Pharm II Cardio ch 42-44 – Flashcards
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When explaining blood supply to the heart muscle, the nurse explains that the left circumflex artery supplies the:
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left ventricle.
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As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which teaching point best captures a component of cardiac function?
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"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
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"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."
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A client is helped out of bed and stands up
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A nurse is explaining to a client the physiology of the heart with reference to the cardiac valves. Which statement by the client about the function of the cardiac valves demonstrates the correct understanding of the nurse's explanation?
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Allow blood to flow in one direction only
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The nurse assists and educates clients about blood pressure regulation. Which information is important to include in the review with clients about blood pressure?
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Force exerted by the blood against the walls of the blood vessels
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A nurse is measuring the BP of a client. The client asks what the BP measures. What is the bestresponse by the nurse about the measurement of BP?
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Pressure of blood within the arteries
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Pressure of blood within the arteries
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To carry oxygenated blood to the body cells
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Pathologic changes in the structure of the capillary and venular endothelium can result in the accumulation of fluid in interstitial space. What term refers to this accumulation?
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Edema
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A group of nursing students is preparing a poster presentation describing the anatomy and function of the heart. In their diagram of the organ, they label the structure that separates the left and right sides of the heart as the
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septum.
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Which phase of the action potential is referred to as the plateau phase?
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Phase 2
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Which are components of the heart's conduction system? (Select all that apply.)
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SA node Purkinje fibers Bundle branches AV node
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Which enzyme is produced in the kidney?
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Renin
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After explaining an electrocardiogram to a patient, which statement indicates that the patient understands this test?
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"It will show how impulses are moving through my heart."
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Fluid moves into the arterial end of a capillary due to:
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Hydrostatic pressure
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Which area of the heart is supplied by the right coronary artery?
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Right side of the heart
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At which area is the conduction velocity the slowest?
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AV node
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A client has severe aortic valve disease. When educating the client about anatomy, what would the nurse include?
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The aortic valve separates the left ventricle and aorta.
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The pathway for blood flow through the heart is:
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The pathway for blood flow through the heart is:
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During which phase of the action potential does calcium slowly enter the cell and potassium begin to leave?
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Phase 2
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The nurse is reviewing a patient's ECG and notes that the ECG is normal, but the rate is 110 beats/minute. The nurse would identify this as:
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Sinus tachycardia
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When describing cardiac conduction, the nurse explains that conduction velocity is fastest in the:
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Purkinje fibers.
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A backflow of blood is noted in the left ventricle from the left atrium. The patient is suffering from a defect in which valve?
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Mitral valve
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A patient is prescribed digoxin (Lanoxin), which affects the function of the sinoatrial node. Which statement describes the function of the sinoatrial node?
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Normal pacemaker
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Which statement most accurately captures a principle of blood flow?
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With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow.
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Which individual is most likely to be experiencing vasodilation?
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A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system
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The nurse is reviewing with the client the three major layers of the heart wall and how they relate to the pericardium. What is the best description by the nurse to the client about the myocardium layer of the heart?
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Thick, strong muscles making up the middle layer
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Proper function of the cardiovascular system relies on blood following the correct pathway through the heart. Valves within the heart separate the organ's chambers and prevent blood from flowing in the wrong direction. What valve separates the left atrium and left ventricle?
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Mitral
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The cardiovascular system consists of the heart, blood vessels, and blood. The efficiency of this system depends on which factors?
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All the above
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While reviewing a patient's electrocardiogram, the nurse observes a P-R interval of 0.26 seconds. This is indicative of:
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first-degree heart block.
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Which factor determines blood pressure?
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Afterload
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The nurse assists and educates clients about blood pressure regulation. Based on this information, the nurse asks the client what the number 80 in the blood pressure 120/80 represents. Which response by the client demonstrates correct understanding of the basic concepts of blood pressure?
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Diastolic pressure
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When describing circulation, which would a nurse include?
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A closed system
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Which is released initially when blood flow to the kidneys is decreased?
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Renin
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Which is responsible for transmitting the nerve impulse to the ventricular cells?
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Purkinje fibers
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A nurse is educating a group of nursing students about the heart's chambers and the muscular septum wall. What information by a nursing student demonstrates a correct understanding about the four chambers into which the heart is divided? (Select all that apply.)
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The thin-walled, low-pressure chambers are the receiving centers for blood. Ventricles are high-pressure chambers because they pump blood out of the heart. The left ventricle is the thickest chamber and it pumps blood to the rest of the body.
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Place the components of the circulatory system in the correct sequence for returning blood back to the heart?
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Capillaries Venules Veins Right atrium
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When explaining the difference between arteries and veins, the nurse would include which statement?
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Arteries have smooth muscles that can change blood pressure by means of vasoconstriction or vasodilatation.
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A nurse is describing an electrocardiogram to a patient. Which would the nurse include in the description?
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Waveform showing electrical activity of the heart
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When reviewing a patient's ECG, the nurse identifies the QRS complex, understanding that this reflects:
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Depolarization of the bundle of His and ventricles
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Contraction of the right atrium sends blood through the:
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tricuspid valve.
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These are activities involved in the action potential of cardiac muscle. Place them in the proper sequence beginning with activities in phase 0 through phase 4.
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Sodium rushes into the cell. Sodium ion concentration equalizes. Calcium slowly enters and potassium begins to leave the cell. Potassium rapidly moves out of the cell. Sodium is outside the cell and potassium is inside the cell.
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A patient has a diminished flow of deoxygenated blood from the lower extremities. Which chamber of the heart receives deoxygenated blood from the lower extremities?
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Right atrium
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A cardiovascular clinical nurse specialist describes the dysfunctional endothelium in relation to cardiovascular disease. What is the major factor in the development of the dysfunctional endothelium?
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Atherosclerosis
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As part of presurgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which teaching point best conveys an aspect of the human circulatory system?
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"Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."
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A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological system that can accompany hypotension. Which response by a student would warrant correction by the physician?
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"Tension and vessel thickness increase proportionately."
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A client who has been diagnosed with blood pressure problems is eager to know more about the condition. What should the nurse explain is one of the internal processes that attempt to maintain blood pressure within normal limits?
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Special sensory receptors in blood vessel walls called baroreceptors are stimulated.
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Which heart valve controls the flow of blood between the left atria and the left ventricle?
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Bicuspid valve
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With an understanding of how hydrostatic forces effect the capillaries, which would increase the capillary hydrostatic pressure?
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Increase in venous pressure
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A nurse is explaining blood flow through the heart to a patient who has experienced a myocardial infarction. How would the nurse explain flow from the lungs to the heart?
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Oxygenated blood from the lungs enters the left artium through the pulmonary veins.
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What property allows the heart cells to generate an action potential without an external stimulus?
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Automaticity
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Which property is related to the ability of the heart cells to transmit an action potential of electrical impulse?
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Conductivity
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When describing Starling's law of the heart, the instructor compares this to:
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stretching of a rubber band
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An instructor is describing the unique characteristic of cells of the conducting system, explaining that these cells can generate action potentials without outside stimulation. The instructor is describing:
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Automaticity
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A nurse is reviewing a patient's electrocardiogram. Which would the nurse identify as indicating depolarization of the bundle of His and ventricles?
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QRS complex
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Place the steps that occur during the process of blood flow through the body into the correct sequence.
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The right atrium receives deoxygenated blood from the superior and inferior vena cava and the coronary sinus. Blood passes through the tricuspid valve into the right ventricle. Blood moves on through the pulmonic valve during ventricular contraction. Blood enters the pulmonary artery and lungs, where it receives oxygen. Blood returns to the left atrium via the pulmonary veins. Blood travels through the mitral valves and into the left ventricle.
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Special bundles of unique tissue in the heart transmit and coordinate electrical impulses to stimulate the heart to beat. Place the path of an electrical impulse through the conduction system of the heart into the correct sequence of steps.
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SA (sinoatrial) node AV (atrioventricular) node Bundle of His (AV bundle) Right and left bundle branches Purkinje fibers to muscles of ventricles
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A male client had a myocardial infarction. He was told that his infarction size was decreased as a result of collateral circulation. This means the client likely had:
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atherosclerosis, which caused resultant dilation of the artery and increased circulation.
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Which substance is responsible for keeping the proteins in the cardiac muscle apart?
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Troponin
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When describing the fluid movement in a capillary, what regulates the movement of fluids at the venous end of the capillary?
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Oncotic pressure
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A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement is the most relevant phenomenon?
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High afterload because of backpressure against the left ventricle
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While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
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Decreased heart rate as a result of parasympathetic innervation of the heart
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The nurse assists and educates clients about the structure and function of the cardiovascular system and its components. Based on the information, what is the correct response by the client about what is the normal "pacemaker" of the heart?
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SA (sinoatrial) node
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A client is admitted with cardiac rhythm problems. The nurse is reviewing the conduction system with the medical team. What are the processes in the conduction system of the heart that stimulate the heart to beat that the nurse should review with the client after discussion with the medical team?
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The formation, transmission, and coordination of electrical impulses
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Which is true regarding the pulmonary circulation?
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It is a low pressure system that allows for improved gas exchange
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Of the following factors, which increases the heart's output, and is dependent on the actions of the heart and the vasculature before contraction?
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Preload
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A patient who has experienced the activation of a vagus nerve, would have which effect?
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Decrease in heart rate
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While reviewing a patient's electrocardiogram, the nurse observes sawtooth-shaped P waves. This is indicative of:
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atrial flutter.
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The volume of blood in the cardiac system is a determinant of:
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preload.
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Sodium ion concentrations are equal inside and outside the cell during which phase of the action potential of the cardiac muscle?
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Phase 1
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When explaining the contraction of the heart muscle, the instructor describes the basic unit as:
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Sarcomere
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The nurse is reviewing a patient's electrocardiogram and notes that the P waves are sawtoothed in shape and there are three P waves for every QRS complex. The nurse would interpret this as suggesting:
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Atrial flutter
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The nurse is reviewing the arteries and veins of the heart with the client. Based on this information, which statements by the client demonstrate the correct understanding of the arteries and veins of the heart? (Select all that apply.)
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The right coronary artery supplies the heart muscle with blood. The left coronary artery supplies the heart muscle with blood.
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An instructor is describing an action of the heart, likening it to that of stretching a rubber band. The instructor is describing:
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Starling's law of the heart
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A patient has a mix of deoxygenated blood and oxygenated blood in the left and right atrium. What defect does the patient suffer from?
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Deviated septum
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In which situation would blood be most likely to be rapidly relocated from central circulation to the lower extremities?
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A client is helped out of bed and stands up
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The nurse is educating a group of nursing students about cardiac output. What information should the nurse include about preload?
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The amount of pressure or stretching force against the ventricular wall at end diastole
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A nurse is assessing the vital signs of a client. The client inquires about the functions of the arteries. What should the nurse include in the client education about the function of arteries?
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To carry oxygenated blood to the body cells
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A group of nursing students is preparing a poster presentation describing the anatomy and function of the heart. In their diagram of the organ, they label the structure that separates the left and right sides of the heart as the:
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septum.
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What component of the normal ECG waveform immediately precedes the contraction of the atria?
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P wave
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Which would the nurse explain is the pacemaker of the heart?
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SA node
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An instructor is describing the venous system, which is distensible and flexible and able to hold a large amount of blood. The instructor is describing:
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capacitancy.
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Blood returning to the heart arrives at the right ventricle by way of the:
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vena cava.
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A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?
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Risk for injury
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After teaching a group of students about nitroprusside and cyanide toxicity, the instructor determines that the teaching was successful when the students identify what as an assessment finding? (Select all that apply.)
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Dyspnea Dilated pupils Distant heart sounds Shallow breathing
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A nurse checks a client's blood pressure and finds it to be 130/82. This client should be classified as having which stage of hypertension?
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Prehypertension
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A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension?
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Stage 2
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During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment?
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Secondary hypertension
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How is hypertension defined with regard to blood pressure readings?
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systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg
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A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors?
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persistent cough
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A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way
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By inhibiting the transformation of angiotensin I to angiotensin II
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A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?
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Angiotensin II receptor blockers
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Mr. Seeman, 65 years old, is admitted to the hospital for cardiogenic shock. He is placed on dopamine to improve his blood pressure. He also has a history of peripheral vascular disease, hyperlipidemia, and diabetes mellitus type 2. What adverse effect(s) would require physician notification?
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Changes in temperature or color of skin
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When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?
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Ineffective Tissue Perfusion
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A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?
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Restore and maintain adequate tissue perfusion.
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A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect?
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Persistent cough
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A provider chooses to treat an African American client with hypertension with a beta blocker and diuretic instead of an ACE inhibitor. The nurse knows that the provider did this for what reason?
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Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors.
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The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education?
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Ham sandwich with mustard, carrots and cheesy dip
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African Americans are more likely to have severe hypertension and to require multiple drugs, for what reasons? (Select all that apply.)
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Low circulating renin Increased salt sensitivity A higher incidence of obesity
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Key behavioral determinants of blood pressure are related to what factor?
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Dietary consumption of calories and salt
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How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)
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Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications
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A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?
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Losartan
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A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?
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Hydrochlorothiazide
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A 37-year-old woman presents with a blood pressure of 118/86 mm Hg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or
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Prehypertension
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After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply?
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Myocardium hypertrophy
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After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?
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Left ventricle
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Most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?
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2
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The blood pressure goal for a client with diabetes is:
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130/80 mm Hg
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Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.)
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Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart.
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What does the administration of a calcium channel blocker result in? (Select all that apply.)
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Relaxation of blood vessels Increase oxygen supply to the heart Reduce the workload on the heart Decrease blood pressure
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A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect?
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By blocking the angiotensin II receptors
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When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone?
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Causes sodium and water retention.
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Which outcome is most important for a client recently diagnosed with hypertension?
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multiple diastolic blood pressure readings less than 90 mm Hg
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A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy?
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Serum potassium levels
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A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:
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monitor the client's blood pressure.
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A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse?
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Slow the rate of the infusion
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The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?
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It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.
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A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question?
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"He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly."
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The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition?
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Diabetes mellitus
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A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?
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Diastolic blood pressure below 90 mm Hg
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A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume?
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Changes in heart contraction
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The client is seen in the clinic today and has a blood pressure of 165/100 mmHg. The nurse knows that this client would be in classified as which stage of hypertension?
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Stage 2
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A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor?
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Aliskiren
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Primary medications used in the management of shock are adrenergic drugs. Medications with alpha-adrenergic activity raise blood pressure via increasing:
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peripheral vascular resistance.
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The squad brought a 48-year-old man to the ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the client reports severe headache and drowsiness. He becomes disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency?
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Lower blood pressure as quickly as possible
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A patient is receiving verapamil. What would be important for the nurse to stress that the patient avoid?
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Grapefruit juice
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What does hypertension increase a person's risk for? (Select all that apply.)
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Heart failure Stroke Blindness Kidney disease
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A nurse is educating a group of nursing students on the mechanism of actions of angiotensin converting enzyme inhibitors (ACEI). Which should the nurse explain is the hormone produced by the adrenal cortex?
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Aldosterone
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What should a client with newly diagnosed hypertension be counseled to do? Select all that apply.
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Lose weight Stop smoking Reduce stress
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A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.)
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Damage to the heart Damage to the kidneys Damage to the eyes
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A malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client?
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lowered
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An African American patient is being treated for stage 2 hypertension. What antihypertensive agent is the drug of choice for this patient?
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Calcium channel blocker
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A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:
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a persistent, dry cough may occur; however, it is not serious.
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An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:
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falls.
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Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect?
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Mark, who is suffering from impaired renal function
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The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?
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Monitoring for complications and side effects of treatment
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The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock?
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Bradycardia
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A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed?
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Hypotensive crisis
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The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?
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"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."
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A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary physician regarding her medication regimen. What would the nurse expect the physician to do?
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Discontinue the drug
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When describing the action of calcium channel blockers, which would be an expected effect?
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Slowed impulse formation
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A male client who has been receiving verapamil for several months comes to the clinic reporting significant dizziness, light-headedness, and fatigue. He also reports frequent episodes of nausea and swelling of his ankles. Drug toxicity is suspected. Which question would be critical to ask the client?
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"Have you been drinking any grapefruit juice lately?"
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A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate?
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Midodrine
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Primary hypertension comprises 90% to 95% of hypertensive cases. It is hypertension for which no cause can be found. Which drug groups are used in the management of primary hypertension? (Select all that apply.)
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ACE inhibitors Antiadrenergics Angiotensin II receptor blockers
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Which agent would the nurse anticipate administering intravenously to lower a patient's severely elevated blood pressure?
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Enalaprilat
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A client is receiving fosinopril. Which adverse effect would the nurse caution the cliient about to help to promote compliance?
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Cough
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A client is receiving candesartan. The nurse understands that this drug acts in which manner?
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Selectively binds with angiotensin II receptors in the vascular smooth muscle
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A client is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n):
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Alpha- and beta-blocker
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When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.)
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Constipation Proteinuria Photosensitivity Cough
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Once a client develops primary hypertension, therapy should last for how long?
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Lifelong
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Which tasks should a nurse assist a client with in the ambulatory setting in regards to hypertensive management? (Select all that apply.)
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Finds local resources in the community for taking blood pressure Teaches client how to properly record weight and blood pressure Schedules regular monitoring of weight and blood pressure
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A patient is receiving a diuretic for the treatment of hypertension. For which condition should the nurse monitor for in patients taking diuretics?
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Hyponatremia
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Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?
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"When was your last menstrual period?"
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A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?
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By inhibiting the transformation of angiotensin I to angiotensin II
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The nurse recognizes that which medication may be used to treat a hypertensive crisis?
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Nitroprusside
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How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.
answer
Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications
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Nonpharmacologic management should be tried alone or with drug therapy. What methods of nonpharmacologic management are used in the treatment of hypertension? (Select all that apply.)
answer
Weight reduction Limited alcohol intake Moderate sodium restriction
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Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites?
answer
Prazosin
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After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker?
answer
Valsartan
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A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent:
answer
Excessive hypotension
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Which drug is used to lower blood pressure primarily via suppression of the renin-angiotensin-aldosterone system?
answer
Lisinopril (Prinivil)
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What electrolyte imbalance might a diabetic client be prone to develop when prescribed captopril?
answer
hyperkalemia
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The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock?
answer
Hypoperfusion of tissues
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When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to:
answer
Decreased venous return
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A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe?
answer
Increased heart rate
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A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the physician concludes that losartan alone is not controlling the hypertension. What would the physician likely add to the regimen to better control the clients hypertension?
answer
A diuretic
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The nurse is reviewing lab results where the client has elevated BUN and creatinine levels. The nurse would question the administration of which antihypertensive?
answer
Quinapril
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The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which?
answer
weight loss and decreased salt intake.
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The nurse has admitted a client with type 1 diabetes mellitus who has been prescribed captopril for treatment of hypertension. The nurse knows this medication is used in clients with diabetes for what reason?
answer
It reduces proteinuria.
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A client is receiving captopril. Which would be most important for the nurse to monitor?
answer
Complete blood count
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The nurse is teaching a client how to take his diltiazem. Which instruction would be mostappropriate?
answer
"Swallow the drug whole with a large glass of water."
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A 37-year-old woman presents with a blood pressure of 118/86 mm Hg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. According to the 2003 guidelines, what would her blood pressure classify?
answer
Prehypertension
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An African American patient is receiving lisinopril. The nurse would need to closely monitor:
answer
Airway patency
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The nurse is administering a beta blocker to a patient with hypertension. Which would the nurse expect this drug to do? (Select all that apply.)
answer
Increase renal blood flow Decrease heart rate Decrease cardiac muscle contraction
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A community health nurse is facilitating a health promotion session to a group of seniors. Which topic related to hypertension is most important to include in the information?
answer
Hypertension will increase the risk of heart disease.
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A client with which diagnosis should be prescribed captopril as the first-line treatment?
answer
diabetes mellitus
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What additional medication will best increase the effectiveness of blood pressure control in a client prescribed losartan?
answer
hydrochlorothiazide
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When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a client with hypertension?
answer
Grilled chicken, green salad, and apple
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A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions?
answer
Bradycardia
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Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause?
answer
Aliskiren
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Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. What are vasoconstrictive substances? (Select all that apply.)
answer
Angiotensin II Endothelin-1
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A patient is receiving a vasodilator that is available only in oral form. Which agent would the nurse most likely identify as being used?
answer
Minoxidil
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Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure?
answer
thiazide diuretics
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A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be
answer
a diuretic.
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A female client has been started on labetalol. Which effect can occur as a result of the beta blocking?
answer
Decrease in the plasma renin level
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A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of:
answer
Absent reflexes
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A client is being treated for hypokalemia. The client's current medications include Inderal, digoxin, and Coumadin. The client reports nausea, abdominal discomfort, and visual changes. Which problem would the nurse suspect?
answer
Digitalis toxicity
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A client has acute onset pulmonary edema. The client has not experienced a response to digitalization. The nurse would expect which drug to be used for this client?
answer
Primacor
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A client is receiving digoxin. The nurse monitors the client's digoxin level. Which level should the nurse interpret as therapeutic?
answer
1.5 ng/mL
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Vasodilators used to treat heart failure include nitrates and ACE inhibitors.
answer
True
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Milrinone (Primacor) is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?
answer
Intravenously
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When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?
answer
Atropine
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A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner?
answer
2.2 ng/ml
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The home care nurse sees a client for the first time. The client has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the client experiencing?
answer
Congestive heart failure
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A male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity?
answer
4.0 nanograms per milliliter
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A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client?
answer
The dose should be decreased in this client.
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A client is being treated for heart failure. Which is most indicative of improved health status?
answer
decreased pitting edema
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A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered?
answer
Digoxin immune fab (Digibind)
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The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?
answer
Positive inotropic
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A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take?
answer
Omit the dose and contact the health care provider.
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The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs?
answer
Ginseng
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The nurse identifies the therapeutic range for digoxin as:
answer
0.8 to 2 ng/mL
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The nurse teaches the client that antacids when taken with digoxin may have which interactions?
answer
Decreased digoxin levels
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The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take?
answer
Notify the health care provider
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The nurse monitors which client for an increased risk of digoxin toxicity?
answer
The client with renal dysfunction
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The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication?
answer
Monitor the infant's apical pulse
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A client's digoxin level is reported to be 2.2 ng/mL. This result indicates:
answer
digitalis toxicity.
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After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure?
answer
Peripheral edema
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question
Nesiritide is a human B-type natriuretic peptide.
answer
True
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question
Digoxin (Lanoxin) exerts which effects on the heart? (Select all that apply)
answer
Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate
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A nurse must immediately report serum digoxin levels greater than:
answer
2.0 nanograms/mL.
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A nurse assessing a client on digoxin observes features of toxicity. Which visual disturbance should the nurse assess for in such clients?
answer
Yellow or green vision
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A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?
answer
Take the drug regularly without skipping a dose.
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The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema?
answer
Measurement of intake and output
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A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?
answer
positive inotropic effect
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A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug?
answer
Digoxin immune fab
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A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient?
answer
Decreased Cardiac Output related to altered cardiac function
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A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be mostimportant for the nurse to monitor?
answer
Potassium levels
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What is the most accurate method for preventing adverse effects associated with the use of digoxin?
answer
Assess the client's heart rate and hold administration if it is less than 60.
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A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac dysrhythmia. If the nurse is correct, which action is likely to be taken?
answer
The patient will be given digoxin immune fab.
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A patient has been prescribed inamrinone. The nurse knows that this drug works by:
answer
increasing cyclic adenosine monophosphate (cAMP).
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A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be:
answer
A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be:
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A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia?
answer
Atropine
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question
Which condition would least likely contribute to the development of heart failure?
answer
Renal failure
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Which would the nurse identify as a cardiac glycoside?
answer
Digoxin
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Which would a nurse expect to assess if a client is experiencing right-sided heart failure?
answer
Peripheral edema
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A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment?
answer
Digoxin
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question
Which symptoms would most likely be present in a client with right ventricular dysfunction? (Select all that apply)
answer
Peripheral edema Neck vein distention Nocturia
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Which is the result of positive inotropic activity?
answer
Increased cardiac output
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Which is an adverse reaction associated with cardiotonic medications?
answer
Visual disturbances
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A nurse is required to monitor a client for right ventricular dysfunction. Which is one of the most common symptoms associated with right ventricular dysfunction?
answer
Swelling of the hands
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A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient?
answer
Check for jugular vein distention.
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question
A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained?
answer
3.5-5.0 mEq/L
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Which is true about digoxin?
answer
The therapeutic range for digoxin is 0.5 to 2 ng/mL.
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question
Ali Kashif, a recent immigrant, is admitted for continued treatment of CHF. During the assessment, he reveals that he has been using drugs containing amrinone because he did not respond positively to treatment with digoxin, diuretics, and vasodilators. Is there a cause for concern in this case?
answer
No; amrinone is the International Nonproprietary Name (INN) of inamrinone.
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question
The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger?
answer
Increased force of heart contraction
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The nurse recognizes which medications may be the cause of a digoxin level of 2.7 nanograms/mL?
answer
Amiodarone
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The client's digoxin level is 0.125. How does the nurse interpret this level?
answer
Low
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A 65-year-old client presents to the physician's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition?
answer
Heart failure
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A male client is diagnosed with heart failure. The physician orders a loading dose of digoxin. Loading doses are necessary for what reason?
answer
Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading.
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When describing how vasodilators help alleviate heart failure, which would the nurse include?
answer
Decrease afterload
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Which would be considered a therapeutic effect of digoxin?
answer
Increased force of contraction
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A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?
answer
5 minutes
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A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route?
answer
Intravenous
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A male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?
answer
"Take the drug on an empty stomach at the same time each day."
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question
A male client takes his pulse rate before taking his regular daily dose of digoxin and finds his pulse to be 52 beats/min. Which would the client do next?
answer
Hold the dose and retake the pulse in 1 hour.
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question
After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify:
answer
renal failure.
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After teaching a group of students about cardiomyopathy as a cause of heart failure, the instructor determines the need for additional teaching when the students identify what as a cause of cardiomyopathy?
answer
Bacterial infection
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question
Heart failure was once called dropsy.
answer
True
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Cardiotonic drugs are used to treat which medical condition? (Select all that apply)
answer
• Heart failure • Atrial fibrillation
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question
When educating a group of nursing students on the mechanisms of action of digitalis, the nurse identifies what as the pharmacological actions of digitalis? (Select all that apply.)
answer
It increases cardiac output by positive inotropic action It decreases the heart rate through negative chronotropic effect It retards the conduction velocity through the AV node in the heart
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question
After receiving a loading dose of milrinone (Primacor), what is a client most likely to experience? (Select all that apply.)
answer
Angina Headache
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Which labs would the nurse expect to see ordered prior to administration of a cardiotonic? (Select all that apply.)
answer
• Liver function tests • Renal function tests • Complete blood count • Electrolyte levels
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A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin?
answer
hypokalemia
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question
A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's:
answer
pulse is 52 beats per minute.
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question
In heart failure, by what mechanism does the body compensate for decreased circulating blood volume?
answer
Activation of the renin-angiotensin-aldosterone system
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question
A female client is prescribed a cardiac glycoside for the treatment of atrial fibrillation. She tells the nurse that she is concerned about her weight and wants to try this new weight loss program she read about on the Internet. What should a nurse advise her about using cardiac glycosides?
answer
Avoid most over-the-counter drugs.
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A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely:
answer
left ventricular failure.
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question
Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.)
answer
Capsule Injection Tablet
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question
The nurse is assessing the client for left-sided heart failure. Which symptom would the nurse identify as left-sided failure? (Select all that apply.)
answer
• Dyspnea • Tachycardia • Cough
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A client with heart failure has been started on a milrinone infusion. Which assessment findings would lead the nurse to believe the milrinone is effective?
answer
Diuresis
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A male client is diagnosed with renal failure secondary to diabetes mellitus. Based on the new diagnosis, how will the physician safely adjust the client's digoxin dose?
answer
0.125 mg three times a week
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question
A nurse suspects that a client is experiencing left-sided heart failure. Which would the nurse assess? (Select all that apply.)
answer
Tachypnea Hemoptysis Orthopnea Polyuria
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question
A client is receiving inamrinone. Which would be most important for the nurse to monitor?
answer
Platelet count
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question
A client who is taking digoxin would withhold the drug if his pulse rate was:
answer
56 beats/minute
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question
A male client has been admitted with digitalis toxicity. He has been taking the same dose for more than 20 years. His family is asking how common this problem is and how he developed a toxic level while taking the usual dose. The nurse's best explanation would be:
answer
Toxicity can occur even on low-dose therapy due to various factors including advanced age
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The nurse would anticipate the need for an increased dosage of digoxin if the client is taking:
answer
Cholestyramine
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question
Cells of a failing heart due to heart failure often lack the ability to produce the energy needed for effective contraction.
answer
True
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What is given to treat a massive digoxin overdose?
answer
Digoxin immune Fab (Digibind)
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question
When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.)
answer
Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics
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A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug?
answer
Hypotension
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What does the use of cardiotonics lead to? (Select all that apply.)
answer
Improved myocardial contractility Increased myocardial efficiency Improved perfusion to all body tissues
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The nursing instructor explains to students that positive inotropic action affects the heart in which way?
answer
Increased myocardial contraction
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question
The nurse recognizes that which finding is associated with right-sided heart failure?
answer
Nocturia
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The nurse explains to the client that with heart failure, what may occur?
answer
Increased heart rate
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A client presents to the emergency department with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client?
answer
Loop
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The physician asks the nurse to obtain an ECG on a client prior to starting digoxin therapy for what reason?
answer
To recognize early changes that indicate digoxin toxicity
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question
The nurse in a physician's office knows that heart failure clients will need which laboratory tests to best monitor their condition? (Select all that apply.)
answer
K+ and Na+ levels Creatinine clearance Digoxin levels
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question
An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms?
answer
Inadequate cardiac output
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question
Which of the following antiarrhythmics would have little effect on the duration of the action potential?
answer
Flecainide
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A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?
answer
Intravenous
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A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor?
answer
Blood glucose levels
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question
Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia?
answer
Intravenously
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Which is part of the nurse's evaluation of anti-arrhythmic drug therapy? (Select all that apply.)
answer
No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist.
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A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy?
answer
Pulse rate
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A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?
answer
Renal impairment
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A client experiencing a ventricular dysrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client?
answer
1 to 4 mg/min
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Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia?
answer
diltiazem
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question
A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to:
answer
avoid grapefruit and grapefruit juice.
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question
A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client?
answer
Respiratory assessment
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A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by:
answer
inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
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question
Which factor would necessitate a reduction in the dosage of disopyramide?
answer
Renal impairment
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The nurse is administering intravenous amiodarone to a patient in the emergency department. Which task would the nurse need to prioritize?
answer
Monitoring the patient's blood pressure
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question
The primary health care provider prescribes sotalol (Betapace) 80 mg BID orally. The drug is available in 40 mg tablets. The nurse will administer how many tablets in 24 hours?
answer
4
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The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect?
answer
Increased digoxin level
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The health care provider orders quinidine for a client who is receiving a common treatment for atrial fibrillation. The nurse would monitor this client for:
answer
digoxin toxicity.
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The nurse is teaching a male client who is receiving quinidine about foods to avoid. The client demonstrates the need for additional teaching when he identifies the need to avoid:
answer
Apple juice
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The nurse would instruct a client receiving acebutolol about which adverse effect?
answer
Bronchospasm
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Any part of the heart's conduction system can spontaneously start an impulse, but the sinoatrial node normally has the fastest automaticity rate, serving as the pacemaker site. What does initiation of an electrical impulse depend predominantly on the movement of? (Select all that apply.)
answer
Sodium and calcium ions into a myocardial cell. Potassium ions out of a myocardial cell.
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When teaching a group of students about antiarrhythmic therapy, the instructor determines that the teaching was successful when the students identify what as the goal of antiarrhythmics?
answer
Altered conductivity
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Which best describes the action of class II antiarrhythmics?
answer
Competitive block beta receptor sites in the heart and kidneys
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question
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as:
answer
calcium channel blockers
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Which would be a contraindication for using a class IV antiarrhythmic? (Select all that apply.)
answer
Sick sinus syndrome Heart block Heart failure Hypotension
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question
A client with a cardiac arrhythmia is admitted to a health care facility. The client is also experiencing myocardial infarction. Which drug is the health care provider most likely to prescribe for the client?
answer
Propranolol
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Before the administration of any anti-arrhythmic, what should the nurse's pre-assessment of the client's general condition include? (Select all that apply.)
answer
Skin color Orientation Level of consciousness
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The nurse should monitor a client receiving lidocaine (Xylocaine) IV closely for which issues? (Select all that apply.)
answer
Respiratory depression Mental status changes Convulsions Bradycardia
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question
What do class IB anti-arrhythmics result in? (Select all that apply.)
answer
Shortening of the action potential duration Depression of cardiac conduction
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question
A patient on anti-arrhythmic drug therapy reports nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which drug should the nurse consider as the cause for these adverse effects?
answer
Quinidine
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A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered?
answer
Premature ventricular contraction
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A client is admitted to the emergency department in ventricular fibrillation. The client is administered amiodarone hydrochloride (Cordarone). What is the major effect of this medication?
answer
It slows the conduction through the AV node.
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question
Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of:
answer
hypersensitivity to beta blockers.
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A clinic nurse is following a 62-year-old woman who is taking quinidine for a cardiac arrhythmia. What nursing action will address the most common adverse effects of quinidine therapy?
answer
Monitor the client for signs and symptoms of GI upset
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question
An antiarrhythmic drug is prescribed for a client whose apical pulse rate is 100. What is the nurse's best action?
answer
Administer the medication with water.
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question
The nurse administering a Class I antiarrhythmic drug understands that the action of this drug is to:
answer
Stabilize or anesthetize the membranes of cardiac cells
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question
Amiodarone is a potassium channel blocker that prolongs conduction in all cardiac tissues. What is another effect of amiodarone? (Select all that apply.)
answer
It decreases heart rate. It decreases contractility of the left ventricle.
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The nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition? (Select all that apply.)
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Hypotension Mental confusion Shortness of breath
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Which would be a contraindication for the use of a class II antiarrhythmic?
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Sinus bradycardia
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When describing the action of dofetilide, the nurse understands that the drug affects which phase of the action potential?
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Phase 3
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A 68-year-old male patient is being discharged status post-atrial flutter cardioversion to NSR. His cardiologist has prescribed propranolol to maintain NSR. What important information should be included in patient education about potential adverse effects?
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Propranolol may cause sexual dysfunction.
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A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important?
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Bleeding
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A patient is receiving procainamide intravenously. The nurse understands that the initial dose should run over which time frame?
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25 to 30 minutes
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Flecainide (Tambocor) is classified as which type of antiarrhythmic?
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Class IC
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A nurse is assigned to care for a client who has to be administered an antiarrhythmic drug. Under what conditions is the use of this drug contraindicated in the client? (Select all that apply.)
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The client has hypotension The client has aortic stenosis The client has cardiogenic shock
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A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about?
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Peripheral edema
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A nurse is caring for a patient receiving digoxin for ventricular arrhythmia. Which apical pulse rate indicates that the nurse should withhold the drug and report to the health care provider immediately?
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58 beats/minute
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What is the mechanism of action for medications prescribed to treat a rapid dysrhythmia?
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reducing automaticity
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A 65-year-old male patient is admitted to the hospital with sinus bradycardia. What is the underlying pathology of sinus bradycardia?
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A decrease in automaticity
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A client is started on antiarrhythmic therapy to treat atrial fibrillation. The nurse caring for this client knows which occurrence is a potential side effect of this medication?
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Other arrhythmias
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Which statement would be true about the mechanism of action of class II antiarrhythmic agents?
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Block the stimulation of the adrenergic receptors
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The teaching plan for a client taking amiodarone should include which instruction?
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Use a reliable form of birth control while taking this medication.
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What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)? Choose the BEST response.
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Place the client on a cardiac monitor.
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The nurse is administering lidocaine to a client and anticipates a reduced dosage if the client also has which conditions? (Select all that apply.)
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Liver disorders Right-sided heart failure
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The health care provider has prescribed quinidine. The nurse knows this drug is used for what physiologic effects on the heart? (Select all that apply.)
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reduces automaticity prolongs the refractory period
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The health care provider has ordered quinidine for a 12-year-old child. The nurse expects to administer this medication in what form?
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Oral
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Which agent would be classified as a class Ia antiarrhythmic?
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Procainamide
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Which phase of the cardiac muscle action potential is affected by class I antiarrhythmics?
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Phase 0
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A client is prescribed disopyramide. The nurse would expect to administer this drug by which route?
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Oral
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A client is to receive esmolol. The nurse would expect to administer this agent by which route?
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Intravenous
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All antiarrhythmic medications can cause which of the following? (Select all that apply)
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New arrhythmias Worsen existing arrhythmias Increased blood pressure
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Which medications are Class II antiarrhythmics? (Select all that apply.)
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Acebutolol (Sectral) Propranolol (Inderal)
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When educating a group of nursing students on the classification of various antiarrhythmic drugs, the nurse cites propafenone (Rythmol) as an example of class IC drugs. Which are the general modes of action of drugs in this class? (Select all that apply.)
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Marked depression of phase 0 Slight effect on repolarization Profound slowing of conduction
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What should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? (Select all that apply.)
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Response to therapy Signs of heart failure Development of new cardiac arrhythmias Worsening of arrhythmia being treated Monitoring of serum flecainide levels
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Quinidine is prescribed to a patient with cardiac arrhythmia. When documenting the patient's drug history, the nurse inquires about the concomitant use of any other drug. Which drug when given concomitantly may cause an increase in serum Quinidine levels?
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Cimetidine
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When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney?
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Acebutolol
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A client is admitted to the emergency department with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV?
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Determine if the client has had a reaction to local anesthesia.
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Which patient would a nurse determine to be at the greatest risk for quinidine toxicity?
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A 44-year-old man diagnosed with cardiac insufficiency
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There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers?
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III
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A cardiovascular assessment before administration of an antiarrhythmic medication includes which of the following? Select all that apply.
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Vital signs Client's general status Subjective symptoms Apical pulse
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A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?
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Elevated glucose
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A patient receives propranolol orally at 9:00 AM. The nurse would expect the drug to begin its action at which time?
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Between 9:20 to 9:30 AM
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The nurse is preparing to administer quinidine intravenously. At what rate will the nurse administer this medication?
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1 mL/min
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A client is released from the hospital after a myocardial infarction. The physician prescribes a class II beta-adrenergic blocker drug. Why does the physician choose this drug?
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It is effective in reducing mortality after myocardial infarction.
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Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with what conditions? (Select all that apply.)
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Cardiac catheterization Cardiac surgery Digitalis-induced ventricular dysrhythmias
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The nurse is visiting the home of a client who is prescribed antidysrhythmic medication. The nurse will teach the client to report which possible adverse effect?
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Dizziness
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When describing the action of antiarrhythmics, which effect would most likely be included?
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Alteration in conductivity
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Beta-blockers reduce both morbidity and mortality associated with heart failure. By what mechanism do they work in heart failure?
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They block the sympathetic response.
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When do the coronary arteries receive blood?
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During diastole
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The nurse is caring for a lactating client who has been prescribed a class II antiarrythmic. What is the nurse's best action?
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Assess the client and administer the drug as prescribed Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the mother is lactating. There is no obvious reason to contact the care provider or withhold the drug, which the nurse cannot independently do.
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Which is true in regards to the drug propranolol (Inderal)? (Select all that apply.)
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Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney. Propranolol reduces the release of renin. Propranolol has membrane stabilizing effects.
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An instructor is preparing a teaching plan for a class about the types of arrhythmias. Which would the instructor include as arising from stimulation of an ectopic focus? (Select all that apply.)
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Premature ventricular contraction Atrial flutter Ventricular fibrillation
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After teaching group of students about antiarrhythmic agents, the instructor determines that the teaching was successful when the students identify which of the following as examples of class III antiarrhythmics? Select all that apply.
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Amiodarone Dofetilide Sotalol Ibutilide
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The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, should the nurse question?
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Verapamil
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Flecainide, propafenone, and moricizine are unique in that they have no effect on the repolarization phase but do have what effect?
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They decrease conduction in the ventricles.
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A patient develops supraventricular tachycardia. Vagal maneuvers were tried but were unsuccessful. Drug therapy is initiated. Which agent would the nurse expect to be used?
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Adenosine
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The nurse is caring for a client who is receiving lidocaine. What type of arrhythmia is this class of drugs used to treat?
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Acute ventricular arrhythmias
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What is a contraindication for class II antiarrhythmics?
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Asthma
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