasthenia gravis
When giving intravenous cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as:
a. peripheral tingling
b. hypotension
c. dry mouth
d. syncope
e. dyspnea
f. tinnitus
B,D,E
drugs that block the action of acetylcholine and substances similar to acetylcholine at receptor sites in the synapse
cholinergic blocking drugs
dilaiton of the pupil of the eye caused by contraction of the dilator muscle of the iris
mydriasis
drugs that reduce the activity of the parasympathetic nervous system/ also called anticholinergics
parasympatholytics
The nurse is providing education about cholinergic blocking drug therapy to an elderly patient. Which is an important point to emphasize for this patient?
a. avoid exposures to high temperatures
b. limit liquid intake to avoid fluid overload
c. begin an exercise program to avoid adverse effects
d. stop the medication if excessive mouth dryness occurs.
A. avoid exposures to high temperatures
The nurse is giving a cholinergic-blocking drug and will assess the patient for which contraindications to these drugs?
a. chronic bronchitis
b. peptic ulcer disease
c. irritable bowel syndrome
d. benign prostatic hyperplasia
D. benign prostatic hyperplasia
When assessing for adverse effects of cholinergic blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect?
a. diaphoresis
b. dry mouth
c. diarrhea
d. urinary frequency
B. dry mouth
The nurse administering a cholinergic blocking drug to a patient who is experiencing drug induced extrapyramidal effects would assess for which therapeutic effect?
a. decreased muscle rigidity and tremors
b. increased heart rate
c. decreased bronchial secretions
d. decreased GI motility and peristalsis
A. decreased muscle rigidity and tremors
During the assessment of a patient about to receive a cholinergic blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with the anticholinergic, including
a. opiods, such as morphine sulfate
b. antibiotics such as penicillin
c. tricylic antidepressants, such as amitriptyline
d. anticonvulsants, such as phenobarbitol
C. tricylic antidepressants, such as amitriptyline
A patient has been given a prescription for transdermal scopolamine patches for motion sickness for use during a vacation cruise. The nurse will include which instructions?
a. apply the patch as soon as you board the ship
b. apply the patch 3 to 4 hours before boarding the ship
c. the patch needs to be placed on a nonhairy area on your upper chest or upper arm
d. the patch need to be placed on a nonhairy area behind your ear.
e. change the patch every 3 days
f. rotate the application sites
B,D,E,F
drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons
alpha 1 blockers
medications used to treat hypertension
antihypertensive drugs
the amount of blood ejected from the left ventricle, measured in liters per minute
cardiac output
drugs that modify the function of the sympathetic nervous system in the brain by stimulating alpha 2 receptors.
centrally acting adrenergic drugs
elevated systemic arterial pressure for which no cause can be found
essential/ primary or idiopathic hypertension
a common often asymptomatic disorder in which systolic blood pressure persistently exceeds 140 mm Hg, and/or diastolic pressure exceeds 90 mm Hg
hypertension
a common adverse effect of adrenergic blocking drugs involving a sudden drop in blood pressure when a person changes position, especially when rising from a seated or horizontal position
orthostatic hypotension
a drug that is inactive in its given form, and which must be metabolized to its active form in the body, generally by the liver, to be effective
prodrug
high blood pressure caused by another disease such as renal, pulmonary, endocrine, or vascular disease
secondary hypertension
The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients?
a. dry mouth
b. hypotension
c. restlessness
d. constipation
B. hypotension
When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs?
a. alpha blockers, such as doxazosin
b. diruetics such as furoesemide
c. ACE inhibitors such as captopril
d. vasodilators such as hydralazine
A, alpha blockers, such as doxazosin
A 56 year old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which would be the most appropriate response by the nurse?
a. Not to worry. Eventually tolerance will develop
b. The physician can work with you on changing the dose and/or drugs.
c. Sexual dysfunction happens with this therapy, and you will learn to accept it.
d. This is an unusual occurence, but it is important to stay on your medications
B. The physician can work with you on changing the dose and/or drugs.
When a patient is being taught about the potential adverse effects of ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension?
a. diarrhea
b. nausea
c. dry, nonproductive cough
d. sedation
C. dry, nonproductive cough
A patient has a new prescription for an ACE inhibitor. During a review of the patient’s list of current medications, which would cause concern for a posusible interaction with this new prescription?
a. benzodiasepine taken as needed for allergies
b. a potassium supplement taken daily
c. an oral anticoagulant taken daily
d. an opioid used for occasional severe pain
e. an NSAID taken as needed for headaches
B & E
Chest pain that occurs when the heart’s supply of blood carrying oxygen is insufficient to meet the demands of the heart
angina pectoris
a common form of arteriosclerosis involving deposits of fattty, cholestrol-containing material within arterial walls
athersclerosis
chest pain that is primarily caused by athersclerosis, which results from long term but relatively stable level of obstruction in one or more coronary arteries
chronic stable angina
arteries that deliver oxygen to the heart muscle
coronary arteries
any one of the abnormal conditions that can affect the arteries of the heart and produce various pathologic effects, especially a reduced supply of oxygen and nutients to the myocardium
coronary artery disease
poor blood supply to an organ
ischemia
poor blood supply to the heart via the coronary arteries
ischemic heart disease
necrosis of the myocardium following interuption of blood supply - it is almost always caused by atherosclerosis of the coronary arteries
myocardial infarction
a rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress
reflex tachycardia
early stage of progressive coronary artery disease
unstable angina
ischemia induced myocardial chest pain caused by spasms of the coronary arteries
vasopastic angina
A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason?
a. to releive exertional angina
b. to prevent palpitations
c. to prevent the occurence of angina
d. to stop an episode of angina
C. to prevent the occurence of angina
A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct?
a. the intravenous form is given by IV push injection
b. because the intravenous forms are short lived, the dosing must be every 2 hourse
c. intravenous nitroglycerin must be protected from exposure to light through use of special tubing
d. intravenous nitroglycerin can be given via gravity drip infusions
C. intravenous nitroglycerin must be protected from exposure to light through the use of special tubing.
Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)?
a. I can take this drug to stop an attack of angina
b. I understand that food and antacids alter the absorption of this oral drug?
c. When the long acting forms are taken, this drug cannot be crushed.
d. This drug may cause my blood pressure to drop, so I need to be careful when getting up.
A. I can take this drug to stop an attack of angina
While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used
a. .hypertension
b. essential tumors
c. exertional angina
d. asthma
D asthma
A 68 year old man has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the provider?
a. He will have to be switched to isosorbide mononitrate if he wants to take sildenafil
b. Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists.
c. I’ll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose.
d. These drugs ar compatible with eac other, and so I’ll write a prescription.
B. Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists.
The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angna symptoms. Which substances listed below could potentially result in a drug interaction?
a. a glass of wine
b. thyroid replacement hormone
c. tadalafil (Cialis), an ED drug
d. metformin (Glucophage), an antidiabetic drug
e. carvedilol (Coreg), a beta blocker
A,C,E
a common cardiac dysrhythmia with arterial contractions that are so rapid that they prevent full repolarization of myocardial fibers between heartbeats
atrial fibrillation
a property of specialized excitable tissue in the heart that allows self-activaiton through the spontaneous development of an action potential, such as in the pacemaker cells of heart
automaticity
drugs that influence the rate of the heartbeat
chronotropic drugs
drugs that influence the conduction of electrial impulses within tissues
dromotropic drugs
the proportion of blood that is ejected during each ventricular contraction compared with the total ventricular filling time
ejection fraction
an abnormal condition in which the heart cannot pump enough blood to keep up with the body’s demand
heart failure
drugs that influence the force of muscular contractions, particularly contraction of the heart muscle
inotropic drugs
the total amount of blood in the left ventricle immediately before it contracts, or the preload
left ventricle end-diastolic volume
the period during which a pulse generator is unresponsive to an electrical input signal, and during which it is impossible for the myocardium to respond
refractory period
When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for
a. visual changes such as photophobia
b. flickering lights or halos around lights
c. dizziness when standing up
d. increased urine output
B. flickering lights or halos around lights
During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as:
a. apical pulse rate of 62 beats/min
b. digoxin level of 1.5 ng/mL
c. serum potassium level of 2.0 mEq/L
d. serum calcium level of 9.9 mEq/L
C. serum potassium level of 2.0 mEq/L
When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect?
a. dysrhythmia
b. proteinuria
c. hyperglycemia
d. hypertension
A. dysrhythmia
A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to
a. increase urine output
b. prevent stimulation of the heart by catecholamines
c. increase the contractility of the heart muscle
d. cause peripheral vasodilation
B. prevent stimulation of the heart by catecholamines
The nurse is assesing a patient who is receiving a milrinone infusion and checks the patient’s cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone?
a. tachycardia
b. bradycardia
c. atrial fibrillation
d. ventricular dysrhythmia
D. ventricular dysrhythmia
The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects?
a. positive inotropic effects
b. vasodilation
c. decreased heart rate
d. increased blood pressure
e. positive chronotropic effects
A,B,E,
electrical activity that consists of a series of polarizations and depolarizations that travel across the cell membrane of a nerve fiber during transmission of a nerve impulse and across the cell membranes of a muscle cell during contraction
action potential
the interval beginning with baseline (resting) membrane potential followed by depolarization and ending with repolarization to baseline membrane potential
action potential duration
technically no rhythm, meaning absence of heart rhythm
arrhythmia
the movement of of positive and negative ions on either side of a cell membrane across the membrane in a direction that brings the net charge to zero
depolarization
any disturbance or abnormality in heart rhythm
dysrhythmia
the period after the firing of an impulse during which a cell may respond to a stimulus but the response will not be passed along or continued as another impulse
effective refractory period
special pathways in the atria that carry electrical impulses generated by the SA node
internodal pathways (Bachmann bundle)
the time after generation of an action potential during which a nerve fiber will show a (reduced) response only to a strong stimulus
relative refractory period
the voltage that exists when the cell membranes of heart muscle (or other muscle) are at rest
resting membrane potential
unexpected, fatal cardiac arrest
sudden cardiac death
the critical state of electrical tension required for spontaneous depolarization of a cell membrane
threshold potential
a rare ventricular arrhythmia that is associated with long QT interval and can degenerate into ventricular fibrillation and sudden death without medical intervention
Torsades de pointes
A patient with a rapid, irregular heart rhythm is being treated in the ED with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect?
a. nausea and vomiting
b. transitory asystole
c. muscle tetany
d. hypertension
B. transitory asystole
When assessing a patient who has been taking amiodarone for 6 months , the nurse monitors for which potential adverse effect?
a. hyperglycemia
b. dysphagia
c. photophobia
d. urticaria
C. photophobia
The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes:
a. muscle pain
b. tinnitus
c. chest pain
d. excessive thirst
B. tinnitus
A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond?
a. The pills are not being digested properly. You need to take them on an empty stomach.
b. The pills are not being digested properly. You need to take them with food.
c. What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed
d. This indicates that you are not tolerating this medication and will need to switch to a different form.
C. What you are seeing is the waxy matrix that contained the medication, but the drug has been absorbed.
The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug?
a. tachycardia
b. hypertension
c. ventricular dysrhythmias
d. renal dysfunction
D. renal dysfunction
When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct?
a. Take the medication with an antiacid if stomach upset occurs.
b. Do not chew sustained-released capsules
c. If weight gain of 5 pounds within 1 week occurs, notifiy your physician at the next office visit
d. If you experience severe adverse effects, stop the durg and notify your physician
e. You may take the medication with food if stomach upset occurs.
B & E
substances that prevent or delay coagulation of the blood
anticoagulants
drugs that prevent the lysis of fibrin and in doing so promote clot formation
antifibrinolytic drugs
substances that prevent platelet plugs from forming
antiplatelet drugs
a substance that inactivates three major activating factors of the clotting cascade; activated factor II (thrombin), activated factor X, and activated factor IX
antithrombin III
insoluble solid elements of blood that have chemically separated from the plasma component of blood
clots
the process of blood clotting
coagulation
the series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot
coagulation cascade
the formation of a thrombus in one of the deep veins of the body/ mostly affects the iliac and femoral veins
deep vein thrombosis
a blood clot that has been dislodged from the wall of a blood vessel and is traveling through the bloodstream
embolus
a protein molecule that catalyzes chemical reactions of other substances without being altered or destroyed in the process
enzyme
a stringy, insoluble protein produced by the action of thrombin on fibrogen during the clotting process; a major component of blood clots or thrombi
fibrin
a plasma protein that is converted into fibrin by thrombin in the presence of calcium ions
fibrinogen
an area of the circulatory system undergoing fibrinolysis
fibrinolytic system
a rare, inheritied blood disorder in which the blood does not clot normally
hemophilia
drugs that alter the function of platelets without compromising their blood clotting properties
hemmorheologic drugs
the arrest of bleeding,either by physiological properties of vasoconstriction and coagulation or by mechanical, surgical, or pharmacological means.
hemostasis
referring to any procedure, device, or substance that arrests the flow of blood
hemostatic
the enzymatic protein that breaks down fibrin into fibrin degradation products; it is derived from plasminogen
plasmin
a plasma protein that is converted to plasmin
plasminogen
the blockage of a pulmonary artery by foreign matter such as fat, air, a tumor or a thrombus
pulmonary embolism
occlusion of the blood vessels of the brain by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in ischemia of the brain tissue
stroke
events in which a blood vessel is blocked by an embolus carried in the bloodstream from the site of its formation
thromboembolic events
drugs that disolve thrombi by functioning similiarly to tissue plasminogen activator
thrombolytic drugs
the technical term for a blood clot
thrombus
a naturally occurring plasminogen activator secreted by vascular endothelial cells in the walls of blood vessels
tissue plasminogen activator
The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time?
a. dizziness
b. blood pressure of 130/95
c. slight bloody oozing from the IV insertion site
d. irregular heart rhythm
D. irregular heart rhythm
A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to aboid which type of medications?
a. opioids
b. acetaminophen
c. NSAIDs
d. there are no restrictions while taking warfarin
C. NSAIDs
The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statment should be included in this teaching session?
a. We will need to teach a family member how to give this drug in your arm
b. This drug is given in the folds of your abdomen, but at least two inches away from your navel.
c. This drug needs to be taken at the same time every day with a full glass of water.
d. Be sure to massage the injection site thoroughly after giving the drug.
B. This drug is given in the folds of your abdomen, but at least two inches away from your navel.
A patient is receiving diabigatran (Pradaxa), 150mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose?
a. asthma
b. renal impairment
c. history of myocardial infarction
d. elevated liver enzymes
B. renal impairment
A patient has received a dobule dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time?
a. Give IV vitamin K as an antidote
b. Give IV protamine sulfate as an antidote
c. call the blood bank for an immeditate platelet transfusion
d. obtain an order for packed red blood cells.
B. give IV protamine sulfate as an antidote
A patient is starting warfarin therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy?
a. teach proper subcutaneous administration
b. administer the oral dose at the same time every day.
c. assess carefully for excessive bruising or unusual bleeding
d. monitor laboratory results for a target INR of 2-3
e. monitor laboratory results for a therapeutic aPTT value of 1.5-2.5 times the control value.
B,C,D
drugs that reduce lipid levels
antilipemic drugs
the protein components of lipoproteins
apolipoproteins
a fat soluble steroid found in animal fats, oils. and egg yolk and widely distributed in the body, especially in the bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerver fibers
cholesterol
microscopic droplets made up of fat and protein that are produced by cells in the small intestine and released into the bloodstream/consists of 90% triglycerides
chylomicrons
lipids originating outside the body or an organ
exogenous fats
the characteristic intial lesion of atherosclerosis, also known as fatty streak
foam cells
a class of cholesterol lowering drugs that work by inhibiting the rate limiting step in cholesterol synthesis
HMG-CoA reductase/ statins
a condition in which higher than normal amounts of cholesterol are present in the blood
hypercholesterolemia
a conjugated protein synthesized in the liver that contains varying amounts of triglycerides, cholesterol, phospholipids, and proteins
lipoproteins
compounds that consist of fatty acids and a type of alcohol known as glycerol
triglycerides
A nurse adminstering niacin would implement which action to help to reduce adverse effects?
a. give the medication with grapefruit juice
b. administer a small dose of aspirin or an NSAID 30 minutes prior to the niacin dose
c. administer the medication on empty stomach
d. have the patient increase dietary fiber intake
B. administer a small dose of aspirin or an NSAID 30 minutes prior to the niacin dose
When administering niacin, the nurse needs to monitor for which adverse effect?
a. cutaneous flushing
b. muscle pain
c. headache
d. constipation
A. cutaneous flushing
Which point will the nurse emphasize to a patient who is taking an antilipemic medicaiton in the statin class?
a. the drug needs to be taken on an empty stomach before meals.
b. a low fat diet is not necessary while taking these medications
c. it is important to report muscle pain immediately
d. improved cholesterol levels will be eviden within 2 weeks
C. It is important to report muscle pain immediately
A patient is being assessed before a newly ordered antileptic medication is given. Which condition would be a potential contraindication?
a. diabetes insipidus
b. pulmonary fibrosis
c. liver cirrhois
d. myocardial infarction
C. liver cirrhois
A patient is currently taking a statin. The nurse considers that the patient may have a higher risk of developing rhabdomyolysis when also taking which product?
a. NSAIDs
b. a fibric acid derivative
c. orange juice
d. fat soluble vitamins
B. a fibric acid derivative
The nurse is administering cholestyramine , a bile acid sequestratn. Which nursing intervention(s) is appropriate?
a. administering the drug on an empty stomach
b. administering the drug with meals
c. instructing the patient to follow a low fiber diet while taking this drug
d. instructing the patient to take a fiber supplement while taking this drug
e. increasing fluid intake
f. not administering this drug at the same time as other drugs
B,D,E,F
the small blood vessels approaching the glomerulus
afferent arterioles
a mineralcorticoid steroid hormone produced by the adrenal cortex that regulates sodium and water balance
aldosterone
intraperitoneal accumulation of fluid (volume of 500mL or more) containing large amounts of protein and electrolytes
ascites
the most distal part of the nephron between the distal convoluted tubule and the ureters, which lead to the urinary bladdder
collecting duct
the part of the nephron immediately distal to the ascending loop ofHenle and proximal to the collecting duct
distal convoluted tubule
drugs or other substances that tend to promote the formation and excretion of urine
diuretics
the small blood vessels exiting the glomerulus
efferent arterioles
the materal that passes through a filter/ the material extracted from the blood
filtrate
the open, rounded and most proximal part of the proximal convoluted tubule that surrounds the glomerulus and receives the filtrate from the blood
glomerular capsule
an estimate of the volume of blood that passes through the glomeruli of the kidney per minute
glomerular filtration rate
the cluster of kidney capillaries that marks the beginning of the nephron and is immediately proximal to the proximal convoluted tubule
glomerulus
the part of the nephron between the proximal and distal convoluted tubules
Loop of Henle
the functional filtration unit of the kidney.consisting of the glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule and collecting duct
nephron
a condition in which pressure is elevated in the eye because of an obstruction of the outflow of aqueous humor
open angle glaucoma
the part of the nephron that is immediately distal to the glomerulus and proximal to the loop of Henle
proximal convoluted tubule
The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following?
a. vitamin D
b. warfarin
c. penicillins
d. NSAIDs
D. NSAIDs
When monitoring laboratory test results for patients receiving loop and thiazide diuretics, the nurse knows to look for
a. decreased serum levels of potassium
b. increased serum levels of calcium
c. decreased serum levels of glucose
d. increased serum levels of sodium
A. decreased serum levels of potassium
When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern?
a. serum sodium level of 140 mEq/L
b. serum calcium level of 10.2 mg/dL
c. serum potassium level of 5.8mEq/L
d. serum magnesium level of 2.0mg/dL
C. serum potassium level of 5.8mEq/L
Which statement needs to be included when the nurse provides patient education with heart failure who is taking daily doses of spironolactone?
a. Be sure to eat foods high in potassium
b. Avoid foods that are high in potassium
c. Avoid grapefruit juice while taking this medication
d. A low fiber diet will help prevent adverse effects of this medication
B. avoid foods that are high in potassium
A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug?
a. There is nothing you should be concerned about when you are taking a thiazide diuretic.
b. Be sure to avoid foods high in potassium
c. You need to take the thiazide at night to to avoid interactions with the diabetes medication
d. Monitor your blood glucose levels closely, because the thiazide diuretics may cause the levels to increase.
D. monitor your blood glucose levels closely, because the thiazide diuretics may cause the levels to increase
An elderly patient has been discharged following treatment for a mild case of heart failure. He will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate?
a. Take the diuretic at the same time each morning.
b. Take the diuretic only if you notice swelling in your feet
c. Be sure to to stand up slowly becasue the medicine makes you feel dizzy if you stand up too quickly
d. Drink at least 8 glasses of water each day
e. Here is a list of foods that are high in potassium- you need to avoid them
f. Please call your doctor immediately if you notice muscle weakness or increased dizziness.
A,C,F
the fluid that circulates through the heart, arteries, capilliaries, and veins, carrying nutrients and oxygen to the body cells
blood
protein substances that increase the colloid osmotic pressure
colloids
another name for oncotic pressure; exerted by protein in the blood plasma that tends to pull water into the circulatory system
colloid oncotic pressure
substances in a solution that diffuse through a semipermeable membrane
crystalloids
excessive loss of water from the body tissue
dehydration
the abnormal accumulation of fluid in interstitial spaces
edema
that portion of the body fluid comprising the interstitial fluid and blood plasma
extracellular fluid
fluid in the body that is outside the blood vessels
extravascular fluid
a difference in the concentration of a substance on two sides of a permeable barrier
gradient
the pressure exerted by a liquid
hydrostatic pressure
Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells?
a. flush the IV line with normal saline before the blood is added to the infusion
b. flush the IV line with dextrose before the blood is added to the infusion
c. check the patient’s vital signs once the infusion is completed
d. anticipate that flushed skin and fever are expected reactions to a blood transfusion
A. flush the IV line with normal saline before the blood is added to the infusion
When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be
a. diarrhea
b. serum sodium level of 145mEq/L
c. serum potassium level of 5.6mEq/L
d. dehydration
C. serum potassium level of 5.6mEq/L
When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be
a. acute liver failure
b. heart failure
c. severe burns
d. fluid volume deficit
B. heart failure
The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate?
a. albumin 5%
b. packed RBCs
c. whole blood
d. fresh frozen plasma
D. fresh frozen plasma
While monitoring a patient who is receiving an infusion of crystalloid solution, the nurse will monitor for which potential problem?
a. bradycardia
b. hypotension
c. decreased skin turgor
d. fluid overload
D. fluid overload
The nurse is administering an IV solution that contains potassium chloride to a patient who has a severly decreased serum potassium level. Which aciton(s) by the nurse are appropriate?
a. administer the potassium by slow IV bolus
b. administer the ptoassium at a rate no faster than 20 mEq/hr
c. monitor the patient’s cardiac rhythm with a heart monitor
d. use an infusion pump for the administration of IV potassium chloride
e. administer the potassium IV push
B,C,D
