Cardiac System Test 5 review , Pharmacology Nursing Class, March 2021 PDF

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Test 5 New ATI Exam Review, March 2, 2021 • • •

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If a Nurse is giving a patient a Beta-Adrenergic Blocker, such as metoprolol, the nurse must make sure to check patients’ heart rate and blood pressure as this medication is a negative chronotropic and negative inotropic medication. If Vital Signs are low, nurse should hold medication and notify physician. Beta Blockers are contraindicated for Asthma Patients. What is the best way to monitor the effectiveness of diuretic therapy? Remember that best way to monitor if the diuretic therapy works is by monitoring weight. Another option would be the I & O. In the case of monitoring I&O, we would like to see higher outputs when compared to intakes. Digoxin (lanoxin), a cardiac glycoside has a very narrow safety range thus digoxin serum levels are monitored while patient is taking the therapy. Digoxin levels of greater than 1.8 ng/dl denotes that it is too high and digoxin toxicity can occur. This is a very serious concern as this medication is a negative chronotropic medication (decreases the heart rate). Be mindful that Digoxin is also a positive inotrope(increases the myocardial contractility) making the heart a more effective pump. Signs of Digoxin Toxicity include: nausea, anorexia, visual disturbances (seeing halos), fatigue and vomiting. When patient is taking digoxin, an apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is low (generally 60 bpm), the medication should be held, and the ordering practitioner informed. Digoxin can suppress electrical activity within the heart and lower heart rate. The drug Digibind can be used to treat toxic levels. Review how ACE inhibitor functions. Reduce afterload, Drug of choice for heart failure, Enhance excretion of sodium and water, Lowers peripheral resistance and reduces blood volume Increases cardiac output Ace Inhibitors can be used for Hypertension, Heart failure, decrease progression of diabetic neuropathy and decrease mortality post M.I. Mechanism of action: to inhibit ACE enzyme and decrease aldosterone secretion Primary use: to decrease blood pressure and reduce blood volume; dilate veins Adverse effects: first-dose hypotension, cough, hyperkalemia, renal failure Other Ace Inhibitors: captopril (Capoten), enalopril (Vasotec) ACE inhibitors are number one choice of therapy for Heart Failure, it can be used for Hypertension, decrease progression of diabetic neuropathy and post MI to improve outcomes. Keep in mind that Hypokalemia can increase the likelihood of Digoxin toxicity. Thus if Potassium levels are less than 3.5 for a patient taking Digoxin the nurse would have to immediately notify MD and intervene accordingly. If Nitrates are administered in conjunction with Viagra, what are the possible consequences? Viagra is know to be used for pulmonary hypertension (lower BP) if someone takes this with nitrate they will become SEVERLY HYPOTENSIVE We can measure that digoxin is working for a heart failure patient; if patient is able to perform ADL’s and walk better than without the medication. Black Tarry stools is an abnormal finding for patients taking Coumadin. This may be indicative of bleeding. If patient is taking Coumadin, they should have PT and INR drawn to measure levels and be able to adjust Coumadin dose. Transdermal Nitroglycerin can build tolerance. For that reason, the nurse should remove the patch for at least 6-8 hours to avoid tolerance to build up. Keep in mind that headache is a common side effect for a patient using Nitrates. Tylenol PRN can be suggested for that. Organic Nitrates common adverse effects/side effects includes headache, orthostatic hypotension, tolerance build up and reflex tachycardia. What is the concern associated with calcium channel blockers and grapefruit juice? Avoid drinking grapefruit juice/ this can cause CCB to accumulate to toxic levels During therapy, monitor heart rate and B/P regularly/ Can cause to hypotension Some of the possible adverse effects/side effects of taking Lasix are as follow: Hypokalemia, Hypotension, Hyperuricemia, Hyperglycemia and Ototoxicity if the medication is IV pushed too fast. If a patient is taking Statins for the treatment of Hypercholesterolemia, The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. Patients that have diabetes and that develop hypertension will most likely be ordered Ace Inhibitors. Ace inhibitors slow the progression of kidney injury in diabetic patients along with decreasing the progression of diabetic neuropathy Why do Ace Inhibitors can lead to hyperkalemia? Must monitor patient for hyperkalemia due to the blocking of Aldosterone If B1 receptors are activated by a B1 agonist drug, we know that this drug is working in the heart. Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration. Epinephrine Adenosine In doing education for hypertensive patient, the nurse should know that: o Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Med Math will include: o Gravity Drip: V(ml)/ T (min) X GTTs/ml (Drop Factor) o D/H x Q

Test 5 New ATI Exam Review, March 2, 2021 Chapter 55 1. The nurse noted a patient’s heart rate decreasing from 45 to 38 while administering a trephine 0.3 MG IV. What is the most likely explanation B. The order does was too low 2.An older adult patient with a hip fracture became unresponsive 20 minutes after receiving morphine three MG intravenously. Which actions with the nurse take? C. Assess the patient; call for additional assistance, support breathing with the bag valve mask device as indicated, and prepare to administer naloxone 3. The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal < 20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action B. Withhold mannitol at all at this time, but take other measures to reduce in traction on pressure 4. A dopamine infusion was started in a patient’s antecubital vein during resuscitation for a profound hypotension, but the electronica fusion device is now sounding an alert for an occlusion. What is the most important immediate concern for the nurse? B. An interruption in the infusion can produce hypotension in the patient 5. The nurse observes a short period of a stall on the cardiac monitor that re-solves spontaneously immediately after administering and then nursing IV to a patient who was experiencing peroxisomal Superventricular tachycardia. Which initial action is the most appropriate for the nurse? D. Closely observe the patient in the cardiac monitor 6. The nurse practitioner has written a number of start orders for drugs to treat a patient on the medical surgical unit who has suffered an acute anaphylactic reaction with hives and bronchospasm during infusion of IV antibiotic. Which priority drug with the nurse and minister first C. Epinephrine 7. The nurse receives a stat order to administer 50% dextrose solution intravenously to a one-year-old child with hypoglycemia. How should the drug test be prepared for safe administration to the child C. Dilute 1:1 with steril water produce dextrose 25% 8. An unresponsive patient who was brought to the emergency department has been reportedly taking alprazolam for a severe anxiety disorder after the mothers death. Knowing this history which drug with the nurse anticipate administering D. Flumazenil 9. A patient was admitted to the emergency department with the post oximeter reading of 85% after successful prehospital resuscitation from cardiac arrest due to an asthma attack. What is the most important initial drug to measure as ordered D. oxygen 10. Which drug concentration is appropriate to administer in an order for epinephrine 0.3 MG IM to treat a severe allergic reaction and an adult patient B. 1:1000 11. Upon preparing to minister activated charcoal by mouth to treat a patient who took an overdose of aspirin and severe unknown drugs, the nurse notes that the patient has become very some Noland and eyes open only to a noxious stimulus which action by the nurse is most appropriate at this point A. Immediately discussed the change in the patient mental status with the nurse practitioner who wrote the activated charcoal orders so that the plan of care can be evaluated 12. A surgeon orders aspirin 325 MG by mouth to a patient who developed chest pain while undergoing a minor outpatient surgery for a mole removal from the lake. Which is the best course of action by the nurse B. After checking for a drug allergies, first instructed patient to chew the aspirin tablet and then a new minister the aspirin.

Chapter 41 1. The patient has serum cholesterol level of 265 MG/DL, Triglyceride level of 235 mg/dL, and a low density lipoprotein of 180 mg/dL. What do these serum levels indicate ? C. hyperlipidemia 2. The nurse knows that a patient’s total cholesterol level should be within which range? a. 150 to 200 mg/dL 3. Patient has low density lipoprotein of 175 MG/DL and a high density lipoprotein of 30 MG/DL. What teaching should the nurse implement for the patient? a. Discuss medications ordered, dietary changes, and exercise 4. Which laboratory test value does the nurse realize can contribute to the development of cardiovascular disease and stroke? b. Increased homocysteine level 5. A patient is taking lovastatin. Which serum level is most important for the nurse to monitor? d. Hepatic enzymes 6. For what severe skeletal muscle adverse reaction should the nurse observed in a patient taking rosuvastatin? b. Rhabdomyolysis 7. A patient is taking as ezetimibe and asks the nurse how it works. The nurse should explain that ezetimibe does what ? a. Inhibits absorption of dietary cholesterol in the intestines 8. A patient is diagnosed with peripheral arterial disease. He is prescribed pentoxifylline. What does the nurse realize are the effects of pentoxyifylline? (select all that apply)

Test 5 New ATI Exam Review, March 2, 2021 b. c. d.

Improves microcirculation tissue perfusion Decreases blood viscosity and improves flexibility of erythrocytes Alleviates intermittent claudication

Chapter 40 1.A patient is placed on heparin, and the nurse acknowledges that heparin is effective for preventing clot formation in patients who have which disorders? (select all that apply) A. Coronary thrombosis B. Acute myocardial infarction C. Deep vein thrombosis D. Hemorrhagic stroke E. Disseminated intravascular coagulation 2. A patient Who received her brain begins to bleed. The nurse anticipates that the healthcare provider will order which antidote a. Protamine sulfate 3.A patient As prescribed enoxaparin The nurse knows that low molecular weight heparin has what kind of half life a. a longer half life then heparin 4. The nurse is teaching a patient about clopidogrel. Which information with the nurse include in the patient’s teaching plan? C. Bleeding may increase one taken with aspirin 5. A patient had an orthopedic surgery and is prescribed enoxaparin. What was the nurse teach the patient and or family members about this low molecular weight heparin before discharge? d. watch for bleeding or excessive bruising 6. A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? B. Warfarin 7. A patient is taking warfarin five MG/day for atrial fibrillation . The patients international normalized ratio is 3.8. The nurse would consider the international normalized ratio to be what? B. elevated range 8. Cilostazol is being prescribed for a patient with corner artery disease. The nurse understands that which of the following is the major purpose for antiplatelet drug therapy? D. suppress platelet aggregation 9.A patient is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reoccolusion of coronary arteries after coronary angioplasty ? B. Abciximab 10. A patient is admitted to the emergency department with an acute myocardial infarction. Which drug does the nurse expect the healthcare provider to order for prevention of tissue necrosis after blood clot blockage in a coronary artery? C. Alteplase Chapter 39 1. A patient’s blood pressure is 130/84. The healthcare provider plans to suggest Nonpharmacologic message to lower blood pressure. Which should the nurse include in teaching? (Select all that apply. ) a. Stress reduction techniques b. An exercise program c. Salt restriction d. Smoking cessation 2. A patient has developed mild hypertension. The nurse acknowledges that the first line drug for treating this patient blood pressure might be which drug? A. diuretic 3. An African-American patient has developed hypertension. The nurse is aware that which groups of antihypertensive drugs or less effective an African-American patients ? C. Beta blockers and angiotensin converting enzyme inhibitors 4. The nurse knows that which diuretic is most frequently combined with antihypertensive drug? B. hydrochlorothiazide 5. The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administering? B. apical pulse 6. Captopril has been ordered for a patient. The nurse to teach the patient at the most commonly occur in side effect of angiotensin converting enzyme drug is which of the following? The nurse to teach the patient at the most commonly occurring side effects of angiotensin converting enzyme drug is which of the following? Deacons D. constant, irritating cough 7. A patient is prescribed losartan. The nurse teaches the patient that an angiotensin two receptor blocker ask by doing what? b. Blocking angiotensin II from angiotensin I receptors 8. During an admission assessment, the patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of calcium channel blocker? (Select all that apply) a. Insomnia b. Dizziness

Test 5 New ATI Exam Review, March 2, 2021 c. d. e.

Headache Angioedema Ankle Edema

Chapter 37 1.The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that the heart failure is improving? B. absence of peripheral Edema 2. The patient serum digoxin Level is 3.0 ng/mL. What does the nurse know about the serum digoxin level? A. it is in the high (elevated) range. 3. The nurse is assessing a patient for possible evidence of digitalis toxicity. Which of these is included in the signs and symptoms for digitals toxicity. D. apical pulse of 48 beats/min with an irregular rate 4. A patient is taking a potassium-depletingDiuretic and digoxin. The nurse expect study low potassium level (hypokalemia) could have what effect on digoxin? a. Increases serum digoxin sensitivity level 5.A patient takes an initial dose of nitrate. Which symptoms will the nurse expect to occur? b. Headcahes 6. A patient is prescribed a beta blocker. Beta blockers are as affective as antianginals because they do what? c. Decrease heart rate and decrease myocardial contractility 7. The healthcare provider is planning to discontinue a patient’s beta blocker. Which instruction will the nurse give the patient regarding the beta blocker? b. The beta blocker should not be abruptly stopped; the dose should be tapered down 8. The beta blocker acebutolol is prescribes for dysrhythmias. What is the primary purpose of the drug? c. Block beta1-adrenergic receptors in cardiac tissues 9. A patient has angina It’s prescribe nitroglycerin. Which are appropriate nursing interventions for nitroglycerin a. Have the patient sit or lay down when taking a nitroglycerin sub lingual tablet b. Teach the patient has taken a tablet to call 911 and five minutes of chest pain persists e. Warned the patient against ingesting alcohol while taking nitroglycerin...