NCLEX- Cardiac Meds Flashcards
A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms?
- Anxiety
- Medication reaction
- Embolus to the lungs
- Fatigue from the extra work of walking with pain
Embolus to the lungs
A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that anxiety, a medication reaction, or fatigue would cause chest pain and dyspnea in this case.
A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction should the nurse include in the patient’s teaching plan?
- “Apply the patch to the same site each day.”
- “Apply the patch to a nonhairy area of the upper torso or arm.”
- “If you have chest pain, apply a second patch next to the first patch.”
- “If you have a headache, remove the patch for 4 hours and then reapply.”
“Apply the patch to a nonhairy area of the upper torso or arm.”
A nitroglycerin patch should be applied to a nonhairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. Sublingual nitroglycerin should be used to treat chest pain, and the patient should only have one patch on at a time. The drug should be continued if headache occurs, because tolerance will develop.
The nurse knows that simvastatin exerts its action by doing what?
- By inhibiting lipolysis in the adipose tissue
- By activating the lipoprotein lipase enzyme
- By preventing the reabsorption of bile acids
- By inhibiting the enzyme HMG-CoA reductase
By inhibiting the enzyme HMG-CoA reductase
Simvastatin exerts its action by inhibiting the enzyme HMG-CoA reductase, reducing the rate of cholesterol production. Antilipemic drugs are known to inhibit lipolysis in the adipose tissue, decrease esterification of the triglycerides in the liver, and increase the activity of lipoprotein lipase. Fibric acid drugs are believed to work by activating the lipoprotein lipase, an enzyme responsible for the breakdown of cholesterol. Bile acid sequestrants bind to bile salts and prevent the resorption of bile acids from the small intestine.
What should the nurse teach the patient to ensure patient understanding of pharmacologic therapy for hypertension?
- “Urinary output determines blood pressure.”
- “Blood pressure is determined by heart contraction.”
- “Sympathetic stimulation causes blood pressure to decrease.”
- “Blood pressure is a product of cardiac output and vascular resistance.”
“Blood pressure is a product of cardiac output and vascular resistance.”
Blood pressure is determined by cardiac output (4 to 8 L/min) and systemic vascular resistance (SVR). Cardiac output is the amount of blood that is ejected from the left ventricle and is measured in liters per minute. SVR is the resistance to blood flow that is determined by the diameter of the blood vessel and the vascular musculature. It is calculated by the blood pressure divided by the cardiac output.
A patient has overdosed on warfarin. Which substance will the nurse administer to reverse the effect of warfarin?
- Aspirin
- Calcium
- Potassium
- Vitamin K
Vitamin K
The administration of vitamin K will help to reverse the action of warfarin. Warfarin interferes with vitamin K–dependent clotting factors. Administration of vitamin K will reverse this action. Aspirin is an antiplatelet aggregator which can increase the risk of bleeding. Calcium and potassium do not reverse the effects of warfarin.
A patient is prescribed digoxin for supraventricular dysrhythmia. The nurse instructs the patient to avoid consuming bran. What is the reason behind this instruction?
- Bran decreases digoxin absorption.
- Bran and digoxin cause constipation.
- Bran and digoxin cause urinary retention.
- Bran increases the digoxin concentration in the body.
Bran decreases digoxin absorption.
Bran is a high-fiber food. It binds to the digoxin and affects the absorption and bioavailability of the drug. Bran decreases the absorption of digoxin, so the patient should avoid consuming bran while taking digoxin. Bran is a high-fiber food, and fiber treats constipation. Bran and digoxin do not affect urinary function and therefore do not cause urinary retention. Bran does not produce an additive effect and thus does not increase the digoxin concentration in the body.
The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. During the assessment, the patient tells the nurse, “These days, my urine has a burnt odor.” Which medications prescribed for the patient may be responsible for such an adverse effect? Select all that apply.
- Ezetimibe
- Colestipol
- Fluvastatin
- Gemfibrozil
- Cholestyramine
Colestipol & Cholestyramine
Urine with a burnt odor is an adverse effect of bile acid sequestrants such as colestipol and cholestyramine. Ezetimibe, fluvastatin, and gemfibrozil are antihyperlipidemics not associated with a burnt odor of the urine. Ezetimibe increases the risk of liver damage and discoloration of urine. Fluvastatin causes constipation, heartburn, and insomnia. Gemfibrozil may cause upset stomach, stomach pain, and diarrhea.
The nurse is teaching a patient about idiopathic hypertension. What statement should be included in the teaching plan?
- “This type of hypertension is not treatable.”
- “Once you have surgery, this will go away.”
- “This type of hypertension has a definitive cause.”
- “The cause of your hypertension is unknown, but treatable.”
“The cause of your hypertension is unknown, but treatable.”
Idiopathic hypertension is essential hypertension. The specific cause is unknown but it is treatable. Surgical treatment may cure secondary hypertension but not idiopathic hypertension.
The patient is being treated with abciximab. The nurse assesses the patent’s laboratory test results and finds that the platelet count has dropped to 75,000/mm3. What action will the nurse perform next?
- Prepare to administer protamine sulfate.
- No action is needed; this is a normal finding.
- Notify the primary care provider of this finding.
- Document the finding and continue to monitor the patient.
Notify the primary care provider of this finding.
If at any time during treatment with this drug the platelet count drops below 90,000/mm3, the health care provider should be notified. Protamine sulfate is the antidote for an excessive amount of heparin.
A patient will be discharged to continue treatment with simvastatin. The nurse will teach the patient to report which symptom?
- Fatigue
- Headache
- Muscle pain
- Nausea and vomiting
Muscle pain
Muscle pain must be reported because it could signify rhabdomyolysis, the uncommon but serious adverse effect that is associated with statin drugs like simvastatin. Fatigue, headache, and nausea and vomiting are also adverse effects of statin drugs, but they are generally not severe.
Which assessment is most important before administering digoxin?
- Apical pulse
- Homans sign
- Breath sounds
- Weight in kilograms
Apical pulse
It is crucial to measure the patient’s apical pulse rate (auscultate the apical heart rate, found at the apical impulse located at the fifth left midclavicular intercostal space) for 1 full minute before administering digoxin. The Homans sign is checked to deduce clots. Breathing sounds are assessed to check chronic obstructive pulmonary disease. Weight is checked before administration of any medication related to cardiovascular disease.
Which statement made by the patient indicates an understanding of discharge instructions on antihyperlipidemic medications?
- “I will stop taking the medication if it causes nausea and vomiting.”
- “It is important to double my dose if I miss one in order to maintain therapeutic blood levels.”
- “I will continue my exercise program to help increase my high-density lipoprotein serum levels.”
- “Antihyperlipidemic medications will replace the other interventions I have tried to decrease my cholesterol.”
“I will continue my exercise program to help increase my high-density lipoprotein serum levels.”
Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels. Patients should not stop taking the medication without consulting the provider. The dose should never be doubled if one is missed or stopped because of side effects.
A patient receiving atorvastatin therapy to reduce high cholesterol levels calls the clinic and reports, “I am experiencing severe pain in both my legs.” What is the nurse’s best response?
- “Stop taking the drug and visit the clinic immediately.”
- “Continue taking the drug; leg pain is a common side effect.”
- “Stop taking the drug if the symptoms persist for another week.”
- “Continue taking the drug along with antilipemic drugs and a painkiller.”
“Stop taking the drug and visit the clinic immediately.”
The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins, leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug, because myopathy is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient’s condition, leading to renal failure. Administration of antilipemic drugs along with atorvastatin further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until the cause of the leg pain is confirmed.
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient?
- “Change the patch daily at the same time.”
- “Remove the patch before taking a shower or bath.”
- “Get up slowly from a sitting to a standing position.”
- “Do not take other antihypertensive medications while using this patch.”
“Get up slowly from a sitting to a standing position.”
Clonidine can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.
Which complication may be experienced by a patient who is prescribed lisinopril?
- Insomnia
- Hyperkalemia
- Abdominal pain
- Cardiac dysrhythmia
Hyperkalemia
Lisinopril is an angiotensin-converting enzyme inhibitor, which causes the kidney to retain potassium, leading to hyperkalemia. Insomnia and abdominal pain are known side effects of nesiritide, not lisinopril. Cardiac dysrhythmia is a side effect of milrinone, not lisinopril.
Which medication acts by blocking sodium channels, accelerating repolarization, and decreasing the duration of the action potential?
- Lidocaine
- Verapamil
- Propafenone
- Dronedarone
Lidocaine
Lidocaine acts by blocking the sodium channels, accelerating repolarization, and decreasing the action potential duration. Verapamil is a calcium channel blocker, which works by inhibiting the calcium channels, resulting in a shortening of the action potential. Verapamil delays repolarization. Propafenone also acts by blocking sodium channels but has little effect on repolarization or action potential duration. Dronedarone increases the action potential duration by prolonging repolarization in phase 3.