Week 8 sherpath Flashcards
Which systemic effect of nitrates works to decrease the workload of the heart?
Decrease in heart rate
Increase in blood pressure
Relaxation of heart muscle
Decrease in venous tone
Decrease in venous tone
A patient with acute chest pain asks the nurse why sublingual nitroglycerin is better than swallowing a pill. The nurse responds knowing which information about sublingual nitroglycerin?
The therapeutic effect of sublingual nitroglycerin lasts longer.
The onset of action is the most rapid with the sublingual formulation of nitroglycerin.
Sublingual nitroglycerin is the most convenient formulation to administer.
The oral mucosa absorbs sublingual nitroglycerin into the systemic circulation more quickly.
The oral mucosa absorbs sublingual nitroglycerin into the systemic circulation more quickly.
Match the form of nitroglycerin with its appropriate onset of action.
1-3 minutes
15-60 minutes
Immediate
Answer choices
Intravenous
Topical
Sublingual
1-3 minutes
Sublingual
15-60 minutes
Topical
Immediate
Intravenous
Which number of nitroglycerin tablets is the maximum amount that Mr. Smitheal should take for chest pain?
One
Two
Three
Four
three
Which guidance would the nurse provide to Mr. Smitheal regarding storage of his nitroglycerin?
Keep the medication in a sealed bag.
Keep the medication in its original, airtight container.
Keep several loose doses of medication accessible in the pocket of his shirt.
Keep a bottle of tablets in the car at all times.
Keep the medication in its original, airtight container.
The nurse would tell patients to place one sublingual nitroglycerin tablet under the tongue every ___ minutes up to a maximum of three tablets.
5 minutes
The presence of which disease process is an absolute contraindication for treatment with nitroglycerin?
Hypotension
Decreased renal function
Pregnancy
Right-ventricular myocardial infarction
Right-ventricular myocardial infarction
Which route of administration for nitroglycerin is most common?
Topical
Sublingual
Oral
Intravenous (IV)
Sublingual
Which route of administration for nitroglycerin is associated with development of tolerance if a drug-free interval is not established?
Sublingual
Transdermal
Oral
Intravenous
Transdermal
The nurse monitors blood pressure while administering nitroglycerin intravenously knowing that the medication has which therapeutic action?
Lowering heart rate
Dilating vessels
Increasing blood pressure
Increasing preload
Dilating vessels
How long after administering nitroglycerin intravenously (IV) would the nurse expect the patient’s chest pain to be relieved?
Within seconds
After 3 minutes
Within 30 minutes
After 60 minutes
Within seconds
A patient asks why a nitroglycerin patch cannot be worn for 24 hours. Which response by the nurse is appropriate?
Rashes are more likely with 24-hour use of a nitroglycerin patch.
Dizziness will occur more frequently with 24-hour use of a nitroglycerin patch.
Headaches will become more frequent and present with increased intensity with 24-hour use of a nitroglycerin patch.
Tolerance to the nitroglycerin can develop with 24-hour use of a nitroglycerin patch.
Tolerance to the nitroglycerin can develop with 24-hour use of a nitroglycerin patch.
A patient diagnosed with angina is being discharged home with sublingual nitroglycerin. Which statement by the patient indicates an understanding of when to take the medication?
“As soon as I start having chest pain, I will take the nitroglycerin.”
“When I have chest pain, I will call my doctor before I take the nitroglycerin.”
“If the pain is not relieved after resting for 15 minutes, I will take the nitroglycerin.”
“I will take the nitroglycerin if the pain is not relieved after taking a nap.”
“As soon as I start having chest pain, I will take the nitroglycerin.”
A nurse is preparing to administer nitroglycerin ointment. Which action by the nurse is most important when handling nitroglycerin?
Wash hands before handling nitroglycerin.
Wear a gown to protect clothing from medication spills.
Wear gloves when handling nitroglycerin.
Wear a surgical mask when handling nitroglycerin.
Wear gloves when handling nitroglycerin.
A patient with a history of angina and peripheral vascular disease inquires about taking sildenafil for erectile dysfunction while on extended-release oral nitroglycerin. Which educational information would the nurse provide?
Because both drugs help dilate vessels, it is safe to take together.
Both drugs can be taken together, but the effects of sildenafil may take longer to achieve.
Drugs for erectile dysfunction should not be taken with nitroglycerin.
Avanafil, not sildenafil, is safe to take with nitroglycerin.
Drugs for erectile dysfunction should not be taken with nitroglycerin.
The nurse is providing teaching to a patient regarding the difference between side effects of nitroglycerin that can be managed and adverse effects, which may necessitate discontinuation of the drug. Which conditions are considered side effects of nitroglycerin?
Select all that apply.
Headache
Swelling
Blurred vision
Hypotension
Confusion
Tachycardia
Headache
Hypotension
Tachycardia
What are key points a nurse would include while teaching another nurse about clonidine’s mechanism of action?
Select all that apply.
Clonidine suppresses the sympathetic nerves to the heart, which leads to bradycardia.
The effects of clonidine are mostly on the heart and vascular system.
Clonidine blocks sympathetic outflow, which increases cardiac output.
Clonidine suppresses the sympathetic regulation of blood vessels, which produces vasodilation.
Clonidine can be absorbed orally and transdermally.
Clonidine is metabolized through the liver.
Clonidine suppresses the sympathetic nerves to the heart, which leads to bradycardia.
The effects of clonidine are mostly on the heart and vascular system.
Clonidine suppresses the sympathetic regulation of blood vessels, which produces vasodilation.
The nurse is preparing to administer an oral dose of clonidine. Which pharmacodynamics would the nurse anticipate?
Peak effects in 6 hours
Onset of action in 90 to 120 minutes
Onset of action in 30 to 60 minutes
Duration of action 24 hours
Onset of action in 30 to 60 minutes
A patient who is prescribed transdermal clonidine asks the nurse, “Why do I only change the patch once a week?” Which response would the nurse provide?
“The patch will irritate your skin if you leave it on longer than 1 week.”
“One week is the length of time that the medication lasts.”
“The health care provider will need to change the prescription to apply the patch daily to get the maximum benefit.”
“Your body no longer responds to the medication after a week.”
“One week is the length of time that the medication lasts.”
Which teachings would the nurse need to include for Ms. Abbott, who is being discharged home on clonidine?
Select all that apply.
Do not eat grapefruit while on clonidine.
Do not discontinue clonidine suddenly.
Avoid hazardous activities initially.
Take the medication with food.
The medication can cause dry mouth.
Do not discontinue clonidine suddenly.
Avoid hazardous activities initially.
The medication can cause dry mouth
Which actions would the nurse take before administering clonidine?
Select all that apply.
Assess for pregnancy.
Teach symptoms of drug interaction with insulin.
Obtain a baseline blood pressure.
Assess glucose level at the bedside.
Document temperature.
Assess for pregnancy.
Obtain a baseline blood pressure.
Which statement is accurate regarding the central nervous system (CNS) side effects of clonidine?
CNS side effects occur only in the older adult.
Drowsiness and sedation are rare.
Sedative effects wear off 2 hours after intake.
Avoid activities that require concentration.
Avoid activities that require concentration.
The nurse is administering an oral dose of clonidine at 0600. At which time would the nurse anticipate the onset of the medication?
0610
0700
0800
1800
0700
The nurse is teaching a new nurse about the pharmacokinetics of oral clonidine. Which teachings would the nurse include?
Select all that apply.
Duration of the medication is 6 hours.
Clonidine is lipid soluble and well absorbed.
Metabolism of clonidine occurs in the liver.
Clonidine does not cross the blood-brain barrier.
The half-life of oral clonidine is 20 hours.
Clonidine is lipid soluble and well absorbed.
Metabolism of clonidine occurs in the liver.
Which description of the mechanism of action of clonidine is accurate?
Increases peripheral vascular resistance and decreases cardiac output
Decreases peripheral vascular resistance and decreases cardiac output
Decreases peripheral vascular resistance and increases cardiac output
Increases peripheral vascular resistance and increases cardiac output
Decreases peripheral vascular resistance and decreases cardiac output
Which teaching would the nurse include for a patient receiving a transdermal clonidine patch?
Place the patch on the upper thigh.
Apply a new patch every 10 days.
Remove the patch when bathing.
Remove one patch before applying another.
Remove one patch before applying another.
A nurse is reviewing home medications with a patient at the time of admission and learns the patient is taking 2 mg of clonidine twice a day. Which nursing intervention would be the priority?
Document the dosage.
Document the frequency.
Question the dosage.
Question about other medications.
Question the dosage.
A patient is taking clonidine 0.1 mg twice a day and questions if the medication is safe during pregnancy. Which response would the nurse provide?
Clonidine is safe after the first trimester.
Clonidine is not recommended for pregnant women.
Transdermal clonidine is safe to use during pregnancy.
There are no concerns about clonidine use during pregnancy.
Clonidine is not recommended for pregnant women.
Which teaching would the nurse provide to a patient receiving clonidine who reports xerostomia?
Take the medication with food.
Take the medication on an empty stomach.
Chew gum to help with discomfort.
Contact the health care provider to change medications.
Chew gum to help with discomfort.
A patient taking clonidine daily was unable to refill the medication and presents to the emergency department with rebound hypertension. What assessment data will the nurse anticipate?
Heart rate 58 beats per minute
Sinus tachycardia
Xerostomia
Eczematous rash on the upper torso
Sinus tachycardia
Beta blockers decrease the sympathetic response by blocking which neurotransmitters?
Select all that apply.
Epinephrine
Acetylcholine
Dopamine
Serotonin
Norepinephrine
Epinephrine
Norepinephrine
Which therapeutic effect is expected in a patient prescribed a beta blocker after a myocardial infarction?
Decreased myocardial workload
Heightened blood pressure
Reduced oxygenation
Increased heart rate
Decreased myocardial workload
Which time frame is the half-life of propranolol extended release?
2 hours
4 hours
8 hours
14 hours
8 hours
Which beta blockers block both beta1 and beta2 receptors?
Select all that apply.
Acebutolol
Propranolol
Pindolol
Metoprolol
Carvedilol
Atenolol
Propranolol
Pindolol
Carvedilol
Cardioselective beta blockers are preferred for patients with which medical conditions?
Select all that apply.
Hypotension
Diabetes
Liver disease
Respiratory disease
Bradycardia
Diabetes
Respiratory disease
Mr. C asks the nurse if he can still take an antacid if he has indigestion while taking metoprolol. Which statement made by Mr. C indicates an understanding of when to take metoprolol?
“Take an antacid with the metoprolol.”
“Take the metoprolol at least 30 minutes after an antacid.”
“Take an antacid at least 2 hours before the metoprolol.”
“If I take an antacid, I will skip the metoprolol.”
“Take an antacid at least 2 hours before the metoprolol.”
Which sign or symptom would the nurse instruct Mr. C to report immediately while he is taking metoprolol?
Constipation
Swelling of feet and legs
Insomnia
Heart rate of 65 beats/min
Swelling of feet and legs
The nurse is preparing to administer metoprolol intravenously. Over how many minutes should the metoprolol be administered? ___ to ___ minutes
1 to 2 minutes
Propranolol is contraindicated for a patient with which conditions?
Select all that apply.
Diabetes
Heart failure
Sinus bradycardia
Myocardial infarction
Paroxysmal atrial tachycardia
Heart failure
Sinus bradycardia
A patient is being discharged on extended-release (ER) metoprolol. Which statement by the patient indicates an understanding of metoprolol ER?
“If I have trouble swallowing, I can open the content and mix it with food.”
“I can let it dissolve in juice prior to taking it.”
“I should take the drug whole.”
“I can skip the next dose since it is an extended-release drug.”
“I should take the drug whole.”
Teaching is provided to a patient who is prescribed metoprolol after a myocardial infarction. Which response by the patient indicates a need for additional teaching?
“I do not need to check my heart rate before taking the drug.”
“I will call my health care provider if the top number of the blood pressure is less than 100.”
“I should call my health care provider if I gain 2 or more pounds in 24 hours.”
“I will take the drug even if I am feeling better.”
“I do not need to check my heart rate before taking the drug.”
In which division of the nervous system are catecholamines blocked by metoprolol, resulting in drowsiness?
Parasympathetic nervous system
Somatic nervous system
Sympathetic nervous system
Peripheral nervous system
Sympathetic nervous system
The nurse reports which assessment finding as contributing to the cardioprotective effect in a patient receiving metoprolol?
The pulse is palpated more strongly.
The frequency of premature beats increased to 8 from 3.
The blood pressure increased to 128/68 mm Hg from 110/60 mm Hg.
The heart rate decreased from 130 to 98 beats/min
The heart rate decreased from 130 to 98 beats/min
The patient refuses to take metoprolol because of its effects on the lungs. The nurse explains that metoprolol will not affect the lungs because it affects which type of cell receptors?
Alpha1
Alpha2
Beta1
Beta2
Beta1
The nurse administers propranolol intravenously at 0900. At which time will the nurse start assessing for its therapeutic effects?
0905
0930
1000
1015
0905
Propranolol is prescribed to a patient for heart failure. Which assessment finding would concern the nurse?
Tachycardia
Wheezing
Insomnia
Nausea
Wheezing
A nurse is preparing to administer a beta blocker to a patient who has the following vital signs: blood pressure 118/68 mm Hg; heart rate 54 beats/min; and respiratory rate 14 breaths/minute. Which action would the nurse take?
Administer the medication.
Notify the health care provider.
Hold the medication.
Discontinue the prescription.
Hold the medication.
A nurse is assessing a patient who has been taking metoprolol. Which assessment finding would be most concerning?
Decrease in pulse by 4 points
Weight gain of 4 lb within 24 hours
Oxygen saturation of 96%
Diastolic blood pressure of 86 mm Hg
Weight gain of 4 lb within 24 hours
Which nursing assessment would be of highest priority when administering a beta blocker?
Heart rate
Daily weight
Respiratory rate
Intake and output
Heart rate
A patient who is prescribed propranolol complains of swelling to the feet. Which action would the nurse take?
Administer a diuretic.
Elevate the legs.
Encourage the patient to walk frequently.
Hold the propranolol.
Hold the propranolol.
A patient taking propranolol complains of dizziness when getting out of bed. Which action would the nurse take first?
Call the health care provider.
Obtain blood pressure and heart rate.
Place the call light near the patient.
Hold the propranolol.
Obtain blood pressure and heart rate.
