Perfusion and Clotting Medications Flashcards
A patient admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. which of the following medications would need to be withheld for 48 hours before and after the procedure?
- glucophage
- prandin
- glucotrol
- regular insulin
The correct answer is: Glucophage
Metformin(Glucophage) needs to be withheld 48 hours before and after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system, the patient would be at increased risk for lactic acidosis.
The other medications do not need to be withheld before or after cardiac catheterization.
A clinic nurse is providing instructions to a client with hypertension who will be taking captopril. Which statement by the client indicates a need for further instruction?
- I need to avoid taking hot baths or showers
- I need to change positions slowly
- I need to drink increased amounts of water
- I need to sit down and rest if dizziness or lightheartedness occur
The correct answer is: “I need to drink increased amounts of water.”
An increased intake of water could actually aggravate hypertension.
Captopril is an antihypertensive medication (angiotensin-converting enzyme (ACE) inhibitor).
Orthostatic hypotension can occur in clients taking this medication. Clients are advised to avoid standing in one position for long periods: to change positions slowly, and to avoid extreme warmth such as with baths, showers, or heat from the sun in warm weather.
The client should be instructed to monitor for signs of orthostatic hypotension, such as dizziness, lightheadedness, weakness, and syncope.
A nurse in the medical unit is reviewing the laboratory test results for a patient who has been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the patient was in the intensive care unit. The nurse determines that this test was performed to assist in diagnosing which of the following conditions.?
- Atrial fibrillation
- Ventricular Tachycardia
- Myocardial infarction
- Congestive heart failure
Cardiac troponin T or cardiac troponin I has been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of myocardial infarction.
The clinic nurse is reviewing the assessment findings for a patient who has been taking spironolactone for treatment of hypertension. Which of the following, if noted in the patient's record, would indicate that the patient is experiencing a side effect related to the medication? 1. K+ of 3.2 2. K+ of 5.8 3 patient complaint of constipation 4. Patient complaint of dry skin
The correct answer is: A potassium level of 5.8 mEq/L
Spironolactone is a potassium-sparing diuretic. Side effects include hyperkalemia, dehydration, hyponatremia, and lethargy. Although the concern with most diuretics is hypokalemia, this medication is potassium-sparing, which means that the concern with the medication is hyperkalemia.
Additional side effects include nausea, vomiting, cramping, diarrhea, headache, ataxia, drowsiness, confusion, and fever.
A nurse is providing instructions to a patient with chronic atrial fibrillation who is being started on quinidine sulfate. Which instruction would the nurse give the patient?
- Take the med only on an empty stomach
- Open the sustained-release capsules and mix with applesauce
- stop taking the prescribed digoxin when this med is started
- Wear a medic-alert bracelet
The correct answer is: Wear a Medic-Alert bracelet
The client should be instructed to wear a Medic-Alert bracelet or tag.
The patient should be instructed to take quinidine sulfate exactly as prescribed. The patient should not chew the sustained-release capsules or open the capsules and mix them with food.
The patient should be instructed to continue taking digoxin as prescribed. Quinidine sulfate is administered for an atrial flutter or fibrillation only after the patient has been digitalized.
A patient receiving parenteral nutrition has a history of congestive heart failure. The physician has ordered furosemide (Lasix) 4o mg by mouth daily to prevent fluid overload. The nurse monitors which laboratory value to identify an adverse effect from this medication?
- Magnesium
- Sodium
- Potassium
- Glucose
The correct answer is: Potassium
Furosemide is a nonpotassium-sparing diuretic, and insufficient replacement of potassium may lead to hypokalemia.
Although the glucose, sodium, and magnesium levels may be monitored, these laboratory values are not specific to administering furosemide.
A patient with heart failure is scheduled to be discharged to home with digoxin and furosemide as daily prescribed medications. The nurse tells the patient to report which of the following as an indication that the medications are not having the intended effect?
- cough accompanied by other signs of respiratory infection
- Sudden increase in appetite
- increased urine output during the day
- weight gain of 2-3 lbs in a few days
The correct answer is: Weight gain of 2 to 3 lbs in a few days
Patients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia.
An increase in urine output during the day is expected with diuretic therapy.
A cough due to respiratory infection does not necessarily indicate that heart failure is worsening.
A hospitalized patient’s serum calcium level is 7.0 mg/dL. The nurse is immediately concerned and takes action knowing that this level could ultimately lead the patient into which of the following conditions.
- Cardiac arrest
- High BP
- Urinary stone formation
- Stroke
The correct answer is: Cardiac arrest
The normal calcium level is 8.6-10mg/dL. A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contractions. The nurse would take action and contact the physician.
High blood pressure and stroke are unrelated to calcium levels.
Elevated calcium levels can lead to urinary stone formation.
A nurse who is auscultating a 56-year-old patient’s apical heart rate before administering digoxin notes that the heart rate is 52 beats/min. What is the interpretation of this heart rate?
- normal as a result of the effects of digoxin
- abnormal requiring further assessment
- normal because this is the reason the pt is receiving digoxin
- normal because of the pt’s age
The correct answer is: Abnormal, requiring further assessment
The normal heart rate is 60-100 beats/min in an adult. On auscultating a heart rate that is less than 60 beats/min, the nurse would not administer the digoxin and would report the finding to the physician.
The other options are incorrect because the heart rate of 52 beats/min is not in the normal range and needs further assessment and intervention.
Which of the following laboratory test results may be associated with peaked or tall, tented T waves on a patient’s electrocardiogram?
- magnesium 1.6
- K+ 6.8
- Chloride 98
- Sodium level 135
The correct answer is: Potassium level of 6.8 mEq/L
Hyperkalemia can cause tall, peaked or tented T waves on the ECG. Levels of potassium 5.1 mEq/L or greater indicates hyperkalemia.
All other lab values in the normal range.
A patient with myocardial infarction is experiencing new multiform premature ventricular contractions (PVCs). Knowing that the patient is allergic to lidocaine hydrochloride, the nurse plans to have which of the following medications available for immediate use?
- metoprolol
- verapamil
- digoxin
- procainamide
The correct answer is: procainamide
Procainamide is an antiarrhythmic that may be sued to treat ventricular arrhythmias in patients who are allergic to lidocaine.
Digoxin is a cardiac glycoside
metoprolol is a B-adrenergic blocking agent
Verapamil is a calcium channel blocking agent.
