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week 7 sherpaths
pharm 315
| Question | Answer |
|---|---|
| The nurse is preparing to administer a loading dose of digoxin to a patient in atrial fibrillation with a heart rate of 130 beats/minute. Which statement describes the rationale for the loading dose? | Achieve therapeutic effect of digoxin more quickly. A loading dose allows the therapeutic level of digoxin to be achieved more quickly. This dose is called “digitalizing.” |
| A nurse would anticipate that which dysrhythmia will likely develop when adenosine is administered? | Asystole The nurse would anticipate asystole when administering adenosine. Asystole is rarely sustained and is resolved quickly. |
| A patient remains in supraventricular tachycardia after administration of adenosine 6 mg. Which action would the nurse anticipate taking? | Administer adenosine 12 mg in 1 to 2 minutes after the previous dose. If the patient is does not respond to the first dose of adenosine within 1 to 2 minutes, then the nurse would prepare to administer adenosine 12 mg. |
| A patient is being treated with digoxin for atrial fibrillation. Which finding would concern the nurse? | Development of second-degree block Digoxin prolongs the PR interval as a result of the slowed atrioventricular (AV) conduction. Development of second-degree block is a contraindication for digoxin. |
| A nurse is reviewing laboratory results on a patient who is taking oral digoxin. Which electrolyte imbalance would the nurse associate with digoxin toxicity? | Hypokalemia Hypokalemia enhances the risk of cardiotoxicity caused by digoxin. |
| A patient’s rhythm is now asystole after receiving adenosine. Which action would the nurse take? | Monitor the patient. Asystole is common for a few seconds after receiving adenosine. While the patient should still be closely monitored, no treatment is required as a result of the short half-life of the drug. |
| A patient who has been taking digoxin for several months is now complaining about changes to vision. Which action would the nurse take? | Further inquire about the vision changes. Vision changes may be normal in this patient, but digoxin can alter vision, such as seeing green, yellow, or purple halos. Therefore the nurse should inquire about the vision changes. |
| A patient with a history of heart failure is taking both a diuretic and digoxin. Which substance would the nurse anticipate administering to this patient? | Potassium supplement Diuretics can cause potassium loss, increasing the risk of digitalis toxicity. Potassium supplements may be needed. |
| Digoxin is prescribed to a patient who has been taking verapamil for hypertension. Which dosing change would the nurse anticipate seeing in the prescription? | A reduction in digoxin dose by 50% Verapamil decreases digoxin clearance, thereby increasing the effects of digoxin. The dose of digoxin should be decreased by 50%. |
| Before administering digoxin, the nurse would conduct a thorough assessment, knowing that digoxin accumulates the highest in which areas of the body? | Kidney, Intestine, Heart, Skeletal muscle |
| A nurse is preparing to administer adenosine through an established intravenous site with intravenous fluids infusing. Which intravenous fluids would the nurse accept as compatible with adenosine? | 0.9% NaCl, D5W, Ringer’s lactate |
| The nurse is teaching a class on angiotensin receptor blockers (ARBs). What would the nurse include in the teaching? | ARBs lower blood pressure by preventing vasoconstriction, ARBs prevent angiotensin II from stimulating release of aldosterone, ARBs prevent angiotensin II from inducing structural changes to heart, ARBs are well absorbed, Valsartan crosses placenta cause |
| The nurse administered a dose of lisinopril at 0800, and the patient’s blood pressure was 189/96 mm Hg. Based on the pharmacodynamics of the drug, at which time would the nurse anticipate the greatest reduction in blood pressure? | 1400 At 1400, the nurse would anticipate peak effects of the drug, as this is 6 hours after administration, and the peak effect occurs within 6 to 8 hours. |
| A patient who is prescribed lisinopril asks the nurse, “Will this drug help the swelling in my legs?” Which nursing response is appropriate? | “Lisinopril may help the edema from progressing, as this drug suppresses aldosterone, which promotes sodium and water excretion.” |
| The nurse is completing discharge teaching, which includes the direction, “Do not stop the angiotensin-converting enzyme (ACE) inhibitor abruptly.” Which effect would the nurse tell the patient to expect if the medication were stopped suddenly? | Dramatic increase in blood pressure |
| For which patients is the use of an angiotensin-converting enzyme (ACE) inhibitor contraindicated? | 32-year-old female patient who is 4 months pregnant, 62-year-old male patient with a history of renal artery stenosis, 29-year-old female patient with a potassium level of 5.2 mEq/L, |
| The nurse is providing education to a patient who is being discharged on valsartan. Which patient responses indicate that more education is required? | Which one of those medications is for my blood pressure?","I have to take it with food or it won’t work.""I take it only when my blood pressure is over 180/80 mm Hg." |
| A patient who is hospitalized following a planned orthopedic surgery has been taking a routine dose of lisinopril since the operative day. Which action will the nurse take when a sudden onset of facial swelling is noted? | Prepare to administer epinephrine subcutaneously. |
| A nurse administered diltiazem intravenously at 0900. At which time will the nurse assess the patient for therapeutic effects of diltiazem? | 0905 The onset of therapeutic effects of diltiazem intravenously is 3 minutes. The peak effect is in 15 minutes. The nurse will assess the effects at 0905. |
| A nurse would question a prescription for verapamil in a patient diagnosed with which condition? | Heart failure Verapamil should be used cautiously in patients with heart failure. Calcium channel blockers decrease contractility of the vessels and decrease total peripheral resistance, blood pressure, and cardiac workload. |
| The nurse is assessing a patient who is taking verapamil for atrial fibrillation and notes 1+ edema to the ankles and feet. Which action would the nurse take? | Assess the patient for heart failure. 1+ edema could indicate early heart failure. The nurse should monitor closely for further evidence of heart failure, such as dyspnea, crackles on lung auscultation, and weight gain. Caution is advised in patients wit |
| Before administering diltiazem, the nurse observes the patient’s pulse at 54 beats/min on the cardiac monitor. Which action will the nurse take next? | Hold the drug. A pulse of 54 beats/min is considered bradycardia, which could indicate an adverse effect of diltiazem. The next action after assessing the pulse is to hold the drug. |
| Which instruction will the nurse provide on avoiding side effects related to diltiazem? | Increase dietary fiber. One side effect of diltiazem is constipation. Increasing dietary fiber can prevent constipation. |
| A health care provider prescribes diltiazem 10 mg intravenous push for persistent atrial fibrillation with a ventricular rate of 115 beats/min. While preparing the diltiazem, the nurse notices the patient is on digoxin 0.125 mg and metoprolol 25 mg. Which | Hold the diltiazem. The nurse would hold the diltiazem until the prescription can be clarified with the health care provider. Giving diltiazem to a patient who is already taking digoxin and metoprolol could suppress the cardiac function and cause severe |
| A patient who is being discharged on diltiazem tells the nurse that cooking with herbs and taking supplements has improved the patient’s physical stamina. Which response by the nurse is appropriate? | “Certain supplements can alter the therapeutic effects of diltiazem.” The nurse would provide teaching on drug-drug, drug-herb, and drug-food interactions. Grapefruit juice, ginkgo, ginseng, hawthorn, and St. John’s wort could increase the drug level of |
| A patient who is receiving verapamil asks the nurse how the drug helps the heart. The nurse responds knowing that verapamil has which mechanisms of action? | Slowing of sinoatrial (SA) node automaticity, Delay of AV nodal conduction,Reduction of myocardial contractility |
| A patient with atrial fibrillation is being discharged on verapamil. Which symptoms will the nurse instruct the patient to report to the health care provider? | Weight gain, Dyspnea, Swelling to feet and ankles |
| A patient asks the nurse why dronedarone needs to be taken with food. The nurse responds knowing that bioavailability of dronedarone is at which level without food? | 4% |
| Which condition will the nurse suspect for a patient who is prescribed amiodarone? | Ventricular tachycardia |
| A patient with new onset atrial fibrillation asks the nurse how dronedarone will help with the heart. The nurse answers knowing that dronedarone has which mechanism of action? | Blocks potassium channels |
| A nurse reviews the cardiac monitor on a patient who is receiving dronedarone for paroxysmal atrial fibrillation. Which cardiac dysrhythmia would most alarm the nurse? | Torsades de pointes |
| Which action related to drug administration will a nurse expect to take for a patient with unstable ventricular tachycardia? | Administer initial intravenous dose of amiodarone over 10 minutes. |
| The nurse is preparing to administer a maintenance dose of amiodarone. Which dose would the nurse administer? | Amiodarone 400 mg daily |
| Which teaching is appropriate for a patient receiving oral amiodarone? | Avoid prolonged sun exposure. |
| A patient who was prescribed amiodarone is concerned about developing heart failure. Which clinical manifestations would the nurse instruct the patient to report that are indicative of heart failure? | Weight gain,Swelling,Difficulty breathing |
| A patient is prescribed to receive an initial dose of amiodarone 800 mg and a maintenance dose of warfarin 8 mg. Which action would the nurse expect when notifying the health care provider about the order? | Decrease the dose of warfarin. |
| Which statements made by the patient indicate a need for more teaching about dronedarone? | “I can take this without regard to food.”,“I can take this without regard to food.”,“It is normal to develop swelling to the feet.” |
| A patient is receiving amiodarone. During patient teaching, the nurse will explain the importance of drug toxicity knowing amiodarone accumulates in which organs? | Lungs, Liver |
Created by:
Brandi Sizemore