Cardiac Drugs – Flashcards
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An important nursing consideration when administering furosemide to a diabetic patient is
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Monitor blood glucose closely
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Loop diuretics are the type of diuretic most commonly administered to hospitalized patients in heart failure because they:
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Are effective when kidney function declines
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Which of the following laboratory results should be reported to the prescriber if a patient is receiving a thiazide or loop diuretic? A.Blood urea nitrogen (BUN) 20mg/dL B. Hemoglobin A1C 5.5 % C. Potassium (K+) 3.2 mEq/L D. Uric acid 20 mg/dL
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C. Potassium (K+) 3.2 mEq/L Normal potassium levels are 3.5-5.0 mEq/L. The other answers fall within normal range but are not as relevant as the potassium levels.
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True / False? ARBs produce hyperkalemia.
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False ARBs do not produce hyperkalemia as do the ACE inhibitors. In contrast to ACE inhibitors, ARBs do not cause clinically significant hyperkalemia
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Beta blockers differ from cardiac glycosides in that beta blockers:
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Decrease the force of cardiac contraction
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Beta-blockers decrease __1__ and __2__ thereby decreasing cardiac output, whereas cardiac glycosides (digoxin) increases __3___ thus increasing __4___. Both decrease __5___.
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1. contractility 2. heart rate 3. myocardial contractility 4. cardiac output 5. heart rate
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Conduction of the impulses through the heart are not affected by __1__ but by __2__ which can alter electrical activity in the heart
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1. beta-blockers 2. digoxin
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Nitrates, including nitroglycerin and isosorbide, reduce the workload of the myocardium by:
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Decreasing the amount of blood returning to the heart. Nitrates work by "decreasing cardiac oxygen demand. Oxygen demand is decreased as follows: by dilating veins, nitroglycerin decreases venous return to the heart , and thereby decreases ventricular filling; the resultant decrease in wall tension (preload) decreases oxygen demand"
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When a patient is receiving isosorbide or nitroglycerin for heart failure, the nurse should carefully assess the patient for the adverse effects of:
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Tachycardia and hypotension Nitroglycerin can cause reflex tachycardia, headache, and orthostatic hypotension secondary to vasodilation
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When a heart failure patient is prescribed digoxin and furosemide, the nurse should carefully assess the patient for early symptoms of the most likely electrolyte disturbances including:
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Muscle spasms and convulsions Hypokalemia is a life-threatening condition for patients taking both digoxin and furosemide, a loop diuretic. With the loss of potassium secondary to furosemide, the risk for digitalis toxicity is great.
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What findings would warrant that the nurse not administer digoxin and notify the prescriber? A. Blood pressure of 100/76 mm Hg B. Digoxin 2.4 ng/mL C. Heart rate of 100 beats/min D. Potassium level of 5.3 mEq/L
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B. Digoxin 2.4 ng/mL Digoxin has a narrow therapeutic range of 0.5-0.8 ng/mL(p. 518). Drug levels only slightly higher than therapeutic greatly increase the risk of toxicity (A) BP is normal. (C) is not as much of a priority as is the digoxin levels. (D) Potassium level is high which can decrease the therapeutic responses to digoxin, it is important but for priority reasons, toxicity which is life-threatening, needs to be addressed STAT.
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The suffix of the generic name of most dihydropyridine calcium channel blockers is:
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-pine
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It is most important for the nurse to discuss adverse effects of the antihypertensive drugs which are prescribed because adverse effects often:
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Affect compliance
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Acebutolol(Sectral), carteolol (Cartrol), penbutolol (Levatol), and pindolol (Visken) are beta-blockers that have intrinsic sympathomimetic activity. This results in less:
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Bradycardia at rest "Intrinsic sympathomimetic beta-blockers can produce mild activation of beta receptors while blocking receptor activation by strong agonists (norepinephrine). As a result, heart rate at rest is slowed less than with other beta-blockers"
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When a patient has been prescribed an alpha blocker including doxazosin (Cardura), it is most important for the nurse to teach the patient to:
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Change positions slowly The most disturbing side effect of alpha blockers is orthostatic hypotension
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*Which of the following drugs has an off-label use for suppressing preterm labor?
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Nifedipine... stops contractions by blocking calcium entry into uterine smooth muscle
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*A nurse has been administering magnesium sulfate to an eclamptic patient. The nurse would notify the obstetrician if the magnesium level is
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Normal magnesium levels are 1.5 to 2.0 mEq/L. "To ensure therapeutic effects and prevent toxicity, blood levels of magnesium should be monitored. The target range is 4 to 7 mEq/L"
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Most diuretics work by: A. Blocking synthesis of pumps responsible for Na+ and K+ transport in the distal nephron. B. Acting on the collecting duct to increase permeability to water C. Blocking reabsorption of Na+ in the distal nephron and increasing K+ reabsorption D. Blocking Na+ and Cl- reabsorption
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D. Blocking Na+ and Cl- reabsorption
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A patient has been prescribed a high-ceiling diuretic. Which of the following foods are important to include in the diet to prevent hypokalemia? (Select all that apply) A. Bananas B. Beans C. Cheese D. Red meat E. Oranges F. Pork G. Raisins H. Spinach I. Yogurt
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A, E, G, H. Citrus fruits, dried fruits, nuts, spinach, potatoes, and bananas are all rich in potassium.
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The recommended diuretic for initial therapy of essential hypertension is a(n)
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Thiazides.... are often the drugs of choice for essential (primary) hypertension
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The nurse would expect pharmacotherapy for an African American patient with hypertension to include a(n)
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Diuretics.... African Americans respond better to some antihypertensive drugs than others.
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When caring for a patient with a dysrhythmia, it is important for the nurse to monitor which of the following laboratory values because abnormalities are very likely to affect depolarization and repolarization of cardiac cells? A. ALT, AST, and bilirubin B. BUN, creatinine, and FBS C. Hematocrit, hemoglobin, and RBC count D. Sodium, calcium, and potassium
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D. Sodium, calcium, and potassium Sodium, potassium and calcium are electrolytes that participate in depolarization and repolarization of cardiac cells. Digoxin is a medication that "alters the distribution of ions (Na+, K+, Ca++) across the cardiac cell membrane.
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The nurse should teach a patient taking a class IA or IV antidysrhythmic drug the importance of reporting which of the following symptoms suggests that torsades de pointes, a potentially fatal prodysrhythmic adverse effect of the prescribed drugs, may be occurring: A. Ankle edema B. Headache C. Near syncope D. Shortness of breath
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C. Near syncope "Torsades de pointes (twisting of the points) is an atypical, rapid, undulating, ventricular tachydysrhythmia that can evolve into potentially fatal ventricular fibrillation. The main factor associated with development of torsades de pointes is prolongation of the QT interval"
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An action that can slow an acute supraventricular dysrhythmia is instructing the patient to
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Bear down as if having a bowel movement
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A focused nursing assessment of a patient with atrial fibrillation should always include assessment of changes in
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Mental status Atrial fibrillation carries a high risk for stroke because in patients with atrial fibrillation, some blood can become trapped in the atria (rather than flowing straight through to the ventricles), thereby permitting formation of a clot.
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Which of the following lab results for INR, if identified in an atrial fibrillation patient receiving warfarin (Coumadin), would indicate that therapy has achieved the desired effect? A. INR 1 B. INR 3 C. INR 5 D. INR 7
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B. INR 3 The recommended range for INR is 2-3, although for some the target is 3-4.5
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Which of the assessment findings, if identified in a patient who is receiving quinidine, should the nurse report to the prescriber immediately? A. BP 150/88 mm Hg B. Ringing in the ears C. Three soft stools in 8 hours D. Wheezing at the end of expiration
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B. Ringing in the ears Quinidine is a class IA anti-arrhythmic drug, it is the most frequently used oral anti-dysrhythmic agent
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True/False? Quinidine can cause widening of the QRS complex.
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True Quinidine can cause severe cardiotoxicity (sinus arrest, AV block, ventricular tachydysrhythmia, asystole). As cardiotoxicity develops, the ECG changes. Important danger signals are widening of the QRS complex (by 50% or more) and excessive prolongation of the QT interval
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Because of extensive first-pass effect, the nurse expects to administer lidocaine:
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Intravenously Lidocaine undergoes rapid hepatic metabolism. If the drug were administered orally, most of each dose would be inactivated on its first pass through the liver.
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The nurse is preparing to administer the cardioselective beta blocker acebutolol (Sectral). Which of the following assessments would indicate a need for immediate consultation with the prescriber? A. Apical pulse 155 beats/min B. Bronchial wheezes C. Capillary blood glucose 220 mg/dL D. One plus pitting edema of the dorsal aspect of the foot
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B. Bronchial wheezes Adverse effects of acebutolol are like those of propranolol: bradycardia, heart failure, AV block, and-despite cardioselectivity-bronchospasm A. Need for medication C. indicates hyperglycemia which beta blockers can increase glucose levels D. indicates fluid overload perhaps related to congestive heart failure however [B] is life-threatening.
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What teaching should the nurse provide relating to blockade of calcium channels in vascular smooth muscle when a patient is prescribed verapamil (Calan)?
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Take orthostatic BP precautions. Verapamil (Calan) produces blockade at peripheral arterioles causes dilation, and thereby reduces arterial pressure.
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In addition to monitoring the heart rate and rhythm, what must the nurse continuously monitor when administering the potassium channel blockers, bretylium, or amiodarone?
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Blood Pressure Bretylium is used for short-term therapy of severe ventricular dysrhythmias. The drug's principal adverse effect is profound hypotension
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When a patient who is receiving adenosine exhibits facial flushing and chest pain, which action should the nurse take first? A. Administer oxygen B. Assess vital signs C. Discontinue the infusion D. Initiate CPR
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C. Discontinue the infusion Chest pain and facial flushing are adverse effects of adenosine. First Discontinue the infusion to prevent more medication from entering the patients blood vessels.
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The nurse recognizes that a drug is a beta blocker if the generic name of the drug ends in:
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-lol
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It is important for the nurse to teach a patient who has been prescribed nitroglycerin on an as needed basis to:
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Write the date that the tablets are opened on the outside of the bottle Because "nitroglycerin tablets are chemically unstable and can lose effectiveness over time
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The nurse is aware that which of the following nitroglycerin preparations has a rapid onset and sustained effect?
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Sublingual tablets & Transmucosal tablet Sublingual tablets have a rapid onset usually within 1-3 minutes but last only one hour. Transmucosal Tablets have a rapid onset of 1-2 minutes and long duration of 3-5 hours.
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When assessing a patient who is scheduled to receive the second dose of newly prescribed sustained-release nitroglycerin, the patient complains of a headache. The nurse should: A. Crush the medication to speed absorption through the oral mucosa B. Notify the prescriber of the headache STAT C. Withhold the drug and consult the prescriber. D. Administer as needed acetaminophen, if ordered, within the time constraints.
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D. Administer as needed acetaminophen, if ordered, within the time constraints. Nitro can cause severe HA. The response diminishes within a few weeks of treatment.
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A patient asks why heparin cannot be administered orally. The basis of the nurse's response is heparin:
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Is large and negatively charged limiting absorption. Because of these negative charges, heparin is highly polar, and hence cannot readily cross membranes
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A patient who has been receiving heparin tells the nurse that she thinks she could be pregnant. The nurse should:
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Administer heparin as ordered and notify the MD of the possible pregnancy status. Heparin does not cross membranes, does not traverse the placenta or enter breast milk. Heparin is a preferred anticoagulant for use during pregnancy
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A patient has been receiving long-term high-dose heparin therapy. What nursing teaching would be best to prevent a common adverse effect of this type of therapy?
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Develop a plan for weight-bearing exercise as approved by physician When a patient is on long-term high dose heparin therapy it is best to exercise caution since they have a high likelihood of bleeding/hemorrhaging. Weight-bearing exercise is important to prevent bleeding.
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Heparin therapy is considered therapeutic when the results of the aPTT are: A. 30-40 sec (normal) B. 40-50 sec (1 to1.5 times normal C. 60-80 sec (2 times normal) D. 90-120 sec (3 times normal)
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C. 60-80 sec (2 times normal) At therapeutic levels, heparin increases the aPTT by a factor of 1.5 to 2, making the aPTT 60-80 sec
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One unit of heparin will prevent 1 mL of sheep plasma from coagulating for what period of time?
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1 hour
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The nurse would consult the prescriber if which of the following drugs was prescribed, but there was no order for monitoring of aPTT? A. Fragmin B. Heparin C. Innohep D. Lovenox
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B. Heparin A, C, D are LMW heparin preparations thus do not require monitoring of aPTT levels
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The nurse should teach patients who are prescribed warfarin (Coumadin) to eat consistent amounts of which of the following foods? (Select all that apply) A. Cabbage B. Citrus fruits C. Dairy products D. Green vegetables E. Liver F. Red meat
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A. Cabbage & D. Green vegetables Can eat foods rich in Vitamin K but they must be consumed in the same amount (consistently) each day
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What should the nurse teach a patient about precautions before dental surgery when the patient is prescribed long-term warfarin therapy?
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Inform the dentist of the most recent INR results Although warfarin can intensify bleeding during dental surgery, it is not much. Accordingly, most patients needn't interrupt warfarin for dental procedures, including dental surgery.
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Which of the following adverse effects, if noted in a patient who has recently been prescribed ticlopidine (Ticlid), would be a reason for the nurse to contact the prescriber immediately? A. Change in level of consciousness B. Diarrhea C. Dyspepsia D. Itchy rash
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A. Change in level of consciousness Ticlopidine (Ticlid) can cause life-threatening hematologic reactions including neutropenia/agranulocytosis, and thrombotic thrombocytopenia purpura (TTP).
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Which of the following laboratory tests, if not ordered for a patient who has been recently prescribed clopidogrel (Plavix), would be a reason for the nurse to consult with the prescriber? A. aPTT B. INR C. Platelets D. PT
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C. Platelets
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The nurse is reviewing the laboratory tests of a patient taking ticlopidine (Ticlid) for the past week. The WBC count is 3000/mm3, and the neutrophil count is 30 %. A nursing priority for this patient is:
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Preventing infection
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The critical care nurse monitors for the adverse effects of hypotension and fever in a patient who is receiving which of the following thrombolytic drugs? A. Alteplase B. Reteplase C. Streptokinase D. Tenecteplase
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C. Streptokinase Streptokinase is a thrombolytic drug than can cause hypotension in 1% to 10% of patients, soon after administration although hypotension is not related to blood loss or allergic reactions
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The nurse should have available which of the following drugs when streptokinase is being administered? A. Aminocaproic acid (Amicar) B. Phytonadione (Vitamin K) C. Protamine sulfate D. Acetylcysteine
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A. Aminocaproic acid (Amicar) The reversal of excessive fibrinolysis (a result of streptokinase) is done with aminocaproic acid, a compound that prevents activation of plasminogen and directly inhibits plasmin
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The method of administration for Tenecteplase (TNKase) is by: A. By IV infusion B. By mouth (tablet) C. SQ injection D. IV bolus
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D. IV bolus Tenecteplase (TNKase) is given by IV bolus whereas tPA must be infused over 90 minutes
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Clinical trials suggest that HMG-CoA reductase inhibitors (statins) benefit patients with atherosclerosis by:
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Stabilizing endothelial plaque HMG-CoA reductase inhibitors (statins) help "promote plaque stability (by decreasing plaque cholesterol content), suppress the production of thrombin, increase HDL and decrease LDL
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A 38-year-old female has been diagnosed with hypercholesterolemia. The prescriber has ordered simvastatin (Zocor) 20 mg, once a day at hour of sleep, to be started after laboratory results are obtained. Which of the following lab results would be a reason to withhold the drug? A. ALT 7 International Units/L B. Creatinine 1 mg/dL C. CRP 3.0 mg/dL D. HCG 287 International Units/L
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D. HCG 287 International Units/L Indicates the patient is pregnant, so the drug must be withheld since this drug is a Category X drug
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The nurse would be most concerned about which of the following patients? A. A patient receiving lovastatin and experiencing a rash. B. A patient receiving nicotinic acid and experiencing hot flashes with facial flushing. C. A patient receiving colesevelam and experiencing nausea. D. A patient receiving gemfibrozil and experiencing right upper quadrant pain.
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D. A patient receiving gemfibrozil and experiencing right upper quadrant pain. Gemfibrozil can cause abdominal pain due to liver toxicity and increases incidence of gallstones which takes priority over the other scenarios
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A patient has been prescribed cholestyramine in addition to other drugs for diabetes mellitus and hypertension. The cholestyramine should be administered:
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Four hours before other drugs Must administer oral medications either one hour before cholestyramine or 4 hours after, due to drug-drug interactions
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A patient receiving nicotinic acid to elevate HDL and reduce triglycerides exhibits dry, hot, and flushed skin; thirst; hunger; and confusion. The nurse should:
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Hold the drug and notify the prescriber. Although nicotinic acid may produce flushing and gastric upset, confusion thirst and hunger are not common side effects.
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A patient currently on lovastatin has now been prescribed ezetimibe (Zetia). The nurse should teach the patient that:
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He can take them both at the same time. Ezetimibe (Zetia) is approved for monotherapy and for combined use with a statin, although taking both drugs slightly increases risk of liver damage (as indicated by transaminase levels)
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True / False? Ezetimibe (Zetia)is used to reduce plasma levels of total cholesterol, LDL, triglycerides, and apolipoprotein B and may produce a small increase in HDL cholesterol
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True Ezetimibe (Zetia) acts on cells of the brush border of the small intestine to inhibit cholesterol absorption
