week9 Cardiac meds too

Question 1

What is the priority nursing assessment for a patient who is about to begin digoxin therapy?

a.Blood glucose levels
b.Neurological function
c.Kidney function
d.Liver function

Answer 1

c.Kidney function

Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal impairment is present. Blood glucose levels and neurological and liver function would not be a priority assessment related to digoxin therapy.

Question 2

The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse warn the patient to avoid taking with digoxin?

A) Black cohosh
B) Ginseng
C) Saw palmetto
D) V alerian

Answer 2

B) Ginseng

Digoxin toxicity can occur if the drug is taken concurrently with licorice, ginseng, or hawthorn. St. John’s wort and psyllium have been shown to decrease the effectiveness of digoxin, so that combination should be avoided. There is no drug-to-drug interaction with black cohosh, saw palmetto, or valerian.

Question 3

The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing?

A) Albuterol (Proventil)
B) Nifedipine (Procardia)
C) Furosemide (Lasix)
D) Lovastatin (Mevacor)

Answer 3

C) Furosemide (Lasix)

Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are no known drug-to-drug interactions with albuterol, nifedipine, or lovastatin.

Question 4

The nurse assesses the patient before administering digoxin (Lanoxin) and withholds the drug and notifies the physician with what finding?

A) Respiratory rate falls below 14
B) History reveals liver failure
C) Pulse is 44 beats/min
D) Blood pressure is 72/40 mm Hg

Answer 4

C) Pulse is 44 beats/min

Monitor apical pulse for 1 full minute before administering the drug to assess for adverse effects. Hold the dose if the pulse is less than 60 beats/min in an adult or less than 90 beats/min in an infant; retake pulse in 1 hour. If pulse remains low, document pulse, withhold the drug, and notify the prescriber.

Question 5

After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time?
A) 30 to 120 minutes
B) 5 to 30 minutes
C) 1 hour
D) 2 hours

Answer 5

B) 5 to 30 minutes

Question 6

The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the patient complains of a headache and nausea. What will the nurse do first?

A) Contact the patient’s physician immediately.
B) Check her laboratory values and vital signs.
C) Administer acetaminophen and Maalox.
D) Give her clear liquids and have her lie down.

Answer 6

B) Check her laboratory values and vital signs.

Question 7

The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient understanding and determines further teaching is needed when the patient says she will do what?

A) ​Take the medication daily in the morning.​

B) ​Take her pulse before taking her dose.​

C) ​Weigh herself daily at the same time.​

D) ​Take the medication with a meal.​

Answer 7

D) ​Take the medication with a meal.​

Avoid administering the oral drug with food or antacids to avoid delays in absorption

Question 8

The nurse reviews the patient’s lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hyponatremia

Answer 8

B) Hypokalemia’

Electrolyte abnormalities (e.g., increased calcium, decreased potassium, decreased magnesium) could alter the action potential and change the effects of the drug. Hypokalemia and hypomagnesemia increase cardiac excitability and ectopic pacemaker activity leading to dysrhythmias.

Question 9

The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? (Select all that apply.)

A) Irregular heart rhythms
B) Nausea
C) Anorexia
D) Headache
E) Peripheral edema

Answer 9

A) Irregular heart rhythms
B) Nausea
C) Anorexia

Digoxin toxicity is a serious syndrome that can occur when digoxin levels are too high. The patient may present with anorexia, nausea, vomiting, malaise, depression, irregular heart rhythms including heart block, atrial arrhythmias, and ventricular tachycardia. Peripheral edema is indicative of heart failure, not digoxin toxicity. Headache is not usually associated with digoxin toxicity.

Question 10

You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug?

A) Assess mental status.
B) Assess breath sounds.
C) Assess pulses and blood pressure.
D) Assess urine output.

Answer 10

C) Assess pulses and blood pressure.

The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. All of the other options are appropriate assessments but are not the priority assessment.

Question 11

The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of lidocaine therapy should the nurse assess for?

A) Dysphagia
B) Dizziness
C) Excessive bruising
D) Tinnitus

Answer 11

B) Dizziness

Adverse effects include dizziness, light-headedness, fatigue, arrhythmias, cardiac arrest, nausea, vomiting, anaphylactoid reactions, hypotension, and vasodilation. Dysphagia, bruising, and tinnitus are not usually associated with lidocaine.

Question 12

16. For what condition would the nurse expect to administer lidocaine via IV drip?

Answer 12

Multiple premature ventricular contractions (PVCs)

Question 13

The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse be aware of?

A) The possible drug​drug interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)

B) The possible development of very serious cardiac arrhythmias

C) The possible development of peripheral edema

D) The possible development of a fatal renal toxicity

Answer 13

B) The possible development of very serious cardiac arrhythmias

Amiodarone has been associated with a potentially fatal liver toxicity rather than a renal toxicity, ocular abnormalities, and the development of very serious cardiac arrhythmias. Sotalol may have a loss

Question 14

The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered?

A) Anticoagulant
B) Digoxin
C) Quinidine
D) Ibutilide

Answer 14

A) Anticoagulant

If the onset of AF is not known and it is suspected that the atria may have been fibrillating than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. In 2011, the American Heart Association and American College of Cardiology endorsed dabigatran (Pradaxa) as the anticoagulant of choice for prophylaxis in AF. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics would not be indicated

Question 15

A nurse is teaching the patient newly prescribed sublingual nitroglycerin how to take the medication. What will the nurse instruct the patient to do first?
A) To check his radial pulse
B) To place the tablet in the buccal cavity
C) To take a sip of water
D) To lie down for 15 minutes before administration

Answer 15

C) To take a sip of water

The nurse should instruct the patient to take a sip of water to moisten the mucous membranes so the tablet will dissolve quickly. The patient does not need to take his pulse or lie down before drug administration. For sublingual administration, the patient will place the tablet under his tongue and not in the buccal cavity (cheek area).

Question 16

An older adult patient who is taking metformin (Glucophage) has just been seen in the clinic. The doctor has ordered metoprolol (Toprol) for angina. What assessment data should the nurse monitor due to this drug combination?

A.Blood pressure
B.Blood glucose
C.Heart rate

Answer 16

B.Blood glucose

Metformin is an antidiabetic drug and the nurse should monitor the patient’s blood glucose frequently throughout the day. The patient will not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Blood pressure, heart rate, and intake and output would not be affected by this drug​drug combination.

Question 17

The patient, diagnosed with angina, tells the nurse he is having chest pain. There is an order for oral sublingual nitroglycerin as needed. What action should the nurse take?

A) Place two nitroglycerin tablets under the patient’s tongue and call the physician.

B) Place one tablet under the patient’s tongue and repeat every 5 minutes for total of three tablets until pain has been relieved.

C) Have the patient swallow a tablet with a full glass of water and repeat in 10 minutes.

D) Apply a nitroglycerin transdermal patch to the patient’s back.

Answer 17

B) Place one tablet under the patient’s tongue and repeat every 5 minutes for total of three tablets until pain has been relieved.

The correct administration for sublingual administration is to place one tablet under the patient’s tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the health care provider should be notified. Transdermal application would be inappropriate and nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects.

Question 18

A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe the patient for what adverse effects?
A) Hypokalemia
B) Renal insufficiency
C) Hypotension
D) Hypoglycemia

Answer 18

C) Hypotension

Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

Question 19

What statements by the 54-year-old patient indicates an understanding of the nurse’s teaching about how to take sublingual nitroglycerin?
A) ​A headache means a toxic level has been reached.​

B) ​I can take up to 3 tablets at 5-minute intervals.​

C) ​I can take as much nitroglycerin as I need because it is not habit forming.​

D) ​If I become dizzy after taking the medication, I should stop taking it.​

Answer 19

B) ​I can take up to 3 tablets at 5-minute intervals.​

Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation so no more than three tablets should be taken, even though it is not habit forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate the patient should stop taking it.

Question 20

The nurse is caring for a patient who takes nitroglycerin sublingually. When providing patient education, the nurse would tell the patient that she can expect relief of chest pain within what period of time?

A) 1 to 3 minutes
B) 5 to 10 minutes
C) 15 to 20 minutes
D) 30 to 60 minutes

Answer 20

A) 1 to 3 minutes

Question 21

When providing patient education about nitroglycerin to the patient, what would the nurse include in the teaching plan about a nitroglycerin patch?

A) ​It only has to be administered once a week.​
B) ​It is more effective than tablets in treating angina.​
C) ​It has a longer duration of action.​
D) ​It is faster acting than the tablet

Answer 21

C) ​It has a longer duration of action.​

Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.

Question 22

Which statement by the patient would lead the nurse to believe that he has understood the teaching provided regarding angina?

A) ​I will not exercise because it precipitates angina.​

B) ​As long as I take the medicine, I need make no lifestyle change.​

C) ​There is no correlation between my hypertension and angina.​

D) ​Heavy meals and cigarette smoking can precipitate an angina attack.​

Answer 22

D) ​Heavy meals and cigarette smoking can precipitate an angina attack.​

Avoid stressful activities, especially in combination. For example, if you eat a big meal, do not drink coffee or alcoholic beverages with that meal. If you have just eaten a big meal, do not climb stairs; rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.

Question 23

The nurse is caring for a patient who is taking a calcium-channel blocker. What adverse effects would the nurse caution this patient about?

A) Hypertension and tachycardia
B) Headache and dizziness
C) Itching and rash
D) Nausea and diarrhea

Answer 23

B) Headache and dizziness

The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.

Question 24

An asthmatic patient taking beta-blockers should be assessed by the nurse for what potential adverse reaction?

A) Bronchospasm
B) Hypoglycemia
C) Pleural effusion
D) Pneumonia

Answer 24

A) Bronchospasm

Question 25

The nurse should instruct the patient to take what action if three nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?

A) To call 911
B) To call her health care provider
C) To lie down after taking an aspirin
D) To take more tablets until pain subsides

Answer 25

A) To call 911
Instruct patient that a sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses, if pain persists, the patient or a family member should call 911 to ensure proper medical support if a myocardial infarction should occur. She should not waste time by calling the health care provider; she can lie down while waiting for the ambulance to arrive, she should not take more tablets.

Question 26

The nurse is caring for a patient who takes metoprolol for angina. The patient asks how long it takes for the medicine to work. What is the nurse’s best response?
A) 15 minutes
B) 30 minutes
C) 1 hour
D) 90 minutes

Answer 26

A) 15 minutes

Question 27

The nurse teaches the patient wearing a nitroglycerin patch to avoid what?

A. Exercise
B. Alcohol beverages
C. Milk products

Answer 27

B. Alcohol beverages

Patients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. There is no need to avoid exercise, milk, or synthetic fabrics.

Question 28

After the patient’s anginal pain is relieved he says to the nurse, ​That nitroglycerin works great. How does it do that?​ What is the nurse’s best response?

A) ​Nitroglycerin decreases the amount of oxygen needed by the heart to function.​

B) ​Nitroglycerin makes the coronary arteries open much wider.​

C) ​Nitroglycerin promotes growth of new, smaller arteries to supply oxygen to the heart.​

D) ​Nitroglycerin decreases preload and afterload.​

Answer 28

A) ​Nitroglycerin decreases the amount of oxygen needed by the heart to function.​

The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance.

Question 29

The nurse is preparing to administer sublingual nitroglycerin to a patient for the first time and warns that the patient may experience what right after administration?
A) Nervousness or paresthesia
B) Throbbing headache or dizziness
C) Drowsiness or blurred vision
D) Tinnitus or diplopia

Answer 29

B. Ha and dizziness

Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid self-contamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the patient usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.