Question 1

The client states, “I always keep my lisinopril (Prinivil) on my kitchen window sill. It helps me to remember to take it.” The nurse’s response would be based on what pharmacologic concepts? Heat and moisture may:

Accepted Answer

Cause the medicine to break down.

Question 2

A client is hospitalized for uncontrolled hypertension and is receiving angiotensin converting enzyme (ACE) inhibitors. The nurse should notify the health care provider if the client exhibits:

Accepted Answer

Nonproductive cough.

Question 3

The nurse is caring for a client with chronic hypertension. The client is receiving losartan (Cozaar) daily. Which client manifestations would the nurse conclude is an adverse effect of this medication?

Accepted Answer

Headache and dizziness

Question 4

Losartan (Cozaar) is prescribed for a client. A nurse should question the order for what client? A client who has:

Accepted Answer

Severe dehydration from diuretic therapy.

Question 5

A client is receiving lisinopril (Prinivil) for hypertension. The nurse should ask the client about a history of what condition?

Accepted Answer

Angioedema

Question 6

The nurse has just administered a dose of an angiotensin II receptor blocker to a client. After the initial dose, what is the priority assessment?

Accepted Answer

Blood pressure

Question 7

A client who is taking losartan (Cozaar) asks a nurse how the medication works. The nurse’s response should be based on an understanding that losartan (Cozaar):

Accepted Answer

is an ARB which blocks antiotensin II after it is formed.

Question 8

The nurse is talking with a group of clients with cardiac conditions who are taking diuretic therapy. The nurse explains that individuals prescribed furosemide (Lasix) should:

Accepted Answer

Rise slowly from sitting or lying positions.

Question 9

The client who is receiving a high-ceiling diuretic is instructed to watch for symptoms associated with electrolyte imbalances. Which condition would the client most likely expect?

Accepted Answer

Hypokalemia

Question 10

While preparing a client for discharge, what statement should the nurse include in the instructions regarding the client’s new prescription of furosemide (Lasix)?

Accepted Answer

“Report muscle cramps or weakness to the health care provider.”

Question 11

Clients prescribed spironolactone (Aldactone) are often at risk for electrolyte imbalance. The nurse assesses for this adverse effect because this drug:

Accepted Answer

Retains potassium.

Question 12

What nursing measures should be included in the therapeutic management of a client receiving spironolactone (Aldactone)?

Accepted Answer

Keep the urinal or bedpan available for clients with limited mobility. Monitor intake and output ratio, and weigh the client daily. Monitor blood pressure and assess for orthostatic hypotension.

Question 13

The nurse is monitoring a client receiving acetazolamide (Diamox).Which acid–base imbalance is a potential risk for this client?

Accepted Answer

Metabolic acidosis

Question 14

When should furosemide (Lasix)be administered to a client with stable hypertension?

Accepted Answer

Schedule doses to avoid sleep disturbance and nocturia

Question 15

A client who is taking furosemide (Lasix) for the treatment of congestive heart failure asks a nurse how the medication works. The nurse's response should be based on an understanding that Lasix:

Accepted Answer

Inhibits the reabsorption of sodium.

Question 16

The nurse knows that teaching a client about hydrochlorothiazide (HCTZ) has been successful when the client voices what statement regarding weight gain?

Accepted Answer

“I should report weight gain of 2 or more pounds within 2 days.”

Question 17

mannitol (Osmitrol) is contraindicated for patients with what problems?

Accepted Answer

Dementia, Dehydration, Hypovolemic shock

Question 18

Methyldopa (Aldomet) is being initiated for a client with hypertension. What health teaching would be most appropriate for this drug?

Accepted Answer

Avoid hot baths and showers, and prolonged standing in one position.

Question 19

A client is receiving a direct vasodilator for elevated blood pressure levels. The nurse would include in the care plan to monitor the client for what adverse effect?

Accepted Answer

Orthostatic hypotension

Question 20

The nurse determines that the client understands an important principle in self-administration of hydralazine (Apresoline) when the client makes what statement regarding driving?

Accepted Answer

“I should not drive until the response to drug therapy is determined.”

Question 21

A client with hypertensive crisis is started on nitroprusside (Nipride) therapy. The nurse would perform what priority intervention during the course of this treatment?

Accepted Answer

Titrate intravenous infusion rate according to the blood pressure response.

Question 22

The nurse knows that the primary factors responsible for blood pressure are:

Accepted Answer

Cardiac output. Peripheral resistance. Blood volume.

Question 23

The client, who is receiving a daily dose of methyldopa (Aldomet), informs the nurse that the medication is causing severe drowsiness during the day. What would be best when addressing this complaint?

Accepted Answer

“You can minimize daytime sedation by changing medication dosages to nighttime.”

Question 24

The client taking hydralazine (Apresoline) is experiencing agranulocytosis. The nurse would assess the client for what?

Accepted Answer

Sore throat, fever, and signs of infection

Question 25

The client has developed hypotension, lethargy, blurred vision, and metabolic acidosis following 4 days of nitroprusside (Nipride) administration. The nurse suspects the client may be developing:

Accepted Answer

Thiocyanate poisoning.

Question 26

Hydralazine (Apresoline) is prescribed for a client. A nurse would question the order for which client?

Accepted Answer

The client with lupus. The client with cerebrovascular disease. The client with coronary artery disease. The client with rheumatic heart disease

Question 27

The nurse will administer Nitroprusside sodium (Nipride) to the client with a diastolic pressure of greater than 120 mm Hg. The nurse will administer this medication by what route?

Accepted Answer

Intravenous

Question 28

What laboratory findings would cause the nurse to be concerned about digoxin (Lanoxin) toxicity?

Accepted Answer

Hypokalemia

Question 29

In providing the heart failure client with information prior to discharge, the nurse will discuss digoxin (Lanoxin) therapy.What would the nurse include in the client‘s teaching?

Accepted Answer

Monitor the pulse daily prior to taking the drug.

Question 30

The nurse is evaluating the effects of a drug that causes a positive inotropic effect. The nurse knows that an agent with this property:

Accepted Answer

Increases the force of cardiac contractions.

Question 31

The client is receiving milrinone (Primacor) infusion for heart failure. The nurse should monitor this client for:

Accepted Answer

Heart beat irregularities

Question 32

The nurse is explaining the reason that angiotensinconverting enzyme (ACE) inhibitors are prescribed for heart failure to a group of clients in a cardiac rehabilitation session. The nurse’s response is based on knowing that ACE inhibitors:

Accepted Answer

Slow the progression of heart failure and reduce mortality

Question 33

The nurse is caring for several clients with heart failure. What would the nurse consider appropriate pharmacologic therapy for a client with heart failure?

Accepted Answer

Angiotensin-converting enzyme (ACE) inhibitors, Diuretics, Cardiac glycosides Phosphodiesterase III inhibitors

Question 34

What statement made by a client indicates that additional teaching by the nurse concerning digoxin (Lanoxin) is needed in regards to pedal edema?

Accepted Answer

"Swelling in my ankles or feet is not uncommon with this medicine.”

Question 35

Normal regulaton of BP:

Accepted Answer

vasomotor factors, baroreceptors, chemoreceptors, emtions, hormones and other agents

Question 36

Where is the vasomotor center located?

Accepted Answer

Medulla oblongata

Question 37

what happens when smoot muscle in arteries contracts?

Accepted Answer

BP raises

Question 38

What happens when smooth muscle in arteries relaxes?

Accepted Answer

BP lowers

Question 39

Where are baroreceptors located?

Accepted Answer

In the aorta and internal carotid arteries.

Question 40

Where are chemoreceptors located?

Accepted Answer

In aorta and internal carotid areteries.

Question 41

How can anger and stress affect BP?

Accepted Answer

raise it

Question 42

How can mental depression and lethargy affect BP?

Accepted Answer

lower it

Question 43

Which hormones can increase BP?

Accepted Answer

epinepherine/norepinephrine, antidiuretic hormone, renin-angiotensin system

Question 44

Which of the following is not a factor in BP? venous pressure, arterial resistance, cardiac output, blood volume

Accepted Answer

venous pressure

Question 45

What is stepped care regarding HTN meds?

Accepted Answer

use two drugs from different classes

Question 46

advantage to stepped care

Accepted Answer

lower dose of each drug, fewer side effects leading to better client compliance

Question 47

five primary classes of drugs to treat chronic HTN

Accepted Answer

diuretics, calcium channel blockers, ACE inhibitors, adrenergic agents, direct-acting vasodilators

Question 48

which drug reduces blood volume through urinary excretion of water and electrolytes

Accepted Answer

diuretics

Question 49

biggest electrolyte imbalance with diuretics

Accepted Answer

hypokalemia

Question 50

nursing considerations for patients on diuretics include:

Accepted Answer

monitor for dehydration and hypovolemia, monitor labe values (esp sodium and potassium), daily weights, intake and output

Question 51

three classes of diuretics

Accepted Answer

potassium sparing, thiazide, loop

Question 52

potassium sparing diuretics are contraindicated for which patients

Accepted Answer

renal insufficiency, hyperkalemia, pregnancy, hx of gout or kidney stones

Question 53

Class of triamterene (Dyrenium)

Accepted Answer

potassium sparing diuretic

Question 54

class of amiloride (Midamor)

Accepted Answer

potassium sparing diuretic

Question 55

spironolactone (Aldactone)

Accepted Answer

potassium sparing diuretic

Question 56

bigges side effect of spironolactone (Aldactone)

Accepted Answer

Men: gnecomastia and androgenic effects; Women: hirsutism

Question 57

Thiazide and thiazide-like diuretics-monitor lab values for:

Accepted Answer

hypokalemia, uric acid level (Gout), serum lipid levels (may increase)

Question 58

Thiazide considerations with hyperglycemia:

Accepted Answer

dec effectiveness of anti-diabetic meds

Question 59

thiazide considerations with lupus

Accepted Answer

exacerbate

Question 60

IV push of loop/high ceiling diuretics need to be anministered:

Accepted Answer

slowly by IV push or will cause ototoxic

Question 61

hydrochlorothiazide (HCTZ, Hydrodiuril) class

Accepted Answer

loop diuretic

Question 62

side effects/adverse effects of hydrochlorothiazide (HCTZ)

Accepted Answer

hypokalemia (leading to heart irregularities)

Question 63

Assessment of patients who are on diuretics should include:

Accepted Answer

health hx, baseline vs & labs, assess breath sounds and legs for edema

Question 64

interventions for the patient on diuretics:

Accepted Answer

monitor lab values, monitor vs, monitor fluid status, observe for hyperglycemia, monitor hearing, vision, liver and kidney function, nutrition, ensure safety (ambulation and photosensitivity)

Question	Answer
The client states, “I always keep my lisinopril (Prinivil) on my kitchen window sill. It helps me to remember to take it.” The nurse’s response would be based on what pharmacologic concepts? Heat and moisture may:	Cause the medicine to break down.
A client is hospitalized for uncontrolled hypertension and is receiving angiotensin converting enzyme (ACE) inhibitors. The nurse should notify the health care provider if the client exhibits:	Nonproductive cough.
The nurse is caring for a client with chronic hypertension. The client is receiving losartan (Cozaar) daily. Which client manifestations would the nurse conclude is an adverse effect of this medication?	Headache and dizziness
Losartan (Cozaar) is prescribed for a client. A nurse should question the order for what client? A client who has:	Severe dehydration from diuretic therapy.
A client is receiving lisinopril (Prinivil) for hypertension. The nurse should ask the client about a history of what condition?	Angioedema
The nurse has just administered a dose of an angiotensin II receptor blocker to a client. After the initial dose, what is the priority assessment?	Blood pressure
A client who is taking losartan (Cozaar) asks a nurse how the medication works. The nurse’s response should be based on an understanding that losartan (Cozaar):	is an ARB which blocks antiotensin II after it is formed.
The nurse is talking with a group of clients with cardiac conditions who are taking diuretic therapy. The nurse explains that individuals prescribed furosemide (Lasix) should:	Rise slowly from sitting or lying positions.
The client who is receiving a high-ceiling diuretic is instructed to watch for symptoms associated with electrolyte imbalances. Which condition would the client most likely expect?	Hypokalemia
While preparing a client for discharge, what statement should the nurse include in the instructions regarding the client’s new prescription of furosemide (Lasix)?	“Report muscle cramps or weakness to the health care provider.”
Clients prescribed spironolactone (Aldactone) are often at risk for electrolyte imbalance. The nurse assesses for this adverse effect because this drug:	Retains potassium.
What nursing measures should be included in the therapeutic management of a client receiving spironolactone (Aldactone)?	Keep the urinal or bedpan available for clients with limited mobility. Monitor intake and output ratio, and weigh the client daily. Monitor blood pressure and assess for orthostatic hypotension.
The nurse is monitoring a client receiving acetazolamide (Diamox).Which acid–base imbalance is a potential risk for this client?	Metabolic acidosis
When should furosemide (Lasix)be administered to a client with stable hypertension?	Schedule doses to avoid sleep disturbance and nocturia
A client who is taking furosemide (Lasix) for the treatment of congestive heart failure asks a nurse how the medication works. The nurse's response should be based on an understanding that Lasix:	Inhibits the reabsorption of sodium.
The nurse knows that teaching a client about hydrochlorothiazide (HCTZ) has been successful when the client voices what statement regarding weight gain?	“I should report weight gain of 2 or more pounds within 2 days.”
mannitol (Osmitrol) is contraindicated for patients with what problems?	Dementia, Dehydration, Hypovolemic shock
Methyldopa (Aldomet) is being initiated for a client with hypertension. What health teaching would be most appropriate for this drug?	Avoid hot baths and showers, and prolonged standing in one position.
A client is receiving a direct vasodilator for elevated blood pressure levels. The nurse would include in the care plan to monitor the client for what adverse effect?	Orthostatic hypotension
The nurse determines that the client understands an important principle in self-administration of hydralazine (Apresoline) when the client makes what statement regarding driving?	“I should not drive until the response to drug therapy is determined.”
A client with hypertensive crisis is started on nitroprusside (Nipride) therapy. The nurse would perform what priority intervention during the course of this treatment?	Titrate intravenous infusion rate according to the blood pressure response.
The nurse knows that the primary factors responsible for blood pressure are:	Cardiac output. Peripheral resistance. Blood volume.
The client, who is receiving a daily dose of methyldopa (Aldomet), informs the nurse that the medication is causing severe drowsiness during the day. What would be best when addressing this complaint?	“You can minimize daytime sedation by changing medication dosages to nighttime.”
The client taking hydralazine (Apresoline) is experiencing agranulocytosis. The nurse would assess the client for what?	Sore throat, fever, and signs of infection
The client has developed hypotension, lethargy, blurred vision, and metabolic acidosis following 4 days of nitroprusside (Nipride) administration. The nurse suspects the client may be developing:	Thiocyanate poisoning.
Hydralazine (Apresoline) is prescribed for a client. A nurse would question the order for which client?	The client with lupus. The client with cerebrovascular disease. The client with coronary artery disease. The client with rheumatic heart disease
The nurse will administer Nitroprusside sodium (Nipride) to the client with a diastolic pressure of greater than 120 mm Hg. The nurse will administer this medication by what route?	Intravenous
What laboratory findings would cause the nurse to be concerned about digoxin (Lanoxin) toxicity?	Hypokalemia
In providing the heart failure client with information prior to discharge, the nurse will discuss digoxin (Lanoxin) therapy.What would the nurse include in the client‘s teaching?	Monitor the pulse daily prior to taking the drug.
The nurse is evaluating the effects of a drug that causes a positive inotropic effect. The nurse knows that an agent with this property:	Increases the force of cardiac contractions.
The client is receiving milrinone (Primacor) infusion for heart failure. The nurse should monitor this client for:	Heart beat irregularities
The nurse is explaining the reason that angiotensinconverting enzyme (ACE) inhibitors are prescribed for heart failure to a group of clients in a cardiac rehabilitation session. The nurse’s response is based on knowing that ACE inhibitors:	Slow the progression of heart failure and reduce mortality
The nurse is caring for several clients with heart failure. What would the nurse consider appropriate pharmacologic therapy for a client with heart failure?	Angiotensin-converting enzyme (ACE) inhibitors, Diuretics, Cardiac glycosides Phosphodiesterase III inhibitors
What statement made by a client indicates that additional teaching by the nurse concerning digoxin (Lanoxin) is needed in regards to pedal edema?	"Swelling in my ankles or feet is not uncommon with this medicine.”
Normal regulaton of BP:	vasomotor factors, baroreceptors, chemoreceptors, emtions, hormones and other agents
Where is the vasomotor center located?	Medulla oblongata
what happens when smoot muscle in arteries contracts?	BP raises
What happens when smooth muscle in arteries relaxes?	BP lowers
Where are baroreceptors located?	In the aorta and internal carotid arteries.
Where are chemoreceptors located?	In aorta and internal carotid areteries.
How can anger and stress affect BP?	raise it
How can mental depression and lethargy affect BP?	lower it
Which hormones can increase BP?	epinepherine/norepinephrine, antidiuretic hormone, renin-angiotensin system
Which of the following is not a factor in BP? venous pressure, arterial resistance, cardiac output, blood volume	venous pressure
What is stepped care regarding HTN meds?	use two drugs from different classes
advantage to stepped care	lower dose of each drug, fewer side effects leading to better client compliance
five primary classes of drugs to treat chronic HTN	diuretics, calcium channel blockers, ACE inhibitors, adrenergic agents, direct-acting vasodilators
which drug reduces blood volume through urinary excretion of water and electrolytes	diuretics
biggest electrolyte imbalance with diuretics	hypokalemia
nursing considerations for patients on diuretics include:	monitor for dehydration and hypovolemia, monitor labe values (esp sodium and potassium), daily weights, intake and output
three classes of diuretics	potassium sparing, thiazide, loop
potassium sparing diuretics are contraindicated for which patients	renal insufficiency, hyperkalemia, pregnancy, hx of gout or kidney stones
Class of triamterene (Dyrenium)	potassium sparing diuretic
class of amiloride (Midamor)	potassium sparing diuretic
spironolactone (Aldactone)	potassium sparing diuretic
bigges side effect of spironolactone (Aldactone)	Men: gnecomastia and androgenic effects; Women: hirsutism
Thiazide and thiazide-like diuretics-monitor lab values for:	hypokalemia, uric acid level (Gout), serum lipid levels (may increase)
Thiazide considerations with hyperglycemia:	dec effectiveness of anti-diabetic meds
thiazide considerations with lupus	exacerbate
IV push of loop/high ceiling diuretics need to be anministered:	slowly by IV push or will cause ototoxic
hydrochlorothiazide (HCTZ, Hydrodiuril) class	loop diuretic
side effects/adverse effects of hydrochlorothiazide (HCTZ)	hypokalemia (leading to heart irregularities)
Assessment of patients who are on diuretics should include:	health hx, baseline vs & labs, assess breath sounds and legs for edema
interventions for the patient on diuretics:	monitor lab values, monitor vs, monitor fluid status, observe for hyperglycemia, monitor hearing, vision, liver and kidney function, nutrition, ensure safety (ambulation and photosensitivity)
When assessing labe tests, the nurse should know that hypokalemia is a common SE of	diuretics
What do calcium channel blockers treat?	HTN, angina pectoris, cardiac arrhythmias
how do calcium channel blockers work?	prevent calcium ions from entering muscle cells causing muslce to not contract as efficiently (also relax arterioles, lower peripheral resistance)
what class is amiodipine (Norvac)	calcium channel blocker
what class is nifedipine (Procaria)	carlcium channel blocker
what class is diltiazem (Cardizem)	calcium channel blocker
what class is verapamil (Calan)	calcium channel blocker
intervention unique to CCB	monitor for signs of heart failure
almost everyone on CCB will have some:	pedal edema
Actions of nifedipine (Procardia)	blocks Ca channels in heart and smooth muscle
adverse effects and interactions of nifedipine (Procardia)	HA, dizziness, flushing, inc dig level (warfarin, raitidine), alcohol can cause syncope, grapefruit can cause toxic overdose
class of lisinopril (Prinvil)	ACE inhibitor
class of captopril (Capoten)	ACE inhibitor
class of quinapril (Accupril)	ACE inhibitor
what does agiotensin converting enzyme (ACE inhibitors) treat	HTN, CHF, MI
ACE inhibitors block enzyme that change:	angiotensin I to angiotensin II
Who are ACE inhibitors less effective for?	African Americans
side effects of ACE inhibitors:	persistent dry cough, postural hypotension, angioedema
contraindications of ACE inhibitors:	hypersensitivity, hx of angioedema, potassium-sparing diuretic, pregnancy and lactation, renal insufficiency
when should ACE inhibitors be taken	at bedtime (may cause first dose effect)
class of elalapril (Vasotec)	ACE inhibitor
enalapril (Vasotec) adverse effects and interactions:	orthostatic hypotension, angioedema, agranulocytosis, inc risk of lithium toxicity, NSAIDS decrease effectiveness of ACE
class of irbesartan (Avapro)	angiotensin receptor blocker (ARB)
class of losartan (Cozaar)	angiotensin receptor blocker (ARB)
monitor patient on ACE inhibitor for:	blood dyscrasia (bruising, fever, sore throat, dyspnea, pallor), dry cough, fluid balance
how do antiotensin receptor blockers (ARB) work	block angiotensis II after it is formed, arteriolar dilation, increased sodium excretion
how do adrenergic blocking agents work for HTN	block effects of sympathetic division of ANS
What can Alpha-1 antagonists treat?	HTN, benign prostatic hypertrophy (BPH)
exampes of adrenergic blockers:	beta blockers, Alpha 1
class of prazosin (Minipress)	Alpha 1
class of terazosin (Hytrin)	Alpha 1
side effects of adrenergic blocking agents	orthostatic hypotension, nausea, dizziness, bradycardia, dry mouth, dec libido, erectile dysfunction, depression, asthma exacerbation
class of doxazosin (Cardura)	Alpha 1
how does doxazosin (Cardura) work	dilates arteries and veins
adverse effects and interations of doxazosin (Cardura)	causes rapid drop in BP, cimetidine (Tagamet) prolongs half life
how do beta blockers work	adrenergic antagonists, dec contractility and rate, dec O2 demand, hypoglycemia without symptoms
what do cardioselective (beta 1) blockers do	decrease HR and myocardial contractility, non-specifice additionally affect respiratory system and blood vessels (vasocontriction), dec myocardial contractility and heart rate
Which drugs are often used in hypertensive emergencies?	direct vasodilators
It is important to monitor what when a patient is on direct vasodilators for emergency?	continuous BP measurement (may need arterial line)
contraindications for direct vasodilators	hypersensitivity, CAD, mitral valve disease, cerebrovascular disease, renal insufficiency, SLE (lupus), priapism
class of diazoxide (Hyperstat)	direct vasodilator (IVP)
class of nitroprusside (Nipride)	direct vasodilator (IV gtt)
half life of nitroprusside (Nipride)	2 minutes
class of clonidine (Catapres)	direct vasodilator (patch, PO) (also used epidural for cancer pain)
class of hydralazine (Apresoline)	direct vasodilator
routes of hydralazine (Apresoline)	PO and parenteral
adverse effects and interactions of hydralazine (Apresloline)	reflex tachycardia, fluid retention, MAOI and NSAID, abrupt withdrawal may cause rebound HTN
Which drug is an ACE inhibitor? clonidine (Catapres), losartan (Cozaar), metolrolol (Toprol), captopril (Capoten)	captopril (Capoten)
signs of heart failure	SHOB, swelling of feet and ankles, chronic lack of energy, difficulty sleeping at night due to breathing problems, swollen or tender abd w/loss of appetite, cough with pink froth sputum, increased urination at night, confusion and/or impaired memory
goals of treatment for heart failure	prevent, treat, or remove umderlying causes
disorders associated with heart failure:	mitral stenosis, MI, chronic HTN, CAD, DM
Heart cannot eject all the blood it receives. Ventricles:	hypertrophy to compensate
Heart cannot eject all the blood it receives. left ventricle blood:	backs up into lungs
Heart cannot eject all the blood it receives. right ventricle blood:	backs up into peripheral veins
traditional drugs of choice for heart failure	cardiac glycosides (digitalis)
toxic level of digitalis	>1.8 ng/ml
prior to starting digitalis what test should be performed?	EKG--evaluate any ventricualr dyshrythmias not caused by heart failure
digitalis side effects	anorexia, nausea, vomitting, fatigue, drowsiness, dizziness, HA, dysrhythmias, visual disturbances (blurred, yellow, halos)
Oral tabs and liquid digitalis	are not directly interchangeable
patients on digitalis should report:	visual changes, palpitations, weakness, loss of appetite, nausea, vomitting, diarrhea
What foods should patients on digitalis consume?	Foods high in potassium (bananas, apricots, sweet potatoes, orange juice)
digitalis antidote	digoxin immune Fab (Digibind)
actions of digoxin (Lanoxin)	dec CHF and inc exercise tolerance, suppresses SA node, slows down AV node
What should be monitored when on digoxin (Lanoxin)	serum levels
diuretics can lead to hypokalemia; hypokalemia plus dig can lead to:	dysrhythmias
ACE inhibitors as tx for heart failure:	lower peripheral resistance which decreases afterload and increases cardiac output; dilates veins returning blood to heart which decreases preload and increases peripheral edema
lisipopril (Prinvil, Zestril) side effects and interactions	cough, nausea, vomitting, headache, diarrhea, taste disturbance, NSAIDs, lithium, potassium sparing diuretics
vasodilators for heart failure directly relax:	blood vessels which decreases BP (many side effects, reserved for clients who cannot tolerate ACE inhibitors
isosorbide dinitrate (Isordil) actions and uses	acts of veins to decrease preload, dilates coronary arteries which decreases angina
SE and AE of isosorbide dinitrate (Isordil)	HA, hypotension, relfex tachycardia
interactions isosorbide dinitrate (Isordil)	sildenafil (Viagra), alcohol, antihypertensives
How do diuretics for heart failure work?	reduce blood volume, edema and congestion: workload on heart reduced and cardiac output increased; used in combination with other drugs to treat heart failure
contraindictaions of diuretics for heart failure	renal dysfunctions, fluid and electrolyte depletion, heptic coma, prenancy and lactation, caution with hepatic cirrhosis or nephrotic syndrome
nursing considerations for diuretics for heart failure include monitoring:	potassium levels, lab values, intake and output, hypovolemia and dehydration, sodium levels
patient education diuretics for heart failure max sodium intake:	no more than 4 grams
patient education diuretics for heart failure report weight loss of more than:	2 pounds per week
patient education diuretics for heart failure sign of hypokalemia:	fatigue, muscle cramping
furosemide (Lasix)blocks:	reabsorption of NaCl and water
administrations alert for furosemide (Lasix)	Ototoxicity esp when given IVP
adverse effects furosemide (Lasix)	hypokalemia, poss cross allergy with sulfa drugs
It is critical for the nurse to evaluate electrolyte levels during digoxin therapy. Which of the following will significantly impact the effect of digoxin? hypokalemia, hypercalcemia, hyperkalemia, hypernatremia	hypokalemia
phosphodiesterase inhibitors are used for	short term control of acute heart failure
How long are patient's on phosphodiesterase inhibitors?	generally two to three days
Phosphodiesterase inhibitors are reserved for clients not responding to:	ACE inhibitors or cardiac glycosides
class of Inocor	phosphodiesterase inhibitor
class of Primacor	phosphodiesterase inhibitor
How do beta-adrenergic blockers for heart failure work?	reduce cardiac workload by decreasing afterload; usually used in combination with other drugs
contraindications for beta blockers:	monitor for worsening symptoms of heart failure, monitor for hepatic toxicity (LFT's)
Patient education for beta blockers	monitor BP and pulse, notify HCP if pulse less than 50; do not abruptly stop meds; monitor blood glucose (will have hypoglycemia with no symptoms)
class of carvedilol (Coreg)	beta blocker
By what mechanism do diuretics, such as Lasix, improve the symptoms of patients with CHF? blocking beta-adrenergic receptors, causing the heart to beat stronger, reducing fluid/plasma volume, slowing the heart rate, dilating the coronary arteries	reducing fluid/plasma volume
signs and symptoms of shock:	skin pale, cold, and clammy; behavioral changes ie. restlessness
assessing for shock:	low blood pressure, rapid weak pulse, rapid and shallow breathing
types of shock:	hypovolemic, neurogenic, cardiogenic, septic, anaphylactic
treatment priorities for shock:	open airway, fluid replacement agents, crystalloids (dextrose) and colloids (proteins)
blood product colloids include:	albumin, plasma protein fraction, serum globulins
non-blood product colloids:	Dextran, Hetastarch
What do you assess for circulatory overload?	BP, pulse, lung sounds, I
Early stages of shock increase activity of what system?	sympathetic nervous system
Sympathomimetics or beta-adrenergic agonists do what for clients in shock?	stabalize BP
class of norepinephrine (Levartenol, Levophed)	sympathomimetrics or beta-adrenergic agonists
class of isoproterenol (Isuprel)	sympathomimetrics or beta-adrenergic agonists
class of methoxamine (Vasoxyl)	sympathomimetrics or beta-adrenergic agonists
class of phenylephrine (Neo-Synephrine)	sympathomimetrics or beta-adrenergic agonists
class of mephentermine (Wayamine)	sympathomimetrics or beta-adrenergic agonists
prior to administering norepinephrine in patient's with existing CV disease, what considerations are there?	assess EKG rhythm, be aware of specific side effects according to drug being administered, monitor for chest pain and EKG changes
Prior to administering norepinephrine, assess for history of what disease?	narrow-angle glaucoma (could close the angle and cause blindness)
norepinephrine adverse effects:	HTN, dysrhytmias (usually tachycardia)
actions of norepinephrine:	constricts blood vessels (increases BP), strengthens force of contraction (inotropic)
contraindications norepinephrine:	ventricualr tachycardia, hypertrophic idiopathic subaortic stenosis, pregnancy and lactation, catuion in patients with HTN, hypovolemia
nursing intervention for extravasation of norepinephrine	administer antidote
Patients should report what immediately when on norepinephrine?	chest pain, burning or pain at the IV site, paresthesias in extremities
Most of the agents used to raise BP in patients with shock: are CNS stimulants, are CNS depressants, activate the parasympathetic nervous system, activate the sympathetic nervous system	activate the sympathetic nervous system
It is important to monitor renal function hourly per foley catheter with norepinephrine for what reason?	for vasoconstriction of renal arteries
class of dopamine (Dopastat, Intropin)	beta I adrenergic agonist
How is dopamine administered?	IV gtt, nurse titrates med according to BP every 15 min
action of dopamine:	low dose: increase blood flow to kidneys; high dose: heart beats stronger and vasoconstriction

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pharm cardio c