Pharmacology Made Easy 5.0 The Cardiovascular System

A nurse is caring for a client on a medical-surgical unit. Which of the following actions should the nurse take? Select all that apply.

-Monitor for tachycardia

-Administer atropine 1 mg IV bolus

-Assess for medication interactions

-Monitor for bradycardia

-Assess mental status

When taking action, the nurse should plan to administer atropine 1 mg IV bolus, monitor for tachycardia and bradycardia, assess for medication interactions, and assess mental status. The client has manifestations of symptomatic bradycardia: disorientation, dizziness, feeling weak, shortness of breath, sinus bradycardia, hypotension, and tachypnea. Therefore, the nurse should administer atropine because it blocks the action of acetylcholine at parasympathetic sites, increases the heart rate and cardiac output, improves mental status and vital signs. The nurse should assess for medication interactions because amantadine can increase the effects of atropine. The nurse should monitor for bradycardia as well because the client can experience paradoxical bradycardia.

A nurse in an outpatient clinic is caring for a male client who has hyperlipidemia. For each current assessment finding, click to specify if the finding is consistent with myopathy, hepatotoxicity, or hyperlipidemia. Each finding may support more than one disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Myopathy:

-Creatine kinase

-Muscle

Hepatotoxicity:

-Hepatic transaminases

-Abdomen

Hyperlipidemia:

-LDL cholesterol

-Total cholesterol

When analyzing cues, the nurse should recognize that manifestations of myopathy include muscle pain and elevated creatine kinase, which occur when the medications break down muscles into myoglobin and are released into the bloodstream. If left untreated, myopathy can progress to rhabdomyolysis. The myoglobin released from the muscles can travel to the kidneys and damage the kidney and cause kidney failure. The nurse should recognize the manifestations of hepatoxicity include abdominal pain and elevated liver function enzymes called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The nurse should recognize that the client continues to have manifestations of hyperlipidemia with treatment, including elevated cholesterol and LDL cholesterol. The combination of taking ezetimibe, a cholesterol absorption inhibitor medication, and an HMG-CoA reductase inhibitor increases the client’s risk for hepatotoxicity and myopathy.

A nurse in an outpatient clinic is preparing to provide education to a client who has heart failure. The nurse is preparing to provide education about the client's new medication during the second clinic visit. For each potential teaching intervention, click to specify if the teaching is indicated or not indicated. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Indicated:

-Notify provider if hearing changes.

-Monitor blood glucose more frequently.

-Notify the provider if having an irregular heartbeat, muscle cramping, or weakness.

-Start taking furosemide today and then each morning.

-Check blood pressure and notify provider if BP drops significantly.

Not Indicated:

-Avoid potassium-rich foods like bananas and nuts.

-Weigh each day in the evening before sleeping.

A nurse is caring for a client who is taking atorvastatin and has a new prescription for gemfibrozil. The nurse should recognize that this drug combination places the client at an increased risk for which of the following adverse effects?

Myopathy

When taking a statin medication, it is important to know that concurrent use of fibric acid derivatives, such as gemfibrozil, or other medications to lower cholesterol, can increase the risk for myopathy.

A nurse is caring for a client who is taking spironolactone to treat hypertension. The nurse should recognize that which of the following client laboratory values require immediate intervention?

Potassium 5.2

A nurse is teaching a client who has a new prescription for nitroglycerine. The nurse should instruct the client that which of the following manifestations is a potential adverse effect of this drug?

Headache

Adverse effects of nitrates, such as nitroglycerin, include headaches, which can be severe at the beginning of nitrate therapy but decrease in severity with continued exposure to nitrates.

A nurse is reviewing new prescriptions with a client who has heart disease. The nurse should instruct the client that which of the following drugs is prescribed to treat hypercholesterolemia.

Simvastatin

A nurse is providing teaching to a client who has a new prescription to losartan to treat hypertension. The nurse should instruct the client that which of the following findings could indicate an adverse reaction to the drug and needs to be reported?

Facial edema

Losartan, an angiotensin II receptor blocker, can cause angioedema, which often manifests as swelling around the eyes and lips. Clients who develop this adverse effect should stop taking the medication and seek medical attention.

A nurse is caring for a client who has a new prescription for verapamil. The nurse should clarify the prescription with the provider if the client has a history of which of the following conditions?

Second-degree AV block

Verapamil, a calcium channel blocker, can affect AV conduction and is contraindicated for clients who have sick sinus syndrome or second- or third-degree AV block. Verapamil is indicated for hypertension, angina pectoris, and the management of atrial flutter and fibrillation. It is also prescribed for the management of migraine headaches.

A nurse is caring for a client who has a glomerular filtration rate of 10 mL/min and a reduced urine output. The nurse should clarify a prescription for hydrochlorothiazide for this client because of which of the following characteristics of the drug?

The drug does not promote diuresis for clients who have renal insufficiency

Adequate kidney function is essential for clients who take hydrochlorothiazide, a thiazide diuretic, to promote urine production and effective excretion.

A nurse is administering hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which of the following findings that indicates an adverse effect of this drug?

Hyperuricemia

Hyperuricemia, or increased uric acid levels, along with gouty arthritis, can occur in clients who have a history of these conditions and are taking hydrochlorothiazide.

A nurse is caring for a client who is taking a diuretic. The nurse should instruct the client to include which of the following foods in their diet to increase potassium intake?

Raisins

Diuretics can deplete the body of potassium, so the nurse should instruct the client to include potassium-rich foods in their diet, such as raisins and other dried fruits.

A nurse is caring for a client who has a new prescription for verapamil to treat atrial fibrillation. The nurse should instruct the client to avoid drinking grapefruit juice while taking verapamil because it can cause the client to experience which of the following conditions?

Hypotension

Large amounts of grapefruit juice can increase blood levels of verapamil by inhibiting its metabolism. An excess amount of the medication in the body can intensify otherwise therapeutic effects like hypotension, causing serious risk for syncope and dizziness.

A nurse is caring for a client who will begin using transdermal nitroglycerin to treat angina pectoris. When speaking to the client about the drug which of the following instructions should the nurse include?

-Apply the patch to a hairless area and rotate sites

-Apply a new patch when you start your day

-Remove patches for 10 to 12 hr each day

"Apply a new patch at the onset of anginal pain" is incorrect. Nitroglycerin patches provide ongoing prevention of angina episodes. They do not treat the acute onset of anginal pain.
"Apply the patch to dry skin and cover the area with transparent dressing" is incorrect. These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches.
"Apply the patch to a hairless area and rotate sites" is correct. Hair can interfere with the adhesion of the patch. Rotating patch application sites helps prevent skin irritation.
"Apply a new patch when you start your day" is correct. The therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last for up to 14 hr. Because angina pain is more likely to occur with activity, most clients require this protection during waking hours.
"Remove patches for 10 to 12 hr each day" is correct. Removing the patches for 10 to 12 hr each day helps prevent the development of tolerance to the medication. For most clients, sleeping hours are the best time to remove the patch and go "patch-free," because angina pain is more likely during activity.

A nurse is caring for a client who is taking lithium for manic-depressive disorder and requires a prescription medication to treat hypertension. The nurse should recognize that which of the following antihypertensive medications is contraindicated and should be given with caution for this client?

Captopril

Captopril, an ACE inhibitor, can increase lithium levels and cause toxicity. Therefore, giving an ACE inhibitor to a client who is taking lithium, the nurse should closely monitor lithium levels and for manifestations of toxicity.

A nurse is caring for a client who is taking amiodarone to treat atrial fibrillation. Which of the following should the nurse instruct the client to avoid while taking this drug?

Grapefruit juice

Grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers, such as amiodarone.

A nurse is caring for a client who is taking carvedilol and has a prescription for an oral antidiabetic drug to manage their diagnosis of type 2 diabetes mellitus. By taking both drugs concurrently, the nurse should identify that the client is at an increased risk for which of the following conditions?

Hypoglycemia

There are two factors that increase the client's risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemic effects of insulin and oral hypoglycemic medications. Also, carvedilol can mask tachycardia in clients who have hypoglycemia. Carvedilol should be used with caution by clients who have diabetes mellitus.

A nurse is caring for a client who is about to genii catopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue drug therapy?

Rash

Distorted taste

Swelling of the tongue

Dry cough

A nurse is caring for a client who is taking digoxin and develops changes on their ECG tracing and other manifestations that indicate the client has severe digoxin toxicity. Which of the following drugs should the nurse expect to administer to treat this complication?

Antigen-binding fragments

Antigen-binding fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.

A nurse is teaching a client who has a new prescription for quinidine. Which of the following statements should the nurse include?

Moniter your pulse and report changes

Sodium channel blockers, like quinidine, can worsen dysrhythmias, or cause new ones. The nurse should teach the client to monitor their pulse rate and report changes from prescribed parameters. It can be helpful to instruct the client to keep a written record of their pulse rate for the provider.

A nurse is caring for a client who has a new prescription for propranolol to treat a tachydysrhythmia. The nurse should instruct the client to avoid taking which of the following types of over the counter drugs while taking propranolol?

NSAIDs

NSAIDs can interact with propranolol and decrease the anti-hypertensive action because vasoconstriction can occur in some COX-2 inhibitors. The nurse should instruct the client to avoid taking NSAIDs and propranolol at the same time.

A nurse is caring for a client who has a new prescription for aliskiren to treat hypertension. The nurse should monitor the client for which of the following findings as an adverse effect of the drug?

Hyperkalemia

Throat swelling

Cough

Hyperkalemia is correct. Aliskiren, a direct renin inhibitor, can cause elevated potassium levels, especially when taken in combination with an ACE inhibitor, potassium supplements, or potassium-sparing diuretics. The nurse should obtain a potassium level at baseline and periodically monitor the client's potassium level thereafter.
Throat swelling is correct. Aliskiren can cause angioedema, which is swelling of the mouth and throat. Clients who develop this adverse effect should stop taking the medication and seek medical attention.
Constipation is incorrect. Constipation is not an adverse effect of aliskiren. This medication can cause diarrhea.
Cough is correct. Aliskiren, a direct renin inhibitor, can cause a cough.
Joint pain is incorrect. Joint pain is not an adverse effect of aliskiren. This medication can cause headaches.

A nurse is teaching a client who has a new prescription for gemfibrozil. Which of the following instructions should the nurse include?

Report any new intolerance to fried foods

Report muscle tenderness

Expect periodic liver function testing

Take the medication with food is incorrect. Clients should take gemfibrozil, a fibrate, 30 min before a meal, not with food.
Report any new intolerance to fried foods is correct. Because gemfibrozil, a fibrate, can cause gallstones, clients should monitor and report any new intolerance to fried foods, as well as any bloating or upper abdominal discomfort.
Report muscle tenderness is correct. Because gemfibrozil, a fibrate, can cause myopathy, clients should monitor and report any unexplained muscle or joint pain.
Expect periodic liver function testing is correct. Because gemfibrozil, a fibrate, increases the risk for liver toxicity, clients will require liver function testing while taking this medication.
Take the medication once each day is incorrect. Clients should take gemfibrozil, a fibrate, twice each day.

A nurse is caring for a client who has a new prescription for dobutamine. The nurse should clarify the prescription with the provider if the client is receiving which of the following types of drugs?

MAOI

General anesthetic

Tricyclic Antidepressant

Beta blocker

A nurse should recognize that milrinone is contraindicated for a client who has which of the following conditions?

Heart valve disorders

Milrinone, a phosphodiesterase inhibitor, is contraindicated for clients who had an allergic reaction to phosphodiesterase inhibitors and for clients who have aortic or pulmonary valve disorders.

A nurse is caring for a client who is about to begin captopril therapy. Which of the following adverse effects should the nurse instruct the client to report because it can indicate a need to discontinue medication therapy? (Select all that apply.)

rash

distorted taste

swelling of tongue

dry cough

Rash is correct. Captopril, an ACE inhibitor, can cause a persistent rash. This often indicates the need to discontinue medication therapy.
Distorted taste is correct. Captopril can cause distortions in taste sensations and loss of taste, which can lead to anorexia and weight loss. This often indicates the need to discontinue medication therapy.
Swelling of the tongue is correct. Captopril can cause angioedema, often manifesting as edema of the tongue, pharynx, and glottis. Clients who develop this adverse effect should discontinue the medication and seek medical attention.
Photosensitivity is incorrect. Captopril can cause photosensitivity, a relatively benign adverse effect that does not require the client to discontinue medication therapy. Clients who experience this adverse effect should be especially careful about wearing sunscreen and protective clothing when outdoors and should limit their exposure to sunlight.
Dry cough is correct. Captopril can cause a dry cough because of an accumulation of bradykinin. This often indicates the need to discontinue medication therapy.