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C: Nurselabs CARDIO #1 D.

Increasing cardiac output and enhancing renal


perfusion
1. Which of the following clients is at greatest
risk for digital toxicity? 8. Before giving milrinone (Primacor) by an IV
infusion to a client with symptoms of CHF,
A. A 25-year-old client with congenital heart which of the following nursing actions is
disease necessary?
B. A 50-year-old client with CHF
C. A 60-year-old client after myocardial infarction A. Record sodium level.
D. An 80-year-old client with CHF B. Administer loading dose over 15 minutes.
C. Assess CV status.
2. Which of the following is a contraindication D. Review medication regimen to identify if client is
for digoxin administration? on IV furosemide (Lasix).

A. Blood pressure of 140/90 9. Johanna has ventricular ectopy, which of the


B. Heart rate above 80 following drugs is the first line used to treat her
C. Heart rate below 60 condition?
D. Respiratory rate above 20
A. quinidine (Cardioquin)
3. The action of medication is inotropic when it: B. digoxin (Lanoxin)
C. procainamide ( Pronestyl)
A. Decreased afterload D. lidocaine (Xylocaine)
B. Increases heart rate
C. Increases the force of contraction 10. Class IA antiarrhythmic agents have little
D. Is used to treat CHF effect on:

4. Which is the MOST appropriate action for the A. AV node


nurse to take before administering digoxin? B. SA node
C. Purkinje fibers
A. Monitor potassium level D. Bundle of His
B. Assess blood pressure
C. Evaluate urinary output 11. Which of the following drugs can cause
D. Avoid giving with thiazide diuretic severe hematologic disorders?

5. The therapeutic drug level for digoxin is: A. digoxin (Lanoxin)


B. quinidine (Cardioquin)
A. 0.1-2.0 ng/mg C. disopyramide (Norpace)
B. 1.0-2.0 ng/mg D. procainamide (Pronestyl)
C. 0.1-0.5 ng/mg
D. 0.5-2.0 ng/mg 12. Which of the following ECG findings alerts
the nurse that the client needs an
6. Blurred vision or halos are signs of: antiarrhythmic?

A. Subtherapeutic digoxin levels A. Normal sinus rhythm


B. Digoxin toxicity B. Sinus bradycardia
C. Nothing related to digoxin C. Sinus arrhythmia
D. Corneal side effects of digoxin D. Frequent ventricular ectopy

7. Amrinone (Inocor) is used for short term 13. When administering an antiarrhythmic
therapy for CHF and acts by which of the agent, which of the following assessment
following mechanisms? parameters is the most important for the nurse
to evaluate?
A. Increasing stroke volume and heart rate
B. Slowing ventricular rate and increasing cardiac A. ECG
output B. Pulse rate
C. Vasodilating and increasing peripheral vascular C. Respiratory rate
resistance D. Blood pressure
14. Which of the following blood tests will tell 20. When administering dopamine (Intropin), it
the nurse that an adequate amount of drug is is most important for the nurse to know that:
present in the blood to prevent arrhythmias?
A. the drug’s action varies according to the dose.
A. Serum chemistries B. the drug may be used instead of fluid
B. Complete blood counts replacement.
C. Drug levels C. the drug cannot be directly mixed in solutions
D. None of the above containing bicarbonate or aminophylline.
D. the lowest dose to produce the desired effect
15. Which of the following drugs should be should be used.
used only in situations in which the client can
be very closely monitored, such as a critical 21. Dobutamine (Dobutrex) improves cardiac
care unit? output and is indicated for use in all of the
following conditions except:
A. bretylium (Bretylol)
B. digoxin (Lanoxin) A. septic shock
C. quinidine (Cardioquin) B. congestive heart failure
D. inderal (Propranolol) C. arrhythmias
D. pulmonary congestion
16. The most toxic antiarrhythmic agent is:
22. Conduction defects will most likely be an
A. digoxin (Lanoxin) adverse associated with the use of:
B. lidocaine (Xylocaine)
C. amiodarone (Cordarone) A. verapamil
D. quinidine (Cardioquin) B. nifedipine
C. diltiazem
17. Epinephrine is used to treat cardiac arrest D. felodipine
and status asthmaticus because of which of the
following actions? 23. Which of the following calcium channel
blockers has the most potent peripheral
A. Increased speed of conduction and smooth muscle dilator effect?
gluconeogenesis
B. Bronchodilation and increased heart rate, A. diltiazem
contractility, and conduction B. nifedipine
C. Increased vasodilation and enhanced C. nimodipine
myocardial contractility D. verapamil
D. Bronchoconstriction and increased heart rate
24. Which of the following adverse reactions is
18. Following norepinephrine (Levophed) found more often in volume-
administration, it is essential to the nurse to depleted elderly clients?
assess:
A. Bradycardia
A. electrolyte status B. Conduction defects
B. color and temperature of toes and fingers C. Ankle edema
C. capillary refill D. Hypotension
D. ventricular arrhythmias
25. Which of the following calcium channel
19. Norepinephrine (Levophed) is blockers is used to counteract or prevent
contraindicated in which of the following cerebral vasospasm?
conditions?
A. verapamil
A. Hypovolemic shock B. nimodipine
B. Neurogenic shock C. nifedipine
C. Blood pressures above 80-100 mmHg (systolic) D. felodipine
D. Decreased renal perfusion
26. Which of the following effects of calcium
channel blockers causes a reduction in blood
pressure?

A. Increased cardiac output


B. Decreased peripheral vascular resistance
C. Decreased renal blood flow
D. Calcium influx into cardiac muscles

27. Jason James is taking ß blockers, all of the


following should be included in his assessment
except:

A. Pulmonary function tests


B. Baseline ECG
C. Glucose level
D. Blood pressure

28. Routine laboratory monitoring in clients


taking ß blockers should include:

A. Sodium
B. Glucose
C. Thyrotropin
D. Creatine phosphokinase

29. Competitive antagonism of which of the


following occurs at ß receptor sites?

A. Catecholamines
B. Adrenergic sites
C. Acetylcholine
D. Norepinephrine

30. ß blockers should be avoided in which of


the following conditions?
A. Bronchoconstriction
B. Hypertension
C. Angina
D. Myocardial infarction
C: NurseLabs CARDIO #2 D. Stimulate vasodilation and inhibit sodium
depletion
1. As a knowledgeable nurse, you know that the
action of nitrates is: 7. Nurse Margie just administered an ACE
inhibitor to her client. Before ambulating the
A. Smooth muscle contraction client for the first time after administration, the
B. Vasoconstriction nurse should monitor for:
C. Smooth muscle relaxation
D. Increase preload A. Hypokalemia
B. Irregular heartbeat
2. A 50-year-old client is prescribed to take C. Edema
nitrate each day for his condition. As a D. Hypotension
competent nurse, you know the result of nitrate
administration is: 8. Mira is managing her hypertension with an
ACE inhibitor. Which of the following
A. Decreased myocardial oxygen demand statements stated by her indicates a need for
B. Increased myocardial oxygen demand further instruction?
C. Increased left ventricular end-diastolic volume
D. Increased atrial pressure A. “I should not take my pills with food.”
B. “I need to increase my intake of orange juice,
3. A student nurse is asked to give an example bananas, and green vegetables.”
of a long-acting nitrate. He is correct by saying: C. “I will avoid coffee, tea, and colas.”
D. “I will use salt substitutes that are not high
A. nitroglycerin sublingual
in potassium.”
B. nitroglycerin IV
C. isosorbide PO 9. Pepito is a hypertensive client who has been
D. nitroglycerin transmucosal placed on captopril (Capoten). He states, “Dr.
del Mundo keeps changing my pills and none
4. When nitrates are administered early to the
are working. I feel like a guinea pig.” Which of
acute MI client, the effect is:
the following responses by the nurse would be
A. Hypotension most appropriate?
B. Bradycardia
A. “It often takes a while before the
C. Reduced mortality
right medication is found.”
D. Reduced morbidity
B. “The doctor is just trying to help you control
5. When teaching about nitrate administration, your blood pressure.”
the nurse should instruct the client to: C. “The action of this drug is to work on both the
arteries and to remove excess fluids.”
A. Change position slowly. D. “This drug is used when other drugs have
B. Take pulse daily. failed.”
C. Reduce salt intake.
D. Chew the sustained-release tablets. 10. The action of an ACE inhibitor interrupts the
renin-angiotensin-aldosterone mechanism,
6. ACEs participate in the renin-angiotensin- thereby producing which of the following?
aldosterone system to have which of the
following physiologic effects? A. Reduced renal blood flow
B. Reduced sodium and water excretion
A. Inhibit conversion of angiotensin II to angiotensin C. Increased peripheral vascular resistance
I D. Increased sodium excretion and potassium
B. Vasoconstriction and sodium depletion reabsorption
C. Promote sodium and water retention
11. Raymund is reviewing on cardiovascular A. Create an osmotic gradient
drugs for his upcoming exam. For a well- B. Inhibit the exchange of sodium for potassium
prepared student, he should know that C. Cause metabolic acidosis
vasodilators are agents that: D. Work poorly in the presence of endogenous
aldosterone
A. Relax smooth muscles
B. Are used to treat hypotension 17. Which of the following is a potential side
C. Stimulate the adrenergic receptors of peripheral effect of IV furosemide (Lasix)?
sympathetic nerves
D. Cause respiratory depression A. Drowsiness
B. Diarrhea
12. As a competent nurse, you are aware that C. Cystitis
vasodilators are used mainly to treat: D. Hearing loss

A. Diabetes 18. A 68-year-old client with a history of mild


B. Hypertension CHF and glaucoma is receiving IV mannitol
C. Atrial fibrillation (Osmitrol) to decrease intraocular pressure. The
D. Hypotension nurse would monitor the client for signs and
symptoms of:
13. The drug/drugs used most commonly to
treat peripheral or cerebral vascular obstructive A. Fluid volume excess
disease is/are: B. Fluid volume deficit
C. Hyperkalemia
A. pentoxifylline (Trental) D. Hypernatremia
B. cyclandelate (Cyclan)
C. isoxsuprine (Vasodilan) 19. All potassium-sparing diuretics:
D. All of the above
A. Are required supplements during blood
14. In a 50-year-old widower who had a transfusion
transient ischemic attack, what is the most B. Enhance aldosterone action
common vasodilator used for his treatment? C. Cause hypokalemia
D. Are weak diuretics
A. norepinephrine
B. dopamine (Intropin) 20. Which of the following clients is most likely
C. papaverine (Pavabid) to experience adverse effects from treatment
D. nitroprusside (Nitropress) with diuretics?

15. For a client taking drugs to treat peripheral A. A 21-year-old student


vascular disease, it is important to provide B. A 40-year-old unmarried man
health education about: C. A 60-year-old widower
D. A 75-year-old man
A. Smoking cessation
B. Developing a proper balance between rest and 21. Kylie is reviewing drugs related to
activity cardiovascular therapies. She should be aware
C. Proper foot care that the desired action of lipid-lowering agents
D. All of the above is to:

16. A clinical instructor asks a nursing A. Decrease HDL


student about aldosterone antagonist. The B. Increase TC
student is correct by saying that aldosterone C. Increase LDL
antagonists: D. Increase HDL
22. For lipid-lowering agents to be successful, C. 8 to 12 hours
drug therapy must lower: D. 1 to 2 days

A. HDL 29. Which drug is used to


B. LDL stop bleeding associated with heparin
C. Total fat overdose?
D. All of the above
A. urokinase (Abbokinase)
23. As a competent nurse, you know that the B. aminocaproic acid (Amicar)
most significant contraindication for therapy C. vitamin K (AquaMEPHYTON)
with lipid-lowering agent is: D. protamine sulfate (Protamine)

A. Renal disease 30. During warfarin (Coumadin) administration,


B. Diabetes the nurse can expect that the initial extension of
C. Liver disease PT occurs within _____ hours after therapy
D. Cardiac disease begins.

24. Which of the following vitamins may not be A. 1 to 2


absorbed properly when giving bile acid B. 4 to 6
sequestrants? C. 8 to 12
D. 12 to 24
A. Vitamin B
B. Vitamin C
C. Vitamin B12
D. Vitamin K

25. Which of the following lipid-lowering agents


has the common side effect of constipation?

A. lovastatin (Mevacor)
B. colestipol (Colestid)
C. gemfibrozil (Lopid)
D. niacin (Nicotinic acid)

26. Parenteral anticoagulants work by


disrupting:

A. Conversion of prothrombin to thrombin


B. Formation of thromboplastin
C. Vitamin K-dependent clotting factors
D. Conversion of prothrombin to fibrin

27. SC heparin should be administered in the:

A. Flank
B. Abdominal fat
C. Leg
D. Gluteal area

28. The half-life of heparin is:

A. 10 minutes
B. 1 to 1.5 hours
C: NurseLabs CARDIO 3 itchiness, and nausea. Which of the following
should be the priority action of the nurse?
1. A nurse is providing instructions to a client
who is receiving warfarin sodium (Coumadin). A. Stop the infusion and notify the physician.
Which statement made by the client indicates B. Administer protamine sulfate and provide oxygen
the need for further instruction? therapy.
C. Administer antihistamine then continue the
A. “I will observe the color of my urine and stool“. infusion.
B. “I will take Ecotrin (Enteric coated aspirin) for my D. Slow the infusion and administer oxygen.
headaches”.
C. “I will avoid drinking alcohol”. 6. A client with deep vein thrombosis is
D. “I will take the medicine daily at the same time”. receiving Streptokinase (Streptase). The nurse
would notify the physician if which of the
2. A nurse is caring for a client receiving a following assessment is noted?
heparin intravenous (IV) infusion. The nurse
expects that which of the following laboratory A. A temperature of 99.2° Fahrenheit.
will be prescribed to monitor the therapeutic B. A pulse rate of 99 beats per minute.
effect of heparin? C. A respiratory rate of 25 breaths per minute.
D. A blood pressure of 185/110 mm Hg.
A. Prothrombin time (PT).
B. Activated partial thromboplastin time (aPTT). 7. A client who is receiving streptokinase
C. Hematocrit (Hgb). therapy suddenly had a nose bleeding. The
D. Hemoglobin (Hct). nurse ensures the availability in which of the
following medication?
3. A client with atrial fibrillation is receiving a
continuous heparin infusion at 1,000 units/hr. A. Vitamin K (Mephyton).
The nurse observes that the client is receiving B. Deferoxamine (Desferal).
the therapeutic effect based on which of the C. Aminocaproic acid (Amicar).
following results? D. Diphenhydramine (Benadryl).

A. Activated partial thromboplastin time of 30 8. A nurse is providing health teachings


seconds. regarding antiplatelet medications. Which of the
B. Activated partial thromboplastin time of 60 following is not true regarding the use of this
seconds. medication?
C. Activated partial thromboplastin time of 120
A. Antiplatelet medication inhibits the aggregation
seconds.
of platelets in the clotting process, thereby
D. Activated partial thromboplastin time of 15
prolonging bleeding time.
seconds.
B. Antiplatelet medications cannot be used
4. A client is receiving intravenous heparin with anticoagulants.
therapy. The nurse ensures the availability in C. Take the medication with food to prevent
which of the following medication? gastrointestinal upset.
D. A routine bleeding time is monitored during the
A. Acetylcysteine (Mucomyst). therapy.
B. Calcium gluconate.
C. Vitamin K (Mephyton). 9. A client is receiving Procainamide
D. Protamine sulfate. (Procanbid) for the treatment of ventricular
arrhythmia. The client suddenly complains
5. A client is receiving a continuous infusion of of nausea and drowsiness. Which of the
streptokinase (Streptase). The client suddenly intervention should the nurse do first?
complaints of a difficulty of breathing,
A. Check the blood pressure and heart rate. B. “This medication will have no effect in the blood
B. Do a 12-lead electrocardiogram right away. sugar level”.
C. Measure the heart rate on the rhythm strip. C. “This medication may mask some of the
D. Give hydralazine (Apresoline) per orem. symptoms of hypoglycemia such as tremor,
palpitation, and rapid heartbeat.
10. A client with myocardial infarction is D. “This medication may mask some of the
receiving tissue plasminogen activator, symptoms of hyperglycemia such as headache,
alteplase (Activase, tPA). While on the therapy, increased thirst, and blurred vision“.
the nurse plans to prioritize which of the
following? 14. A client is about to receive Metolazone
(Zaroxolyn). The nurse in charge understands
A. Observe for neurological changes. that which of the following laboratory results
B. Monitor for any signs of renal failure. are related to the administration of the
C. Check the food diary. medication?
D. Observe for signs of bleeding.
A. Hyperkalemia and hypocalcemia.
11. A nurse is caring a client who is B. Hyperkalemia and hypoglycemia.
taking digoxin (Lanoxin) 0.25mcg tab once a C. Hypouricemia and hypoglycemia.
day. The client suddenly complaints of D. Hypokalemia and hyperglycemia.
anorexia, nausea, vomiting, and diarrhea. The
physician is ruling a digoxin toxicity. As a 15. A client with congestive heart failure is
nurse, you know the therapeutic digoxin rate being treated with Torsemide (Demadex). The
is? nurse obtains the following vital signs: Blood
pressure of 100/65 mm hg; pulse rate of 91
A. 0.25-0.5 ng/ml. beats per minute; and respiration of 25 breaths
B. 0.5-2 ng/ml. per minute? Which of the following will be the
C. 1.5-3 ng/ml. priority assessment of the nurse after the
D. 3.5-4.5 ng/ml. initiation of the dose?
12. A nurse is monitoring a client who is A. Urine output.
taking Carvedilol (Coreg CR). Which of the B. Serum potassium and calcium.
following assessment made by the nurse would C. Blood pressure.
warrant a possible complication with the use of D. Weight.
this medication?
16. A nurse is giving instruction to a client who
A. Baseline blood pressure of 160/100 mm hg is receiving Cholestyramine (Questran) for the
followed by a blood pressure of 120/70 mm hg after treatment of hyperlipidemia. Which of the
3 doses. following statements made by the client
B. Baseline heart rate of 97 bpm followed by a indicates the need for further instructions?
heart rate of 62 bpm after 3 doses.
C. Complaints of nightmares and insomnia. A. “This medication comes in a powder that must
D. Complaints of dyspnea. be mixed with juice or water before administration”.
B. “I will avoid eating foods rich in saturated fats”.
13. A nurse is interviewing a client who is about C. “I will continue taking nicotinic acid as part of the
to receive metoprolol. Upon the history taking, treatment”.
the client is also taking insulin. Which of the D. “Constipation, belching and heartburn are some
following statements made by the nurse will of the side effects”.
correctly explain the possible interaction of
these medications? 17. A nurse is providing instructions to a client
who is on nicotinic acid for the treatment of
A. “This medication will maintain the blood sugar hyperlipidemia. Which statement made by the
level on a normal range”.
nurse indicates a comprehension of the
instructions?

A. “I should take aspirin 30 minutes before nicotinic


acid”.
B. “I will drink alcohol in moderation”.
C. “Yellowing of the skin is a common side effect”.
D. “This medication is taken on an empty stomach“.

18. A nurse is monitoring a client who is taking


Digoxin (Lanoxin). All of which are the side
effects associated with the medication, except?

A. Anorexia.
B. Blurred vision.
C. Diarrhea.
D. Tremors.

19. A nurse is interviewing a patient who


is about to receive bumetanide (Bumex). Which
of the following is a concern related to the
administration of the medication?

A. Penicillin allergy.
B. Sulfa allergy.
C. Soy containing allergy.
D. Cephalosporin allergy.

20. A client arrives in the emergency with


complaints of chest pain and is diagnosed with
acute MI. A morphine 4mg IV was given 5
minutes ago. Which of the following
assessment made by the nurse indicates a
further immediate action?

A. Respiratory rate from 20 bpm to 12 bpm.


B. Blood pressure from 120/70 to 100/60 mmHg.
C. The client still complains of chest pain with a
pain scale of 2/10.
D. Cardiac rate of 103 bpm and a normal sinus
rhythm of the ECG.
C: Quizlet & answers CARDIO 4 ulcers, bleeding from trauma
22. clopidogrel: contra? Intracranial hemorrhage, GI
1. acebutolol (Action) blocks beta 1 adrenergic
bleeding
receptors
23. clopidogrel: misuse ↓ effects if given w/ grapefruit
2. acebutolol (adverse) bradycardia
juice
3. acebutolol: albuterol
24. clopidogrel: side Abdominal pain, dizziness,
antoagonist?
effects? epistaxis(nose bleed), headache,
4. acebutolol (avoid what) alcohol, tobacco, caffeine fatigue, chest pain
usage
25. clopidogrel: uses? Prevention of recurrence of MI's
5. acebutolol (monitor Assess BP and pulse. and strokes
what?) Monitor EKG.
26. digoxin (action) increases contraction and
6. acebutolol ( side Dizziness, nausea, vomiting, decreases conduction
effects) anorexia, edema, headache,
27. digoxin(adverse) bradycardia, cardiac
fatigue, ↓ BP, palpation with
dyrhythmias, thrombocytopenia
withdrawl
28. digoxin(anidote) digoxin immune fab (digibind)
7. acebutolol (Uses) HTN, angina, cardiac
dyrhythmias 29. digoxin(asses for?) s&s of toxicity

8. Ace inhibitors: Lisinopril 30. digoxin(hold if?) HR is less than 60


prototype? 31. digoxin(monitor?) serum K+, serum dig levels
9. alpha adrenergic prazosin HCl 32. digoxin(side effects) anorexia, Nausea, vomitting,
blockers: prototype? blurred or yellow vision,
10. Angiotensin II receptor valsartan confusion, fatigue
blockers: protype? 33. digoxin(use) HF, afib, atrial flutter,
11. Antianginal: nitroglycerin 34. diltiazem: action? CALCIUM CHANNEL
prototype? BLOCKER
12. anticoagulant: warfarin Inhibits transport of calcium
prototype? into myocardial & vascular
smooth muscle cells causing
13. anticoagulants: heparin
systemic vasodilation (↓ BP)
protoype?
35. diltiazem: adverse? HF, Stevens Johnson syndrome
14. Antidysrhythmic: acebutolol HCl
prototype? 36. diltiazem: FOOD Grape-fruit juice ↑ drug level
INTERACTION and effects
15. antiplatelet: prototype? Clopidogrel bisulfate
37. diltiazem: NSAIDs ↓ anti- HTN effects;
16. beta blocker: metropolol
interactions? use w/ other beta blockers or
prototype?
digoxin may result in
17. Calcium channel Diltiazem HCl bradycardia; diltiazem ↑ dig
blockers: prototype? levels
18. cardiac glycosides: digoxin 38. diltiazem: Side Peripheral edema, headache,
prototype? effects? dizziness, bradycardia,
19. clopidogrel: action? Inhibit platelet aggregation by abnormal dreams
irreversibly inhibiting the 39. diltiazem: uses? HTN, angina pectoris, A. Fib
binding of ATP to platelet
40. heart failure (left side) blood backs up in lungs
receptors to platelet receptors
41. heart failure (right blood backs up in periphery
20. clopidogrel: adverse? Agranulocytosis, aplastic
sided)
anemia, thrombocytopenia,
Stevens Johnson syndrome 42. heparin: actions? Inhibits thrombin which
prevents conversion of
21. clopidogrel: caution? Hepatic & renal disease, peptic
fibrinogen to fibrin flow, and decrease O2
64. nitroglycerin severe HTN, paradoxical,
43. heparin: adverse? Hemorrhage, ↑ hepatic (adverse?) bradycardi, circulatory collapse
enzymes, heparin induced 65. nitroglycerin glass bottle(away from light),
thrombocytopenia, risk of (caution) gloves when administering,
bleeding with NSAIDs don't use expired, don't apply
44. heparin: caution? Thrombo-cytopenia, peptic over hairy areas/defib areas
ulcers, head trauma, hepatic or 66. nitroglycerin heparin
renal disease (decrease effects)
45. heparin: contra? Bleeding disorders 67. nitroglycerin (do what rotate patches
46. heparin: interactions? Risk of bleeding when used w/ every 3 hours?)
drugs that affect platelet 68. nitroglycerin ( increase alcohol, beta blockers,
function effects) calcium channel blockers,
47. heparin: side effects? Injection site reaction, anemia, benzos
itching, fever, chills 69. nitroglycerin(side headaches, syncope, fatigue
48. heparin: uses? Prevent/treat DVT's, acute PE, effects)
flushing of lines and arterial line 70. nitroglycerin tabs? 1 tab 5 minx3
potency
71. nitroglycerin(used for) angina, HF, decrease BP
49. HMG CoA reductase Rosuvastatin hypertension emergency,
inhibitors: treat pulmonary edema
50. lisinopril: action blocking conversion of 72. prazosin: action? dilates blood vessels, alpha
angiotension 1 to 2, blocks adrenergic blocker
release of aldosterone
73. prazosin: adverse Orthostatic hypotension,
51. lisinopril: adverse? agranulocytosis, angioedema palpitations, ↑ liver enzymes,
52. lisinopril: asses for? hyperkalemia, BP, Potassium pancreatitis
levels, evaluate lab values for 74. prazosin: cautions bedtime-> orthostatic HTN,
renal function, angina
53. lisinopril: caution? renal dysfunction, angioedema, 75. prazosin: may not have 4 weeks because its a highly
54. lisinopril: contra? contraindicated in pregnancy full therapeutic effect for protein bound drug
how long?
55. lisinopril: monitor? renal function and K+, and
giving diuretics at same time as 76. prazosin: monitor? BP and HR, monitor liver
hypertensives enzymes, weight, retention

56. lisinopril: side effects irritating cough, hyperkalemia, 77. prazosin: side effects? dizziness, ED, nausea,
taste altering, insomnia drowiness, urinary
incontinence, depression
57. lisinopril: uses HTN, HF
78. prazosin: used for? HTN, BPH
58. metropolol: action? blocks action of
catecholemines(decrease blood 79. Rosuvastatin: action? Inhibits enzyme HMG CoA
pressure and heart rate) reductase

59. metropolol: adverse? bradycardia, heart block 80. rosuvastatin: adverse? Rhabdomyolysis, myopathy,
↑ hepatic enzymes,
60. metropolol: caution OTC drugs, diabetics caution
hyperglycemia
for hypoglycemic effects, don't
abruptly stop 81. rosuvastatin: caution Alcoholics, renal
impairment, Asian
61. metropolol: side effets fatigue, ED
population
62. metropolol: used for? HTN, angina, HF, MI
82. rosuvastatin: contra: Acute liver disease and
63. nitroglycerin(action) vasodilation, increase blood pregnancy (cat. X)
83. rosuvastatin: ↑ effect if given w/
interactions propranolol and antacids
84. rosuvastatin: side Abdominal cramps,
effects? constipation, headache,
myalgia, photosensitivity
85. rosuvastatin: uses? ↓ cholesterol levels, ↓ serum
lipids (LDL and
triglycerides)
86. valsartan: action? Potent vasodilator that
inhibits binding of
angiotensin II
87. valsartan: caution: Pregnancy, breast feeding,
renal & hepatic impairment,
hypovolemia, and hyper-
kalemia
88. valsartan: interaction? Hyperkalemia, renal
dysfunction; ↑ ALT/AST
89. valsartan: Side effects Dizziness, hypotension,
headache, fatigue, cough
(rare)
90. valsartan: uses? HTN
91. warfarin: action? Depresses hepatic synthesis of
vit. K clotting factors
92. warfarin: adverse? Bleeding, purple toe
syndrome, ↑ hepatic enzymes
93. warfarin: anidote? foods high in vitamin K
94. warfarin: interactions? Many D/I which both ↑v or ↓
med effects
95. warfarin: side effects? Anorexia, nausea, cramps,
fever, rash
96. warfarin: uses? Thrombo-phlebitis, PE,
embolism formation b/c of A.
Fib
C: Quizlet & Answers CARDIO 5 planning to discontinue a blocker
client's beta blocker. What should NOT
1. A newly admitted client takes digoxin 0.25 b. 0.5 to 2.0 instruction should the nurse be abruptly
mg/day. The nurse knows that which is the ng/mL give the client regarding the stopped; the
serum therapeutic range for digoxin? beta blocker? dose should
be tapered
a. 0.1 to 1.5 ng/mL a. The beta blocker should be down.
b. 0.5 to 2.0 ng/mL abruptly stopped when
c. 1.0 to 2.5 ng/mL another cardiac drug is
d. 2.0 to 4.0 ng/mL prescribed.
2. The client's serum digoxin level is 3.0 a. It is in the b. The beta blocker should
ng/mL. What does the nurse know about high NOT be abruptly stopped; the
this serum digoxin level? (elevated) dose should be tapered down.
range. c. The beta blocker dose
a. It is in the high (elevated) range. should be maintained while
b. It is in the low (decreased) range. taking another antianginal
c. It is within the normal range. drug.
d. It is in the low average range. d. Half the beta blocker dose
should be taken for the next
3. The client is also taking a diuretic that a. Increase
several weeks.
decreases her potassium level. The nurse the serum
expects that a low potassium level digoxin 7. The beta blocker acebutolol c. To block
(hypokalemia) could have what effect on sensitivity (Sectral) is prescribed for the beta1-
the digoxin? level dysrhythmias. The nurse adrenergic
knows that what is the receptors in
a. Increase the serum digoxin sensitivity primary purpose of the drug? the cardiac
level tissues
b. Decrease the serum digoxin sensitivity a. To increase the beta1 and
level beta2 receptors in the cardiac
c. Not have any effect on the serum digoxin tissues
sensitivity level b. To increase the flow of
d. Cause a low average serum digoxin oxygen to the cardiac tissues
sensitivity level c. To block the beta1-
adrenergic receptors in the
4. When a client first takes a nitrate, the nurse b.
cardiac tissues
expects which symptom that often occurs? Headaches
d. To block the beta2-
adrenergic receptors in the
a. Nausea and vomiting
cardiac tissues
b. Headaches
c. Stomach cramps 8. A client is to be discharged a. "Apply the
d. Irregular pulse rate home with a transdermal patch to a
nitroglycerin patch. Which nonhairy
5. The nurse acknowledges that beta blockers c. Decrease
instruction will the nurse area of the
are as effective as antianginals because they heart rate
include in the client's upper torso
do what? and
teaching plan? or arm."
decrease
a. Increase oxygen to the systemic myocardial
a. "Apply the patch to a
circulation. contractility.
nonhairy area of the upper
b. Maintain heart rate and blood pressure.
torso or arm."
c. Decrease heart rate and decrease
b. "Apply the patch to the
myocardial contractility.
same site each day."
d. Decrease heart rate and increase
c. "If you have a headache,
myocardial contractility.
remove the patch for 4 hours
6. The health care provider is b. The beta and then reapply."
d. "If you have chest pain, a. Client states that she has no
apply a second patch next to chest pain.
the first patch." b. Client states that the
A nurse is monitoring a client d. Client swelling in her feet is reduced.
9.
with angina for therapeutic stating that c. Client states the she does not
effects of nitroglycerin. pain is 0 out feel dizzy.
Which assessment finding of 10 d. Client states that she feels
indicates that the stronger.
nitroglycerin has been 13. What statement is the most d. "This
effective? important for the nurse to medication
include in the teaching plan for will work for
a. Blood pressure 120/80 mm a client who has started on a 24 hours and
Hg transdermal nitroglycerin you will need
b. Heart rate 70 beats per patch? to change the
minute patch daily."
c. ECG without evidence of a. "This medication works
ST changes faster than sublingual
d. Client stating that pain is 0 nitroglycerin works."
out of 10 b. "This medication is the
The nurse is monitoring a d. Chest pain strongest of any nitroglycerin
10.
client during IV nitroglycerin preparation available."
infusion. Which assessment c. "This medication should be
finding will cause the nurse to used only when you are
take action? experiencing chest pain."
d. "This medication will work
a. Blood pressure 110/90 mm for 24 hours and you will need
Hg to change the patch daily."
b. Flushing 14. What will the nurse instruct the c. Apply the
c. Headache client to do to prevent the nitroglycerin patch
d. Chest pain development of tolerance to for 14 hours and
11. Which statement made by the d. "I can nitroglycerin? remove it for 10
client demonstrates a need for take up to hours at night.
further instruction regarding five tablets a. Apply the nitroglycerin patch
the use of nitroglycerin? at 3-minute every other day.
intervals for b. Switch to sublingual
a. "If I get a headache, I should chest pain if nitroglycerin when the client's
keep taking nitroglycerin and necessary." systolic blood pressure elevates to
use Tylenol for pain relief." more than 140 mm Hg.
b. "I should keep my c. Apply the nitroglycerin patch
nitroglycerin in a cool, dry for 14 hours and remove it for 10
place." hours at night.
c. "I should change positions d. Use the nitroglycerin patch for
slowly to avoid getting dizzy." acute episodes of angina only.
d. "I can take up to five tablets 15. The client asks the nurse how b. "It's best to keep
at 3-minute intervals for chest nitroglycerin should be stored it in its original
pain if necessary." while traveling. What is the container away
12. Which client assessment would a. Client nurse's best response? from heat and
assist the nurse in evaluating states that light."
therapeutic effects of a calcium she has no a. "You can protect it from heat by
channel blocker? chest pain. placing the bottle in an ice chest."
b. "It's best to keep it in its original
container away from heat and 19. The nurse is monitoring a client b. Heart rate 58
light." taking digoxin (Lanoxin) for beats per minute
c. "You can put a few tablets in a treatment of heart failure. Which
resealable bag and carry it in your assessment finding indicates a
pocket." therapeutic effect of the drug?
d. "It's best to lock them in the
glove compartment to keep them a. Heart rate 110 beats per minute
away from heat and light." b. Heart rate 58 beats per minute
Which statement indicates to the d. "I should sit or c. Urinary output 40 mL/hr
16.
nurse that the client understands lie down after I take d. Blood pressure 90/50 mm Hg
sublingual nitroglycerin a nitroglycerin 20. A client's serum digoxin level is a. Administer
medication instructions? tablet to prevent drawn, and it is 0.4 ng/mL. What is ordered dose of
dizziness." the nurse's priority action? digoxin.
a. "I will take up to five doses
every 3 minutes for chest pain." a. Administer ordered dose of
b. "I can chew the tablet for the digoxin.
quickest effect." b. Hold future digoxin doses.
c. "I will keep the tablets locked in c. Administer potassium.
a safe place until I need them." d. Call the health care provider.
d. "I should sit or lie down after I A client is taking digoxin (Lanoxin) a. Evaluate
21.
take a nitroglycerin tablet to 0.25 mg and furosemide (Lasix) 40 digoxin levels.
prevent dizziness." mg. When the nurse enters the
17. What instruction should the nurse b. Apply the room, the client states, "There are
provide to the client who needs to ointment to a yellow halos around the lights."
apply nitroglycerin ointment? nonhairy part of Which action will the nurse take?
the upper torso.
a. Use the fingers to spread the a. Evaluate digoxin levels.
ointment evenly over a 3-inch area. b. Withhold the furosemide
b. Apply the ointment to a nonhairy c. Administer potassium.
part of the upper torso. d. Document the findings and
c. Massage the ointment into the reassess in 1 hour.
skin.
22. Which assessment finding will a. Loss of appetite with
d. Cover the application paper with
alert the nurse to suspect early slight bradycardia
ointment before use.
digoxin toxicity?
18. A client receiving intravenous b. Decrease the
nitroglycerin at 20 mcg/min intravenous a. Loss of appetite with slight
complains of dizziness. Nursing nitroglycerin by 10 bradycardia
assessment reveals a blood pressure mcg/min. b. Blood pressure 90/60 mm
of 85/40 mm Hg, heart rate of 110 Hg
beats/min, and respiratory rate of 16 c. Heart rate 110 beats per
breaths/min. What is the nurse's minute
priority action? d. Confusion and diarrhea
23. The nurse reviews a client's b. To administer
a. Assess the client's lung sounds.
laboratory values and finds a digoxin immune FAB
b. Decrease the intravenous
digoxin level of 10 ng/mL and (antidote)
nitroglycerin by 10 mcg/min.
a serum potassium level of 5.9
c. Stop the nitroglycerin infusion
mEq/L. What is the nurse's
for 1 hour, and then restart.
primary intervention?
d. Recheck the client's vital signs in
15 minutes but continue the
a. To administer atropine
infusion.
b. To administer digoxin
immune FAB
c. To administer epinephrine a. Hemoglobin and
d. To administer Kayexalate hematocrit
Which assessment finding will b. Crackles in the lungs b. Blood urea nitrogen
24.
alert the nurse to possible (BUN)
toxic effects of amiodarone? c. Arterial blood gases
d. Serum glucose (sugar)
a. Heart rate 100 beats per 29. A client has heart failure and c. High-ceiling (loop)
minute is prescribed Lasix. The diuretic
b. Crackles in the lungs nurse is aware that
c. Elevated blood urea furosemide (Lasix) is what
nitrogen kind of drug?
d. Decreased hemoglobin
What must the nurse monitor b. Continuous blood a. Thiazide diuretic
25.
when titrating intravenous pressures b. Osmotic diuretic
nitroglycerin for a client? d. Presence of chest c. High-ceiling (loop)
(Select all that apply.) pain diuretic
d. Potassium-sparing diuretic
a. Continuous oxygen 30. The nurse acknowledges that a. Hypokalemia
saturation which condition could occur
b. Continuous blood pressures when taking furosemide?
c. Hourly ECGs
d. Presence of chest pain a. Hypokalemia
e. Serum nitroglycerin levels b. Hyperkalemia
f. Visual acuity c. Hypoglycemia
A client is taking b. Hypokalemia d. Hypermagnesemia
26.
hydrochlorothiazide 50 31. The client has been receiving b. Hyperkalemia
mg/day and digoxin 0.25 spironolactone (Aldactone)
mg/day. What type of 50 mg/day for heart failure.
electrolyte imbalance does the The nurse should closely
nurse expect to occur? monitor the client for which
condition?
a. Hypocalcemia
b. Hypokalemia a. Hypokalemia
c. Hyperkalemia b. Hyperkalemia
d. Hypermagnesemia c. Hypoglycemia
What would cause the same c. Hydrochlorothiazide d. Hypermagnesemia
27.
client's electrolyte imbalance? 32. A client who has angina is a. Have the client lie
prescribed nitroglycerin. The down when taking a
a. High dose of digoxin nurse reviews which nitroglycerin sublingual
b. Digoxin taken daily appropriate nursing tablet.
c. Hydrochlorothiazide interventions for b. Teach client to repeat
d. Low dose of nitroglycerin (Select all that taking a tablet in 5
hydrochlorothiaizde apply.) minutes if chest pain
28. A nurse teaching a client who d. Serum glucose (sugar) persists.
has diabetes mellitus and is a. Have the client lie down e. Warn client against
taking hydrochlorothiazide when taking a nitroglycerin ingesting alcohol while
50 mg/day. The teaching sublingual tablet. taking nitroglycerin.
should include the b. Teach client to repeat
importance of monitoring taking a tablet in 5 minutes if
which levels? chest pain persists.
c. Apply Transderm-Nitro 36. A nurse admits a client diagnosed c. The fact that
patch to a hairy area to with pneumonia. The client has a Lasix has shown
protect skin from burning. history of chronic renal efficacy in treating
d. Call the health care insufficiency, and the health care persons with renal
provider after taking 5 tablets provider orders furosemide (Lasix) insufficiency.
if chest pain persists. 40 mg twice a day. What is most
e. Warn client against important to include in the
ingesting alcohol while teaching plan for this client?
taking nitroglycerin.
a. That the medication will have to
33. Which laboratory value will the b. Fasting blood
be monitored very carefully owing
nurse report to the health care glucose level of 140
to the client's diagnosis of
provider as a potential adverse mg/dL
pneumonia.
response to hydrochlorothiazide
b. The fact that Lasix has been
(HydroDIURIL)?
proven to decrease symptoms with
pneumonia.
a. Sodium level of 140 mEq/L
c. The fact that Lasix has shown
b. Fasting blood glucose level of
efficacy in treating persons with
140 mg/dL
renal insufficiency.
c. Calcium level of 9 mg/dL
d. That the medication will need to
d. Chloride level of 100 mEq/L
be given at a higher than normal
34. What is the best information for b. "This dose owing to the client's medical
the nurse to provide to the client combination problems.
who is receiving spironolactone promotes diuresis
37. A client taking spironolactone c. Fish
(Aldactone) and furosemide but decreases the
(Aldactone) has been taught about
(Lasix) therapy? risk of
the therapy. Which menu selection
hypokalemia."
indicates that the client
a. "Moderate doses of two different
understands teaching related to this
diuretics are more effective than a
medication?
large dose of one."
b. "This combination promotes
a. Apricots
diuresis but decreases the risk of
b. Bananas
hypokalemia."
c. Fish
c. "This combination prevents
d. Strawberries
dehydration and hypovolemia."
d. "Using two drugs increases the 38. Which client would the nurse need c. A 47-year-old
osmolality of plasma and the to assess first if the client is client with anuria
glomerular filtration rate." receiving mannitol (Osmitrol)?
35. The nurse is assessing a client who c. Administer 2
a. A 67-year-old client with type 1
is taking furosemide (Lasix). The mEq potassium
diabetes mellitus
client's potassium level is 3.4 chloride per
b. A 21-year-old client with a head
mEq/L, chloride is 90 mmol/L, and kilogram per day
injury
sodium is 140 mEq/L. What is the IV.
c. A 47-year-old client with anuria
nurse's primary intervention?
d. A 55-year-old client receiving
cisplatin to treat ovarian cancer
a. Mix 40 mEq of potassium in 250
mL D5W and infuse rapidly. 39. A client is ordered furosemide b. Assess lung
b. Administer Kayexalate. (Lasix) to be given via intravenous sounds before and
c. Administer 2 mEq potassium push. What interventions should after
chloride per kilogram per day IV. the nurse perform? (Select all that administration.
d. Administer PhosLo, two tablets apply.) c. Assess blood
three times per day. pressure before and
a. Administer at a rate no faster after a. Normal
than 20 mg/min. administration. b. Prehypertension
b. Assess lung sounds before and d. Maintain c. Stage 1 hypertension
after administration. accurate intake and d. Stage 2 hypertension
c. Assess blood pressure before output record. The nurse acknowledges that a. Diuretic
44.
and after administration. the first-line drug for treating
d. Maintain accurate intake and this client's blood pressure
output record. might be which drug?
e. Monitor ECG continuously.
f. Insert an arterial line for a. Diuretic
continuous blood pressure b. Alpha blocker
monitoring. c. ACE inhibitor
40. A client with hyperaldosteronism c. Decreased d. Alpha/beta blocker
is prescribed spironolactone aldosterone The nurse is aware that which c. Beta blockers and
45.
(Aldactone). What assessment group(s) of antihypertensive ACE inhibitors
finding would the nurse evaluate as drugs are less effective in
a positive outcome? African-American clients?

a. Decreased potassium level a. Diuretics


b. Decreased crackles in the lung b. Calcium channel blockers
bases and vasodilators
c. Decreased aldosterone c. Beta blockers and ACE
d. Decreased ankle edema inhibitors
41. A client with acute pulmonary c. Lungs clear. d. Alpha blockers
edema receives furosemide The nurse knows that which b. hydrochlorothiazide
46.
(Lasix). What assessment finding diuretic is most frequently
indicates that the intervention is combined with an
working? antihypertensive drug?

a. Potassium level decreased from a. chlorthalidone


4.5 to 3.5 mEq/L. b. hydrochlorothiazide
b. Crackles auscultated in the c. bendroflumethiazide
bases. d. potassium-sparing diuretic
c. Lungs clear.
d. Output 30 mL/hr. 47. The nurse explains that which a. Beta1 blocker
beta blocker category is
42. Which assessment indicates a a. Decreased preferred for treating
therapeutic effect of mannitol intracranial pressure hypertension?
(Osmitrol)?
a. Beta1 blocker
a. Decreased intracranial b. Beta2 blocker
pressure c. Beta1 and beta2 blockers
b. Decreased potassium d. Beta2 and beta3 blockers
c. Increased urine osmolality
48. Captopril (Capoten) has been d. Constant, irritating
d. Decreased serum osmolality
ordered for a client. The nurse cough
43. A client's blood pressure (BP) c. Stage 1 hypertension teaches the client that ACE
is 145/90. According to the inhibitors have which
guidelines for determining common side effects?
hypertension, the nurse realizes
that the client's BP is at which a. Nausea and vomiting
stage? b. Dizziness and headaches
c. Upset stomach
d. Constant, irritating cough makes me feel."
49. A client is prescribed losartan b. Blocking angiotensin 52. A nurse is caring for a client who a. Call the health
(Cozaar). The nurse teaches II from AT1 receptors is taking an angiotensin- care provider to
the client that an angiotensin converting enzyme inhibitor and switch the
II receptor blocker (ARB) acts develops a dry, nonproductive medication.
by doing what? cough. What is the nurse's
priority action?
a. Inhibiting angiotensin-
converting enzyme a. Call the health care provider to
b. Blocking angiotensin II switch the medication.
from AT1 receptors b. Assess the client for other
c. Preventing the release of symptoms of upper respiratory
angiotensin I infection.
d. Promoting the release of c. Instruct the client to take
aldosterone antitussive medication until the
50. During an admission b. Dizziness symptoms subside.
assessment, the client states c. Headache d. Tell the client that the cough
that she takes amlodipine e. Ankle edema will subside in a few days.
(Norvasc). The nurse wishes 53. The nurse is reviewing a d. spironolactone
to determine whether or not medication history on a client (Aldactone)
the client has any common taking an ACE inhibitor. The
side effects of a calcium nurse plans to contact the health
channel blocker. The nurse care provider if the client is also
asks the client if she has taking which medication?
which signs and symptoms?
(Select all that apply.) a. docusate sodium (Colace)
b. furosemide (Lasix)
a. Insomnia c. morphine sulfate
b. Dizziness d. spironolactone (Aldactone)
c. Headache
54. A client is prescribed a b. Respiratory
d. Angioedema
noncardioselective beta1 blocker. assessment
e. Ankle edema
What nursing intervention is a
f. Hacking cough
priority for this client?
51. Which statement indicates that a. "I will check my
the client needs additional blood pressure daily a. Assessment of blood glucose
instruction about and take my medication levels
antihypertensive treatment? when it is over 140/90." b. Respiratory assessment
c. Orthostatic blood pressure
a. "I will check my blood assessment
pressure daily and take my d. Teaching about potential
medication when it is over tachycardia
140/90."
55. Which client will the nurse assess c. The client who has
b. "I will include rest periods
first? stopped taking a
during the day to help me
beta blocker due to
tolerate the fatigue my
a. The client who has been on cost.
medicine may cause."
beta blockers for 1 day.
c. "I will change my position
b. The client who is on a beta
slowly to prevent feeling
blocker and a thiazide diuretic.
dizzy."
c. The client who has stopped
d. "I will not mow my lawn
taking a beta blocker due to cost.
until I see how this medication
d. The client who is taking a beta
blocker and Lasix (furosemide). d. Cerebrovascular accident
The nurse is caring for a client d. Get up slowly (CVA) (stroke)
56.
with hypertension who is from a sitting to a e. Venous disorders
prescribed Clonidine transdermal standing position. 60. A client who received heparin a. protamine sulfate
preparation. What is the correct begins to bleed, and the
information to teach this client? physician calls for the antidote.
The nurse knows that which is
a. Change the patch daily at the the antidote for heparin?
same time.
b. Remove the patch before a. protamine sulfate
taking a shower or bath. b. vitamin K
c. Do not take other c. aminocaproic acid
antihypertensive medications d. vitamin C
while on this patch. A client is prescribed a. A longer half-life
61.
d. Get up slowly from a sitting to enoxaparin (Lovenox). The than heparin
a standing position. nurse knows that low-
57. A calcium channel blocker has c. Hypotension molecular-weight heparin
been ordered for a client. Which (LMWH) has what kind of half-
condition in the client's history life?
is a contraindication to this
medication? a. A longer half-life than heparin
b. A shorter half-life than
a. Hypokalemia heparin
b. Dysrhythmias c. The same half-life as heparin
c. Hypotension d. A four-times shorter half-life
d. Increased intracranial than heparin
pressure
62. The nurse is teaching a client c. Bleeding may
58. Which is a priority nursing a. Alteration in about clopidogrel (Plavix). What increase when taken
diagnosis for a client taking an cardiac output related is important information to with aspirin.
antihypertensive medication? to effects on the include?
sympathetic nervous
a. Alteration in cardiac output system a. Constipation may occur.
related to effects on the b. Hypotension may occur.
sympathetic nervous system c. Bleeding may increase when
b. Knowledge deficit related to taken with aspirin.
medication regimen d. Normal dose is 25 mg tablet per
c. Fatigue related to side effects day.
of medication
63. A client is prescribed dalteparin d. Subcutaneously
d. Alteration in comfort related
(Fragmin). LMWH is
to nonproductive cough
administered via which route?
59. When a newly admitted client is a. Coronary
placed on heparin, the nurse thrombosis a. Intravenously
acknowledges that heparin is b. Acute myocardial b. Intramuscularly
effective for preventing new clot infarction c. Intradermally
formation in clients who have c. Deep vein d. Subcutaneously
which disorder(s)? (Select all thrombosis (DVT)
64. A client is being changed from an b. warfarin
that apply.) d. Cerebrovascular
injectable anticoagulant to an oral (Coumadin)
accident (CVA)
anticoagulant. Which
a. Coronary thrombosis (stroke)
anticoagulant does the nurse
b. Acute myocardial infarction e. Venous disorders
realize is administered orally?
c. Deep vein thrombosis (DVT)
a. enoxaparin sodium (Lovenox) of 12 mg/dL
b. warfarin (Coumadin) A client who has been taking b. Administer
69.
c. bivalirudin (Angiomax) warfarin (Coumadin) is admitted vitamin K.
d. lepirudin (Refludan) with coffee-ground emesis. What is
65. A client is taking warfarin 5 b. Elevated INR the nurse's primary action?
mg/day for atrial fibrillation. The range
client's international normalized a. Administer vitamin E.
ration (INR) is 3.8. The nurse *therapeutic range b. Administer vitamin K.
would consider the INR to be is 2.0-3.0 c. Administer protamine sulfate.
what? d. Administer calcium gluconate.
70. The client has an international a. Administer an
a. Within normal range normalized ratio (INR) value of 1.5. additional dose of
b. Elevated INR range What action will the nurse take? warfarin
c. Low INR range (Coumadin).
d. Low average INR range a. Administer an additional dose of
66. Cilostazol (Pletal) is being d. To suppress warfarin (Coumadin).
prescribed for a client with platelet aggregation b. Hold the next dose of warfarin
coronary artery disease. The nurse (Coumadin).
knows that which is the major c. Increase the heparin drip rate.
purpose for antiplatelet drug d. Administer protamine sulfate.
therapy? A client is receiving warfarin c. "I will increase
71.
(Coumadin) for a chronic condition. dark-green, leafy
a. To dissolve the blood clot Which client statement requires vegetables in my
b. To decrease tissue necrosis immediate action by the nurse? diet."
c. To inhibit hepatic synthesis of
vitamin K a. "I will avoid contact sports."
d. To suppress platelet aggregation b. "I will take my medication in the
67. A client is admitted to the c. Thrombolytic early evening each day."
emergency department with an agent c. "I will increase dark-green, leafy
acute myocardial infarction. Which vegetables in my diet."
drug category does the nurse expect d. "I will contact my health care
to be given to the client early for provider if I develop excessive
the prevention of tissue necrosis bruising."
following blood clot blockage in a
72. A client is taking enoxaparin a. "I take aspirin daily
coronary or cerebral artery?
(Lovenox) daily. Which for headaches."
client statement requires
a. Anticoagulant agent
additional monitoring?
b. Antiplatelet agent
c. Thrombolytic agent
a. "I take aspirin daily for
d. Low-molecular-weight heparin
headaches."
(LMWH)
b. "I take ibuprofen (Motrin)
68. A client is receiving an intravenous b. Activated at least once a week for joint
heparin drip. Which laboratory partial pain."
value will require immediate action thromboplastin c. "Whenever I have a fever, I
by the nurse? time (aPTT) of 120 take acetaminophen
seconds (Tylenol)."
a. Platelet count of 150,000 d. "I take my medicine first
b. Activated partial thromboplastin *normal thing in the morning."
time (aPTT) of 120 seconds therapeutic range
73. A nurse is preparing to c. Administer the
c. INR of 1.0 is 45-75 secs
administer enoxaparin medication into
d. Blood urea nitrogen (BUN) level
sodium (Lovenox) to a client subcutaneous tissue.
for prevention of deep vein therapy while still receiving therapeutic effect for
thrombosis. What is an intravenous heparin. The warfarin, so the heparin
essential nursing client questions the nurse is continued until the
intervention? about the risk for bleeding. warfarin is therapeutic."
How should the nurse
a. Draw up the medication in respond?
a syringe with a 22-gauge, 1-
½ inch needle. a. "Your concern is valid. I
b. Utilize the Z-track method will call the doctor to
to inject the medication. discontinue the heparin."
c. Administer the medication b. "It usually takes about 3
into subcutaneous tissue. days to achieve a therapeutic
d. Rub the administration site effect for warfarin, so the
after injecting. heparin is continued until
A client has been admitted b. Administer protamine the warfarin is therapeutic."
74.
through the emergency sulfate. c. "Because of your valve
department and requires replacement, it is especially
emergency surgery. The important for you to be
client has been receiving anticoagulated. The heparin
heparin. What nursing and warfarin together are
intervention is essential? more effective than one
alone."
a. Teach the client about the d. "Because you are now up
phenytoin. and walking, you have a
b. Administer protamine higher risk of blood clots
sulfate. and therefore need to be on
c. Assess the INR before both medications."
surgery. 77. The nurse evaluates that the d. "I should use a soft
d. Administer vitamin K. client understood discharge toothbrush for dental
A client who is taking b. Teach the client of teaching regarding warfarin hygiene."
75.
warfarin (Coumadin) requests potential drug (Coumadin) based on which
an aspirin for headache relief. interactions with statement?
What is the nurse's best anticoagulants.
response? a. "I will double my dose if I
forget to take it the day
a. Administer 650 mg of before."
acetylsalicylic acid (ASA) b. "I should keep taking
and reassess pain in 30 ibuprofen for my arthritis."
minutes. c. "I should decrease the
b. Teach the client of dose if I start bruising
potential drug interactions easily."
with anticoagulants. d. "I should use a soft
c. Explain to the client that toothbrush for dental
ASA is contraindicated and hygiene."
administer ibuprofen as 78. Which nursing diagnosis c. Risk for injury
ordered. would be possible for a
d. Explain that the headache client receiving intravenous
is an expected side effect and heparin therapy?
will subside shortly.
A client is started on b. "It usually takes about a. Potential for fluid volume
76.
warfarin (Coumadin) 3 days to achieve a excess
b. Potential for pain
c. Risk for injury d. Agranulocytosis
d. Potential for body image When a client is taking ezetimibe a. Inhibits absorption
84.
disturbance (Zetia), she asks the nurse how it of dietary cholesterol
79. A client has a serum cholesterol c. Hyperlipidemia works. The nurse should explain in the intestines.
level of 265 mg/dL, triglyceride that Zetia does what?
level of 235 mg/dL, and LDL of
180 mg/dL. What do these serum a. Inhibits absorption of dietary
levels indicate? cholesterol in the intestines.
b. Binds with bile acids in the
a. Hypolipidemia intestines to reduce LDL levels.
b. Normolipidemia c. Inhibits HMG-CoA reductase,
c. Hyperlipidemia which is necessary for
d. Alipidemia cholesterol production in the
liver.
80. The nurse knows that the client's a. 150 to 200 mg/dL
d. Forms insoluble complexes
cholesterol level should be
and reduces circulating
within which range?
cholesterol in blood.
a. 150 to 200 mg/dL 85. Which statement indicates the b. "I will increase
b. 200 to 225 mg/dL client understands discharge fiber in my diet."
c. 225 to 250 mg/dL instructions regarding
d. Greater than 250 mg/dL cholestyramine (Questran)?
81. A client's high-density b. It is the desired
a. "I will take Questran 1 hour
lipoprotein (HDL) is 60 mg/dL. level of HDL.
before my other medications."
What does the nurse
b. "I will increase fiber in my
acknowledge concerning this
diet."
level?
c. "I will weigh myself weekly."
d. "I will have my blood pressure
a. It is lower than the desired
checked weekly."
level of HDL.
b. It is the desired level of HDL. 86. The nurse plans which b. Administer
c. It is higher than the desired intervention to decrease the aspirin 30 minutes
level of HDL. flushing reaction of niacin? before nicotinic
d. It is a much lower HDL level acid.
than desired. a. Administer niacin with an
antacid.
82. A client is taking lovastatin d. Liver enzymes
b. Administer aspirin 30 minutes
(Mevacor). Which serum level is
before nicotinic acid.
most important for the nurse to
c. Administer diphenhydramine
monitor?
hydrochloride (Benadryl) with
niacin.
a. Blood urea nitrogen
d. Apply cold compresses to the
b. Complete blood count
head and neck.
c. Cardiac enzymes
d. Liver enzymes 87. The nurse is reviewing b. "Take this
instructions for a client taking an medication at the
83. The client is taking rosuvastatin b. Rhabdomyolysis
HMG-CoA reductase inhibitor same time each
(Crestor). What severe skeletal
(statin). What information is day."
muscle adverse reaction should
essential for the nurse to include?
the nurse observe for?

a. "Take this medication on an


a. Myasthenia gravis
empty stomach."
b. Rhabdomyolysis
b. "Take this medication at the
c. Dyskinesia
same time each day." The client is complaining of fiber in his diet.
c. "Take this medication with constipation. What will the nurse
breakfast." do?
d. "Take this medication with an
antacid." a. Call the health care provider to
A client is prescribed gemfibrozil b. "You may change the medication.
88.
(Lopid) for treatment of experience b. Tell the client to skip a dose of
hyperlipidemia type IV. What is headaches with this the medication.
important for the nurse to teach medication." c. Have the client increase fluids
the client? and fiber in his diet.
d. Administer an enema to the
a. "Take aspirin before the client.
medication if you experience 92. Which statement indicates to the d. "I should stir the
facial flushing." nurse that the client needs further powder in as small
b. "You may experience medication instruction about an amount of fluid
headaches with this medication." colestipol (Colestid)? as possible to
c. "You will need to have weekly maintain potency
blood drawn to assess for a. "The medication may cause of the medication."
hyperkalemia." constipation, so I will increase
d. "Cholesterol levels will need to fluid and fiber in my diet."
be assessed daily for one week." b. "I should take this medication 1
hour after or 4 hours before my
89. Which statement made by the d. "I will continue
other medications."
client indicates understanding my exercise
c. "I might need to take fat-soluble
about discharge instructions on program to help
vitamins to supplement my diet."
antihyperlipidemic medications? increase my high-
d. "I should stir the powder in as
density lipoprotein
small an amount of fluid as
a. "Antihyperlipidemic serum levels."
possible to maintain potency of the
medications will replace the other
medication."
interventions I have been doing to
try to decrease my cholesterol." 93. Which assessment finding in a b. Elevated liver
b. "It is important to double my client taking an HMG-CoA function tests
dose if I miss one in order to reductase inhibitor will the nurse
maintain therapeutic blood act on immediately?
levels."
c. "I will stop taking the a. Decreased hemoglobin
medication if it causes nausea and b. Elevated liver function tests
vomiting." c. Elevated HDL
d. "I will continue my exercise d. Elevated LDL
program to help increase my high- 94. A 70-year-old client who is taking b. "These factors
density lipoprotein serum levels." several cardiac antidysrhythmic may put you at
90. A client is prescribed ezetimibe c. Muscle pain. medications has been prescribed higher risk for
(Zetia). Which assessment finding simvastatin (Zocor) 80 mg/day. myopathy."
will require immediate action by What is essential information for
the nurse? the nurse to teach the client?

a. Headache. a. "This dose may lower your


b. Slight nausea. cholesterol too much."
c. Muscle pain. b. "These factors may put you at
d. Fatigue. higher risk for myopathy."
c. "You should not take this drug
91. A nurse is caring for a client c. Have the client
with cardiac medications."
taking cholestyramine (Questran). increase fluids and
d. "This combination will cause
you to have nausea and vomiting."
95. A client diagnosed with b. Hepatic disease
hypercholesterolemia is prescribed
lovastatin (Mevacor). The nurse is
reviewing the client's history and
would contact the health care
provider about which of these
conditions in the client's history?

a. Chronic pulmonary disease


b. Hepatic disease
c. Leukemia
d. Renal disease
96. A nurse is caring for a client with c. gemfibrozil
elevated triglyceride levels who is (Lopid)
unresponsive to HMG-CoA
reductase inhibitors. What
medication will the nurse administer?

a. cholestyramine (Questran)
b. colestipol (Colestid)
c. gemfibrozil (Lopid)
d. simvastatin (Zocor)
97. The nurse would question an order a. Impaction
for cholestyramine (Questran) if the
client has which condition?

a. Impaction
b. Glaucoma
c. Hepatic disease
d. Renal disease
98. The nurse reviews the history for a c. Client is on
client taking atorvastatin (Lipitor). oral
What will the nurse act on contraceptives.
immediately?

a. Client takes medications with


grape juice.
b. Client takes herbal therapy
including kava kava.
c. Client is on oral contraceptives.
d. Client was started on penicillin for
a respiratory infection.
C: Quizlet & Answers CARDIO 5 . EKG Changes - ST depression, T wave alteration,
increased PR interval
1 What is CHF? Congestive heart failure, heart is High doses:
. unable to effectively pump blood - Potential conduction blockages
2 3 Compensatory Hypertrophy: Trying to increase 8. Cardiac Improved CO --> Improved renal
. mechanisms of force of contractions Glycosides: flow --> decreased edema
untreated CHF SNS Activation: NE and epi Kidney
released to increase cardiac output Effect
and blood pressure
9. Cardiac 1. ATPase is inhibited (no power
Kidneys: Renin released to increase
Glycosides: to Na/K pump)
BP
Mechanism 2. Na accumulates in the cell
3 Decreased Cardiac for 3. Na accumulation --> decreased
. Output Chart Myocardial Na/Ca exchanger action
Contractili 4. This leads to slowed loss of Ca
ty 5. Causes stronger myocardial
contraction
6. Also causes stronger
contraction
10. Cardiac - Interference with Na/K pump
Glycosides: slows the return of intracellular K
Mechanism after contraction
for AV - Vagus nerve stimulation slows
Conductio SA and AV conduction
n (lengthens PR and slows
4 Renin Angiotensin repolarization)
. Aldosterone 11. Cardiac Digoxin (Lanoxin)
Mechanism Chart Glycosides: Digitoxin (Digitoxinum)
Examples
12. Define: Front loading of a drug, higher
Digitalizati and more frequent doses to
on of a achieve therapeutic effects
drug rapidly
13. Define: Lower doses which maintain
Maintenan therapeutic levels
ce of a
drug
14. Cardiac Hypokalemia: Increases heart
5 Typical Treatment Mild CHF: Decrease Na+ intake,
Glycosides: sensitivity to toxic levels,
. of CHF (Mild, diuretic therapy
Effects to increases risks of ectopy and
Severe, Tachy) Severe CHF: ACEIs or ARBs
Ca and K arrhythmias
considered
serum
Tachy: Low dose beta blockers
levels Hyperkalemia: Antagonizes
- Digoxin considered when other
effects
drugs arent enough
6 Cardiac Glycosides: 1. Increase FOC Hypercalcemia: Enhances effects
. Pharmacological - Doesn't increase O2 consumption
Effects 2. Decrease HR Hypocalcemia: Reduces effects
- Vagus nerve stimulation
15. Cardiac - Ectopic beats
- Decreased action at AV node
Glycosides: - Can cause PVCs
7 Cardiac Glycosides: Therapeutic Dose: Adverse / - Can cause arrhythmias
Toxic - Can cause PVC induced VT or 28. ARBs: Primary Bind to Angiotensin II receptors
Effects VF (R on T) Effect to stop Angiotensin II from
Dieuretic - Eliminate excess H2O and Na taking effect
16.
Therapy: via urinary tract 29. ARBs: Vasodilation increases excretion
Primary Secondary Effect of sodium and water
Role 30. ARBs: Examples * End in -sartan
17. Dieuretic - Used to treat CHF Candesartan (Atacand)
Therapy: Irbesartan (Avapro)
Indications Iosartan (Cozaar)
Dieuretic Thiazide Family: Milder, long Valsartan (Diovan)
18.
Therapy: 3 term usage Telmisartan (Micardis)
Common Organic Acids: Potent, used in 31. Nitroglycerin: - Decrease venous return and
Types CHF Primary Effect therefore workload of heart
Aldosterone Antagonists - Contains nitrate ions converted
Dieuretic Thiazide Family: HCTZ to NO in blood which is a
19.
Therapy: 3 Organic Acids: Furosemide smooth muscle relaxant
Common Type (Lasix) 32 Cardiac Action
Examples Aldosterone Antagonists: . Potential
Spironolactone (Aldactazide,
Aldactone)
20. Vasodilator - Relax and dilate blood vessels
Therapy: (Arteries and Veins)
Primary Effect
21. Vasodilator - Lower PVR
Therapy: Why - Lower cardiac workload
are they Used - Lower cardiac O2 consumption
22. Vasodilator - Heart able to pump more blood 33 Anti- - Affect electrophysiological properties
Therapy: Result with less effort . Arrhythmics: of cardiac membrane
- Decreased BP Therapeutic - Restore proper movement of ions
23. ACE Inhibitors: - Decrease Angiotensin II Effects (fixed back to normal or at lease
Primary Effect formation improved)
- Dilate arteries and veins 34 Vaughn-
- Increase excretion of Na and . Williams
H2O Classification
24. Define: - Also known as PVR of
Afterload - Amount of resistance against Antiarrhythmi
which the heart must pump blood cs
out of the ventricles
25. Define: Preload - Amount of blood entering
ventricles prior to systole 35 Class IA - Interfere with Na channels to alter Na
26. ACE Inhibitors: - Decreased bradykinin . Antiarrhythmi movement during cardiac action
Secondary Effect inactivation = vasodilation cs: Mechanism potential
27. ACE Inhibitors: * End in -pril 36 Class IA - Harder for cells to reach action
Examples Captopril (Capoten) . Antiarrhythmi potential
Lisinopril (Zestril, Prinivil) cs: Result - Important for irritable foci
Enalpril (Vasotec) 37 Class IA 1. Slowed conduction velocity - Altered
Ramipril (Altase) . Antiarrhythmi cardiac action potential during phase 0
Fosinopril cs: Overall 2. Prolonger refractory period
Actions 3. Decreased automaticity of the heart 48 Class IC - - Marked decrease in cardiac
Class IA - - Atrial Flutter . Flecainide conduction phase 0
38
. Quinidine: - A fib (Tambocor) and
Indications - Ventricular arrhythmias Propafenone
(Rythmol):
39 Class IA - - Depression of cardiac conduction Therapeutic
. Quinidine: system excitability Effects
Therapeutic - Slowed conduction
Effects - Depression of myocardium FOC 49 Class IC - - Heart failure, heart block,
. Flecainide bradycardia
40 Class IA - - GI irritation (Tambocor) and
. Quinidine: - Smooth muscle depression Propafenone
Adverse - Widened QT and PR (Rythmol):
Effects - Slowed conduction may lead to PACs Adverse Effects
and PVCs even cardiac arrest
50 Class II: - Blockage of Beta Adrenergic
41 Class IA - - Usually for ventricular arrhythmias Mechanism Receptors
.
. Procainamide - Can be used for Afib or A flutter - Antagonism of Epi and NE which
(Procan): prevents SNS activation
Indications
51 Class II: Result - Heart rate, AV conduction,
42 Class IA - - Slowed conduction automaticity of SA and AV nodes,
.
. Procainamide - Depression of cardiac conduction heart muscle
(Procan): system excitability - Prolonged refractory period
Therapeutic - Depression of myocardium FOC - Eliminates arrhythmias in pts with
Effects increased SNS activity
43 Class IA - - Hypotension (esp with IV push) Class II - - Supraventricular and ventricular
52
. Procainamide - Skin rash Propanolol arrhythmias
.
(Procan): (Inderal):
Adverse Effects Indications
44 Class IB - - Only works on ventricles Class II - - Decreased HR because of slowed
53
. Lidocaine - Used for tachy ventricular Propanolol AV conduction
.
(Xylocaine): arrhythmias (Inderal): - Prolonged refractory period
Indications - Short acting, bolus infusion (only Therapeutic
parenteral) Effects
- Used especially post MI
54 Class II - - Hypotension, bradycardia,
45 Class IB - - Depresses automaticity Propanolol bronchoconstriction
.
. Lidocaine - Depolarization in pacemaker cells (Inderal):
(Xylocaine): esp. ectopic foci Adverse Effects
Therapeutic
Effects 55. Class II - Esmolol - Emergency situations
(Brevibloc): Indications - SNS activity in heart is
46 Class IB - - Rapidly metabolized by the liver
dangerous
. Lidocaine - Possible impaired liver functions
(Xylocaine): with high levels 56. Class II - Esmolol - Depresses chronotropic and
Adverse Effects - High doses = CNS stimulation which (Brevibloc): Therapeutic inotropic effects of SNS
can lead to seizures, CNS depression Effects - Rapidly metabolized
which can cause confusion 57. Class II - Esmolol - OD can lead to bradycardia
47 Class IC - - Last ditch antiarrhythmics (Brevibloc): Adverse and hypotension
. Flecainide - Usually for supraventricular rhythms Effects
(Tambocor) and 58. Class III: Mechanism - Interferance with K
Propafenone channels
(Rythmol):
59. Class III: Result - Slowed leaving of K during
Indications
repolarization which leads to
a prolonged refractory 66. Class IV - Verapamil - Primary: Decreases and
period (Isoptin), Diltiazem slows conduction through
- Fewer beats = frequency of (Cardizem): Therapeutic AV node
arrhythmias Effects - Secondary: Slows firing
Class III - Amiodarone - Powerful supraventricular of SA node
60.
(Cordarone): Indications and ventricular 67. Class IV - Verapamil - High doses can lead to
antiarrhythmic (Isoptin), Diltiazem heart blocks
- Very long half life (1-3 (Cardizem): Adverse - Decreased myocardial
months) Effects contractility
Class III - Amiodarone - Prolonged refractory period - Hypotension
61.
(Cordarone): - HR, AV conduction, PR, - Constipation
Therapeutic Effects QRS intervals 68. Other Antiarrhythmics - - Terminate SVT
Class III - Amiodarone - Long half life, used Adenosine (Adenocard): - Duration of action is 15-
62.
(Cordarone): Adverse carefully Indications 30 seconds
Effects - Ataxia, thyroid 69. Other Antiarrhythmics - - Decreases Ca activity at
dysfunction, pulmonary Adenosine (Adenocard): the AV node which slows
fibrosis Therapeutic Effects conduction
- Cardiac toxicities: - Fewer signals get to
bradycardia, heart block, ventricles therefore a
heart failure, pro arrhythmias slowed ventricular HR
e.g. Torsades Other Antiarrhythmics - - Transient asystole,
70.
63. Class IV: Mechanism - Calcium channel blockers Adenosine (Adenocard): transient bronchospasm,
(CCBs) Adverse Effects feeling of impending doom
- Decreases entry of Ca into Angina Drugs - Nitrates: - Nitrate ions converted to
71.
excitable cells (example: SA Mechanism nitric oxide (potent
and AV nodes) vasodilator)
64. Class IV: Result 1. Altered cardiac action - Vascular smooth muscle
potential: relaxed
- Ca plays important role in Angina Drugs - Nitrates: - Decreased venous return
72.
action potential formation Results (preload)
- CCB causes decreased rate - Decreased PVR
of SA node, therefore (afterload)
conduction speed of the AV - Decreased cardiac
workload, oxygen
2. Decreased force of consumption, and chest
muscular contraction pain
- Less Ca entry means less
Ca is available for 73. Angina Drugs - Nitrates: - Sublingual (1-3 min
contraction Routes of Admin onset)
- Not desirable in cardiac - Ointment (30 min onset)
tissue, could cause CHF - IV (instant onset)
- Very useful in vascular - Transdermal patch
smooth muscle = (gradual release over 24
vasodilation hours)
- Extended release capsule
65. Class IV - Verapamil - Arrhythmias originating in (8-12 hour duration)
(Isoptin), Diltiazem the AV node
(Cardizem): Indications - Other supraventricular 74. Angina Drugs - Nitrates: - Flushed skin, dizziness,
tachycardias Adverse Effects headache, faint
- Also an effective - Reflex tachycardia
antihypertensive - Glaucoma
75. Angina Drugs - Beta - Management of SNS 85. Cation Exchange PCT and DCT:
Blockers: Therapeutic stimulation to keep HR and - Na reabsorbed
Action FOC low - H ions secreted into urine
- Minimizes cardiac
workload and O2 DCT specifically:
consumption - Na reabsorbed
- K ions secreted into urine
76. Angina Drugs - - Long term management of angina
- Controlled by aldosterone
Beta Blockers: - Allows increased work capacity
- Carbonic anhydrase catalyzes this
Indications and exercise tolerance
reaction
77. Angina Drugs - - Non selective have the potential - Turns CO2 into H ion
Beta Blockers: for causing bronchoconstriction - Can be exchanged for Na and
Adverse Effects leading to asthma attacks secreted
78. Angina Drugs - Non Selective: Propanolol 86. Chloride Ion - Happens in the LoH
Beta Blockers: (Inderal), Nadolol Transport - Happens through Cl ions being
Examples Selective: Metoprolol (Lopressor), actively reabsorbed and Na ions
Atenolol (Tenormin) following through charge association
79. Angina Drugs - - Decreased cardiac workload by 87. Osmotic Gradient - Pulls water from urine to the blood
CCBs: Therapeutic decreased vascular tone - Happens in the PCT and collecting
Action - Some decrease in SA and AV ducts
node conduction
88. ADH Action and - Pores of collecting ducts open
80. Angina Drugs - Verapamil (Isoptin) Effects - Water rushes towards the Na
CCBs: Examples Diltiazem (Cardizem) - Water returns to the blood and
Amlodipine (Norvasc) causes the urine to be more
Nifidipine (Adalat) concentrated, and the plasma volume
81. Kidney Filtration - Main Role: Water, electrolyte, maintained
and acid-base balance 89. Acid Base - Renal system helps buffer blood to
- Small ions become filtrate: ions, Regulation keep it between 7.35 and 7.45 pH
water, glucose, cell waste products by...
82. 3 Renal Functions 1. Filtration a. Secreting H into urine to make
- In glomerulus blood less acidic
- First line of defence b. Reabsorbing Bicarb (HCO3-) to
- Filters substances from blood to buffer blood pH
nephron 90. Removal of Weak - Weak acids and bases are created
2. Tubular reabsorption Acids and Bases during normal metabolism
- Pulling ions out of the urine back - PCT secretes them into the urine
into the blood - Many drugs are weak acids or
- Happens in the PCT, LoH, DCT bases
3. Tubular secretion - Compete with endogenous acids
- Secretion of substances into urine and bases for secretion sites
- Maintains electrolyte and acid- - Competition may alter drug
base balance excretion
- Happens in the PCT, LoH, DCT
91. Osmotic Compounds which can be filtered
83. Tubular - Some substances are blocked such Diuretics: but not reabsorbed
Reabsoption as blood products and plasma Definition
proteins (too big to fit)
92. Osmotic a. Cannot cross tubular lumen
- Renal tubules reabsorb much of
Diuretics: b. Create osmotic gradient
what is in filtrate
Mechanism c. Water moves into the lumen
84. 2 Mechanisms for 1. Cation exchange (urine)
Na Reabsorption 2. Chloride ion transport d. Na and electrolyte balance not
altered 104. Potassium Sparing - Inhibit K secretion in DCT
Osmotic Mild diuresis without acid-base or Diuretics: - Risk of hyperkalemia and
93.
Diuretics: Result electrolyte imbalance Mechanism gynecomastia

Osmotic Diuretics - Most common osmotic diuretic 105. Potassium Sparing Spironolactone (Aldactone)
94.
- Mannitol - Given IV Diuretics: Examples Amiloride (Midamor)
(Osmitrol): - Used for cerebral swelling, drug 106. Chronic - Increases peripheral resistance
toxicities, renal failure or damage Hypertension Effects - Leads to decreased blood flow
to kidneys
95. Thiazide Diuretics: - Inhibit Na transport in the
- Triggers RAAS which makes
Mechanism distal nephron
hypertension worse
- Substantial loss of Na and H2O
- Cl and K ions also excreted 107. Vasodilators: - Relaxant of smooth muscle
- Common result is Mechanism leading to decreased BP and
hypochloremic alkalosis and vasodilation
hypokalemia - Used in combo with beta
blockers and diuretics
96. Thiazide Diuretics: - Hypochloremic alkalosis and
Other Adverse hypokalemia 108. Vasodilators: Hydralazine (Apresoline)
Effects - Hypotension and hyponatremia Examples Minoxidil (Lonitem)
- Orthostatic hypotension, 109. Vasodilators: Long term usage can cause lupus
lightheadedness, syncope Adverse Effects like syndrome and rheumatoid
- Muscle spasm and cramps arthritis (autoimmune)
- Electrolyte imbalance
110. How Coagulation 1. After injury, platelets migrate
97. Thiazide Diuretics: Hydrochlorothiazide (HCTZ) Works to damaged area
Examples Chlorothiazide 2. Platelets perform aggregation
and adhesion
Metolazone (Zaroxolyn) 3. Platelets form plug around the
Indapamide (Lozide) injured tissue
98. Carbonic Anhydrase - Diuresis by inhibiting carbonic 4. Circulating clotting factors
Inhibitors: anhydrase interact with new plug to stabilize
Mechanism - Less H and HCO3 ions and strengthen
produced 111. Stabilizing the 1. Production of thromboplastin 2
- Less H available for Na plug/clot mechanisms
exchange Intrinsic: Activity of clotting and
- Na and water get excreted factors stimulates production of
99. Carbonic Anhydrase Acetazolamide (Acetazolam) thromboplastin protein
Inhibitors: Example Extrinsic: Injured tissues release
Factor VII and thromboplastin
100. Refractory vs. Non Refractory Diuretics: No longer
which work together to initiate
Refractory Diuretics function when acid-base balance
coagulation
is altered
101. Organic Acid - Inhibit Na and Cl transport in 2. Thromboplasin converts
Diuretics: LOH prothrombin into thrombin
Mechanism - Stronger than thiazides 3. Thrombin converts fibrinogen
- Useful in pulmonary edema into fibrin
102. Organic Acid Hypotension 4. Fibrin works with active
Diuretics: Adverse Hypokalemia clotting factors, builds fibrin mesh
Effects Hyperuricemia to hold platelets, begins
Hyperglycemia solidification
103. Organic Acid Furosemide (Lasix) 112. Dissolving the Clot 1. After cellular injury tPa is
Diuretics: Examples slowly released by injured tissue
2. After accumulation: conversion
of plasminogen into plasmin respective clotting factor
3. Plasmin acts on fibrin to break - Max effect within 1-3 hours
down clot - Duration is 24-36 hours
113. Anticoagulant 1. Antiplatelet Drugs 124. Novel Oral Dabigatran (Pradaxa)
Therapy Types 2. Anticoagulants Anticoagulant: Rivaroxaban (Xarelto)
Antiplatelet Drugs: - Inhibit platelet aggregation so Examples Apixaban (Eliquis)
114.
Function platelet plug doesn't form 125. Clinical Indications for - Prophylactic clot prevention
- Inhibit platelet adhesion - won't Anticoagulants (family or personal Hx, post
stick to vessel wall MI)
Antiplatelet Drugs: Make platelets less sticky by - Peripheral vascular disease
115.
Mechanism inhibiting ADP mediated platelet (e.g. Crohn's, previous CVA
aggregation or MI)
- Pregnancy (ONLY
116. Antiplatelet Drugs: Aspirin HEPARIN!), post surgery:
Examples Clopidogrel (Plavix) prevention of DVT
Dipyridamole (Aggrenox: Mix of - During surgery, dialysis, and
ASA and Dipyridamole) transfusions to prevent clotting
Ticlopidine - CAD - preventing blockages
Ticagrelor (Brilinta) - New drug - Oral anticoagulants common
117. Anticoagulants: - Inhibit plasma clotting factors for Afib
Function attach to preformed proteins of Thrombolysis: What What: Thrombolytic enzymes
126.
clotting cascade, disabling normal and How "clot busters" used to dissolve
function clots
- Or block formation of those How:
proteins - Medications activate
118. Anticoagulants - - Binds to thromboplastin to fibrinolysin - breaks clots into
Heparin: Function prevent thrombin formation soluble products
- Fast onset, short duration of - tPa converts plasminogen
action which prevents clotting into plasmin which degrades
cascade from starting fibrin
- Given IV or SC 127. Thrombolysis: - Tissue Plasminogen
119. Anticoagulants - - Given orally Examples Activator: tPa, alteplase
Coumarins: Function - Cause inhibition of clotting (Activase)
factors - Tenecteplase (TNKase)
- Slower onset, longer duration - Streptokinase (Streptase)
(2-10 days) 128. Thrombolysis: Clinical - Acute MI
- This is rat poison! Indications - Acute ISCHEMIA CVA
120. Anticoagulants - Warfarin (Coumadin) - PE
Coumarins: Examples - DVT
121. Anticoagulants - - Major danger: hemorrhage 129. Thrombolysis: - Hemorrhage esp. when
Coumarins: Adverse - Hematuria, bleeding of Adverse Effects combined with other
Effects gums, petechaie anticoagulants
- Requires vitamin K as an - Mild allergic reactions
antidote 130. Thrombolysis: - Active internal bleeding
122. Anticoagulants - - Hemorrhage Contraindications - CVA in the past 2 months
Heparin: Adverse - GI bleeding - Intracranial or intraspinal
Effects - Thrombocytopenia / HIT injury
- Intracranial tumors
123. Novel Oral - High specificity for specific
- Etc, etc, etc,
Anticoagulant: clotting factors
Function - Reversible inhibition of
C: KEE & HAYES CARDIO 6 d. Decrease heart rate and increase myocardial
1. The patient is receiving digoxin for treatment of contractility
heart failure. Which finding would suggest to the
7. The health care provider is planning to
nurse that heart failure is improving?
discontinue a patient’s beta blocker. Which
a. Pale and cool extremities
instruction will the nurse give the patient regarding
b. Absence of peripheral edema
the beta blocker?
c. Urine output of 60 mL/4 h
a. The beta blocker should be abruptly stopped
d. Complaints of increasing dyspnea
when another cardiac drug is prescribed.
2. The patient’s serum digoxin level is 3.0 ng/mL. b. The beta blocker should not be abruptly stopped;
What does the nurse know about this serum the dose should be tapered down.
digoxin level? c. The beta blocker dose should be maintained
a. It is in the high (elevated) range. while taking another antianginal drug.
b. It is in the low (decreased) range. d. Half the beta blocker dose should be taken for
c. It is within the normal range. the next several weeks.
d. It is in the low average range.
8. The beta blocker acebutolol (Sectral) is
3. The nurse is assessing a patient for possible prescribed for dysrhythmias. The nurse knows that
evidence of digitalis toxicity. The nurse what is the primary purpose of the drug?
acknowledges that which is included in the signs a. Increase beta1 and beta2 receptors in cardiac
and symptoms for digitalis toxicity? tissues
a. Apical pulse rate of 100 beats/min b. Increase the flow of oxygen to cardiac tissues
b. Apical pulse of 72 beats/min with an irregular c. Block beta1-adrenergic receptors in cardiac
rate tissues
c. Apical pulse of 90 beats/min and an irregular rate d. Block beta2-adrenergic receptors in cardiac
d. Apical pulse of 48 beats/min and irregular rate tissues

4. A patient is taking a potassium-depleting diuretic 9. A patient who has angina is prescribed


and digoxin. The nurse expects that a low nitroglycerin. Which are appropriate nursing
potassium level (hypokalemia) could have what interventions for nitroglycerin? (Select all that
effect on digoxin (Lanoxin)? apply.)
a. Increase serum digoxin sensitivity level a. Have patient sit or lie down when taking a
b. Decrease serum digoxin sensitivity level nitroglycerin sublingual tablet.
c. Have no effect on serum digoxin sensitivity level b. Teach patient who has taken a tablet to call 911
d. Cause a low average serum digoxin sensitivity in 5 minutes if chest pain persists.
level c. Apply Transderm-Nitro patch to a hairy area to
protect skin from burning.
5. A patient takes an initial dose of a nitrate. Which d. Call the health care provider after taking five
symptom(s) will the nurse expect to occur? tablets if chest pain persists.
a. Nausea and vomiting e. Warn patient against ingesting alcohol while
b. Headaches taking nitroglycerin
c. Stomach cramps
d. Irregular pulse rate

6. A patient is prescribed a beta blocker. The nurse


acknowledges that beta blockers are as effective as
antianginals because they do what?
a. Increase oxygen to the systemic circulation
b. Maintain heart rate and blood pressure
c. Decrease heart rate and decrease myocardial
contractility
C: KEY AND HAYES CARDIO 7 c. To decrease glucose level
d. To increase glucose level
1. A patient is taking hydrochlorothiazide (HCTZ) 50 mg/
day and digoxin (Lanoxin) 0.25 mg/day. The nurse plans 7. The patient has been receiving spironolactone
to monitor the patient for which potential electrolyte (Aldactone) 50 mg/day for heart failure. The nurse
imbalance? should closely monitor the patient for which condition?
a. Hypocalcemia a. Hypokalemia
b. Hypokalemia b. Hyperkalemia
c. Hyperkalemia c. Hypoglycemia
d. Hypermagnesemia d. Hypermagnesemia

2. The nurse knows that which statement is correct


regarding nursing care of a patient receiving
hydrochlorothiazide (HCTZ)? (Select all that apply.) a.
Monitor patient for signs of hypoglycemia.
b. Administer ordered potassium supplements.
c. Monitor serum potassium and uric acid levels.
d. Assess blood pressure before administration.
e. Notify health care provider if patient has had oliguria
for 24 hours.
f. Assess for decreased cholesterol and triglyceride
levels.

3. A patient has heart failure, and a high dose of


furosemide (Lasix) is ordered. What suggests a
favorable response to Lasix?
a. Decrease in level of consciousness and sleeping
more
b. Respiratory rate decreases from 28/min to 20/min and
the depth increases.
c. Increased congestion heard in breath sounds and
complains of shortness of breath
d. Urine output of 50 mL/4 h and intake of 200 mL

4. What does the nurse know to be correct concerning


the use of mannitol (Osmitrol) in patients?
a. Decreases intracranial pressure
b. Increases intraocular pressure
c. Causes sodium and potassium retention
d. Causes diuresis in several days

5. What should the nurse do when a patient is taking


furosemide (Lasix)?
a. Instruct patient to change positions quickly when
getting out of bed.
b. Assess blood pressure before administration.
c. Administer at bedtime for maximum effectiveness d.
Teach to avoid fruits to prevent hyperkalemia.

6. For the patient taking a diuretic, a combination such


as triamterene and hydrochlorothiazide may be
prescribed. The nurse realizes that this combination is
ordered for which purpose?
a. To decrease serum potassium level
b. To increase serum potassium level
C: KEY AND HAYES CARDIO 8 b. Dizziness and headaches
c. Upset stomach
1. A patient’s blood pressure (BP) is 130/84. The d. Constant, irritating cough
health care provider plans to suggest
nonpharmacologic methods for the patient. Which 7. A patient is prescribed losartan (Cozaar). The
should the nurse include in teaching? (Select all nurse teaches the patient that an angiotensin II
that apply.) receptor blocker (ARB) acts by doing what?
a. Stress-reduction techniques a. Inhibiting angiotensin-converting enzyme
b. Starting an exercise program b. Blocking angiotensin II from AT1 receptors
c. Salt restriction c. Preventing the release of angiotensin I
d. Smoking cessation d. Promoting the release of aldosterone
e. Diet with increased protein
8. During an admission assessment, a patient
2. A patient has developed mild hypertension. The states that she takes amlodipine (Norvasc). The
nurse acknowledges that the first-line drug for nurse wishes to determine whether the patient has
treating this patient’s blood pressure might be any common side effects of a calcium channel
which drug? blocker. The nurse asks the patient if she has
a. Diuretic which signs and symptoms? (Select all that apply.)
b. Alpha blocker a. Insomnia
c. ACE inhibitor b. Dizziness
d. Alpha/beta blocker c. Headache
d. Angioedema
3. An African-American patient has developed e. Ankle edema
hypertension. The nurse is aware that which f. Hacking cough
group(s) of antihypertensive drugs are less
effective in African-American patients?
a. Diuretics
b. Calcium channel blockers and vasodilators c.
Beta blockers and ACE inhibitors
d. Alpha blockers

4. The nurse knows that which diuretic is most


frequently combined with an antihypertensive drug?
a. chlorthalidone
b. hydrochlorothiazide
c. bendroflumethiazide
d. potassium-sparing diuretic

5. The nurse is administering a beta blocker to a


patient. Which is an important assessment to
perform before administration?
a. Urine output
b. Apical pulse
c. Potassium level
d. Serum level of medication

6. Captopril (Capoten) has been ordered for a


patient. The nurse teaches the patient that
angiotensin-converting enzyme (ACE) inhibitors
have which common side effects?
a. Nausea and vomiting
C: KEE AND HAYES CARDIO 9 a. enoxaparin sodium (Lovenox)
b. warfarin (Coumadin)
1. A patient is placed on heparin, and the nurse c. bivalirudin (Angiomax)
acknowledges that heparin is effective for d. lepirudin (Refludan)
preventing clot formation in patients who have
which disorder(s)? (Select all that apply.) 7. A patient is taking warfarin 5 mg/day for atrial
a. Coronary thrombosis fibrillation. The patient’s international normalized
b. Acute myocardial infarction ratio (INR) is 3.8. The nurse would consider the
c. Deep vein thrombosis INR to be what?
d. Hemorrhagic cerebrovascular accident (stroke) a. Within normal range
e. Disseminated intravascular coagulation b. Elevated range
c. Low range
2. A patient who received heparin begins to bleed. d. Low-average range
The nurse anticipates that the health care provider
will order which antidote? 8. Cilostazol (Pletal) is being prescribed for a
a. protamine sulfate patient with coronary artery disease. The nurse
b. vitamin K1 (Mephyton) understands that which is the major purpose for
c. aminocaproic acid (Amicar) antiplatelet drug therapy?
d. potassium chloride (KCl) a. Dissolve the blood clot
b. Decrease tissue necrosis
3. A patient is prescribed enoxaparin (Lovenox). c. Inhibit hepatic synthesis of vitamin K
The nurse knows that low–molecular-weight d. Suppress platelet aggregation
heparin has what kind of half-life?
a. A longer half-life than heparin 9. A patient is to undergo a coronary angioplasty.
b. A shorter half-life than heparin The nurse acknowledges that which drug is used
c. The same half-life as heparin primarily for preventing reocclusion of coronary
d. A four times shorter half-life than heparin arteries following coronary angioplasty?
a. clopidogrel (Plavix)
4. The nurse is teaching a patient about clopidogrel b. abciximab (ReoPro)
(Plavix). Which information will the nurse include in c. warfarin (Coumadin)
the patient’s teaching plan? d. cilostazol (Pletal)
a. Constipation may occur.
b. Hypotension may occur. 10. A patient is admitted to the emergency
c. Bleeding may increase when taken with aspirin. department with an acute myocardial infarction.
d. Normal dose is 25 mg tablet per day. Which drug does the nurse anticipate the health
care provider to order for prevention of tissue
5. A patient had an orthopedic surgery and is necrosis following blood clot blockage in a coronary
prescribed dalteparin (Fragmin). What would the artery?
nurse teach the patient and/or family about this a. heparin sodium
low–molecular-weight heparin (LMWH) before b. clopidogrel (Plavix)
discharge? c. alteplase (rPA, Activase)
a. How to administer the medication intramuscularly d. aminocaproic acid (Amicar)
b. PT and INR monitoring will be done weekly. c.
Avoidance of green leafy vegetables is
recommended.
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?
C: KEE AND HAYES 10 6. For what severe skeletal muscle adverse
reaction should the nurse observe in a patient
1. A patient has a serum cholesterol level of taking rosuvastatin (Crestor)?
265 mg/dL, triglyceride level of 235 mg/dL, and a. Myasthenia gravis
LDL of 180 mg/dL. What do these serum levels b. Rhabdomyolysis
indicate? c. Dyskinesia
a. Hypolipidemia d. Agranulocytosis
b. Normolipidemia
c. Hyperlipidemia 7. A patient is taking ezetimibe (Zetia) and asks
d. Alipidemia the nurse how it works. The nurse should
explain that ezetimibe does what?
2. The nurse knows that a patient’s total a. Inhibits absorption of dietary cholesterol in
cholesterol level should be within which range? the intestines.
a. 150 to 200 mg/dL b. Binds with bile acids in the intestines to
b. 200 to 225 mg/dL reduce LDL levels.
c. 225 to 250 mg/dL c. Inhibits HMG-CoA reductase, which is
d. >250 mg/dL necessary for cholesterol production in the
3. A patient has a low-density lipoprotein (LDL) liver.
of 175 mg/ dL and a high-density lipoprotein d. Forms insoluble complexes and reduces
(HDL) of 30 mg/dL. What teaching should the circulating cholesterol in the blood.
nurse implement for this patient? 8. A patient is diagnosed with peripheral
a. Discuss medications ordered, dietary arterial disease. He is prescribed pentoxifylline
changes, and exercise. (Trental). What does the nurse realize are the
b. No changes in lifestyle are needed and effects of pentoxifylline? (Select all that apply.)
continue with current plan. a. May lead to hypertension and bradycardia
c. Discuss how to have fat intake be 40% of b. Improves microcirculation and tissue
caloric intake. perfusion
d. Begin keeping a food diary and schedule lab c. Decreases blood viscosity and improves
work to be repeated in 6 months. flexibility of erythrocytes
4. Which laboratory test value does the nurse d. Alleviates intermittent claudication
realize can contribute to the development of e. Commonly causes an adverse effect of
cardiovascular disease and stroke? rhabdomyolysis
a. Decreased antidiuretic hormone f. Allows vasodilation of arteries in skeletal
b. Increased homocysteine level muscles
c. Decreased triglycerides
d. Increased HDL level

5. A patient is taking lovastatin (Mevacor).


Which serum level is most important for the
nurse to monitor?
a. Blood urea nitrogen
b. Complete blood count
c. Cardiac enzymes
d. Liver enzymes