[CARDIO] CAD, Perfusion, ACS, PAD meds

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:

a. The same as the client's own baseline level

b. Lower than the needed therapeutic level.

c. Within the therapeutic range

d. Higher than the therapeutic range

c.

The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.

A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?

a. "Eat foods high in potassium."

b."Take daily potassium supplements."

c."Discontinue sodium restrictions."

d."Avoid salt substitutes."

d.

Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.

A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?

a. Monitor the apical pulse rate

b. Instruct the client to take medication with food

c. Question the physician about the order

d.Caution the client to rise slowly when standing

c.

Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:

a. Moderate doses of two different types of diuretics are more effective than a large dose of one type

b. This combination promotes diuresis but decreases the risk of hypokalemia

c. This combination prevents dehydration and hypovolemia

d. Using two drugs increases osmolality of plasma and the glomerular filtration rate

b.

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

a. "Apply the patch to a non hairy, nonfatty area of the upper torso or arms."

b. "Apply the patch to the same site each day to maintain consistent drug absorption."

c. "If you get a headache, remove the patch for 4 hours and then reapply."

d. "If you get chest pain, apply a second patch right next to the first patch."

a.

A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principal effects are produced by:

a. Antispasmodic effect on the pericardium

b. Causing an increased myocardial oxygen demand

c. Vasodilation of peripheral vasculature

d. Improved conductivity in the myocardium

c.

Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?

a. Vitamin K

b. Aminocaproic acid

c. Potassium chloride

d. Protamine sulfate

d.

The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:

a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.

c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.

d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II

a.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

what are some contraindications in giving warfarin?

treating existing thromboses or for emergencies because the onset is delayed

Why would a pt need Clopidogrel (plavix)?

used to prevent platelet aggregation. A pt may use this after getting an MI. If pt is allergic to aspirin, this will be used (however it is more expensive)

What is the purpose of a beta blocker?

used to suppress the harmful effects of the SNS. (decrease O2 demands and contractility, therefore slowing the heart rate)

Why would a patient need a calcium channel blocker after an MI?

to prevent cardiac remodeling. (will decrease aldosterone and prevent water and sodium retention)

What is important to teach about Clopidogrel (Plavix)?

do not abruptly stop taking the drug without contacting the prescriber first (may precipitate a thrombotic event), take with food to avoid GI distress, apply pressure to bleeding

What is the purpose of Alteplase?

Used as a thrombolytic (clot buster) to break up clots (by fibrinolysis) in someone with an MI.

After receiving Alteplase, what should the nurse look for in the patient?

needs close monitoring of neurological status (to make sure the clot hasn't moved in the brain), watch for severe HA, dramatic increase in BP. (send to get a CT scan if change in LOC)

What are some symptoms of using an ACE-1 inhibitor

can cause hypotension, chronic cough, hyperkalemia, neutropenia, (watch BUN and creatinine)

When would someone use an ARB (Losartan)?

If they cannot tolerate an ACE inhibitor, does not cause chronic cough

A pt is taking Lovastatin due to high cholesterol. The nurse should be concerned if the client complains of

a. Headache

b. muscle pain

c. nausea

d. tiredness

b. muscle pain

increased creatine kinase causes muscle soreness or pain

A patient with stable angina also has erectile dsyfunction. What is something important to teach this patient?

Don't combine nitrates with drugs used for erectile dysfunction (Viagra).

A patient taking ACE-inhibitor has labs of: Na 136, K+ 6.2, creatinine 1.2 mg/dL, and Cl 90. What is the best nursing action?

Withhold the medication. ACE- inhibitors cause hyperkalemia.