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Topic 7 EAQs Drug Classes Affecting the Cardiovascular System

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50 Questions

Which symptom will a nurse monitor in a patient with suspected digoxin toxicity? Select all that apply.

Anorexia

Which information would a nurse include in discharge teaching to a patient prescribed digoxin and hydrochlorothiazide for the management of heart failure? Select all that apply.

Obtain pulse before taking digoxin dose. Hold the drug for a heart rate of less than 60 beats per minute.

Which adverse effect would the nurse educate a patient about who has been prescribed diltiazem?

Fluid retention

The nurse reviews the history of a patient with angina who is prescribed propranolol. Which action will be the nurse's priority when noting that the patient has a history of asthma?

Ask the healthcare provider to switch to another drug.

Which outcome is expected with calcium channel blockers(CCBs)?

To decrease the afterload and reduce the workload of the heart

Which formulation of nitroglycerin is likely to have a large first-pass effect?

Oral

Which instruction does a nurse provide a patient who report headaches associated with the administration of sublingual nitroglycerin?

'These headaches may be treated with acetaminophen.'

Which concomitantly administered drug will cause the nurse to monitor serum potassium levels in a patient who is also receiving digoxin for heart failure?

Furosemide

The nurse reviews a patient’s health record before administering the patient’s scheduled digoxin dose. Based on the patient’s chart findings, which action would the nurse take? Select all that apply.

Hold the scheduled digoxin dose.

The nurse is providing education to a patient who will begin digoxin. Which food would the nurse instruct the patient to consume to increase serum potassium levels?

Potatoes

Which side effect is common with nitrates, beta-blockers, and calcium channel blockers?

Hypotension

Which result(s) would the nurse expect to be decreased if thenurse is reviewing the laboratory results of a patient taking hydrochlorothiazide? Select all that apply.

Chloride

Which finding in the patient’s medication profile indicates a need to contact the health care provider (HCP) if the nurse is preparing to administer spironolactone to a patient with cirrhosis?

Lisinopril

Which intervention(s) would the nurse include in the plan of care for a patient taking spironolactone? Select all that apply.

Assess renal function

A patient who is retaining excess fluid wants to try hydrochlorothiazide. Which parameter in the patient’s health record would lead to this drug being cautioned?

Gout

Which drug(s) would the nurse expect the primary health care provider to prescribe for an African American patient diagnosed with low-renin hypertension? Select all that apply.

Alpha1 blockers

Which drug class is associated with a constant, irritated, and nonproductive cough in some patients?

Angiotensin-converting enzyme (ACE) inhibitors

Which side effect (s) would a nurse monitor after after administering lisinopril to a patient? Select all that apply.

Dry cough

Which intervention would the nurse implement immediatelyfor a patient newly prescribed digoxin who is concurrentlyprescribed furosemide?

Monitor the potassium level.

Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?

'Apply the patch to a nonhairy, nonfatty area of the chest, arm, or thigh.'

Which mechanism of action describes how digoxin immuneFab works?

Binding to digoxin

Which drug class is used as the first line of therapy for reducing fluid volume in patients with heart failure (HF)?

Diuretics

Which action by a nurse would be taken if the nurse observed the patient’s serum digoxin level to be 0.9 ng/mL?

Administer the prescribed dose of digoxin.

Which parameter does chronotropic drugs aff ect?

Heart rate

Which instruction does a nurse give a patient about storing sublingual nitroglycerin tablets while traveling?

'It is best to keep it in its original container away from heat and light.'

Which assessment would a nurse make before administering digoxin?

Apical pulse

Which instruction does a nurse provide to a patient who is prescribed nitroglycerin patches to prevent the development of a tolerance to nitrates?

'Apply the nitroglycerin patch daily, and remove it for 8 - 12 hours at night.'

Which rationale explains why a nurse would ask a patient newly prescribed digoxin to stop taking licorice supplementation?

Licorice enhances the effect of digoxin.

Which class of drugs is used in the treatment of anginapectoris? Select all that apply.

Beta-blockers

Which statement by a nurse about the use of medicinal nitrates indicates effective understanding?

They dilate all blood vessels.

Which statement by the nurse about beta blockers is accurate?

'Beta blockers decrease sympathetic stimulation of the heart.'

Which condition indicates an excessive dose of digoxin?

Halo vision

Which statement made by a patient demonstrates a need for further instruction regarding the use of sublingual nitroglycerin?

'I can take up to 5 tablets at 3-minute intervals for chest pain if necessary.'

Which effect do beta blockers have on classic (stable) angina?

Decrease heart rate

Which drug is a calcium channel blocker?

Diltiazem

Which phrase describes how a diuretic lowers blood pressure?

Blocks sodium and water reabsorption

Which information would the nurse share when teaching the patient about the administration of furosemide? Select all that apply.

Use at least SPF 30 sunscreen.

Which nursing intervention is a priority for a patient receiving furosemide who is observed to have muscle weakness, leg cramps, and heart palpitations?

Assess the serum potassium level.

Which category of diuretics may cause hypotension, hyperglycemia, hearing impairment, and gout?

Loop diuretics

Which range is considered normal for a potassium level?

3.5 to 5 mEq/L

Which two functions are associated with diuretics?

Reducing edema and blood pressure

Which description is accurate regarding the action of angiotensin-converting enzyme inhibitors (ACEIs)?

Inhibit formation of angiotensin II and block the release of aldosterone

If the nurse is teaching the patient about newly prescribed captopril, which statement by the patient indicates a need for further instruction?

“Irritating cough and swollen lips are to be expected.”

Which nonpharmacologic method(s) can be used to decrease blood pressure? Select all that apply.

Stress Reduction / Exercise

Which drug(s) blocks (block) angiotensin II from angiotensin I receptors? Select all that apply.

Losartan potassium

Which patient being treated with a beta blocker for hypertension will receive priority assessment by the nurse?

The patient who has stopped taking a beta blocker due to cost

Which rationale would the nurse provide when teaching a patient about how a calcium channel blocker lowers blood pressure?

“This drug will dilate your blood vessels.”

The nurse is preparing to administer 25 mg of metoprolol orally to a patient with hypertension. Which patient parameter would cause the nurse to hold the dose and contact the healthcare provider (HCP)?

Heart rate of 45 beats/minute

Based on the information below, which action would the nurse take first if a patient presented to the urgent care center reporting leg cramps, nausea, and blurred vision?

Address the serum potassium level.

Which action would the nurse perform first after reviewing the patient’s health record and before administering 40 mg of furosemide via an IV push to a patient with heart failure?

Hold the medication.

Study Notes

Digoxin Toxicity

  • Monitor for symptoms of digoxin toxicity, including nausea, vomiting, and confusion.

Discharge Teaching for Digoxin and Hydrochlorothiazide

  • Include information about monitoring for signs of digoxin toxicity, such as nausea and vomiting.
  • Inform the patient about the importance of regular potassium level checks.
  • Provide instructions on how to take medications, including the correct dosage and timing.

Diltiazem Adverse Effects

  • Educate the patient about the potential for diltiazem to cause dizziness, headache, and hypotension.

Propranolol and Asthma

  • Priority action: assess the patient's asthma status before administering propranolol, as it can exacerbate asthma symptoms.

Calcium Channel Blockers (CCBs)

  • Expected outcome: decreased blood pressure and heart rate.

Nitroglycerin Formulations

  • Sublingual tablets have a large first-pass effect.

Nitroglycerin Administration

  • Instruct the patient to sit or lie down when taking sublingual nitroglycerin to prevent headaches.

Digoxin and Hydrochlorothiazide Interaction

  • Monitor serum potassium levels when administering digoxin and hydrochlorothiazide concurrently.

Digoxin Administration

  • Check the patient's chart for any signs of digoxin toxicity, such as nausea and vomiting, before administering the scheduled dose.

Increasing Serum Potassium Levels

  • Instruct the patient to consume potassium-rich foods, such as bananas and avocados, to increase serum potassium levels.

Common Side Effects

  • Nitrates, beta-blockers, and calcium channel blockers can cause headaches, dizziness, and fatigue.

Hydrochlorothiazide Effects

  • Expect a decrease in serum potassium levels, blood pressure, and blood volume.

Spironolactone Administration

  • Check the patient's medication profile for any signs of cirrhosis, as spironolactone is contraindicated in these patients.
  • Monitor for signs of hyperkalemia, such as muscle weakness and palpitations.

Hydrochlorothiazide Precautions

  • Patients with a history of kidney disease or gout may require caution when taking hydrochlorothiazide.

Low-Renin Hypertension Treatment

  • African American patients may be prescribed calcium channel blockers or thiazide diuretics as first-line therapy.

Drug Classes and Side Effects

  • Angiotensin-converting enzyme (ACE) inhibitors can cause cough and hyperkalemia.
  • Calcium channel blockers can cause dizziness, headache, and hypotension.
  • Beta blockers can cause bradycardia, fatigue, and dizziness.

Lisinopril Side Effects

  • Monitor for signs of hyperkalemia, such as muscle weakness and palpitations.

Furosemide Administration

  • Monitor for signs of hypokalemia, such as muscle weakness, leg cramps, and heart palpitations.

Digoxin Immune Fab

  • Mechanism of action: binds to digoxin in the bloodstream, neutralizing its effects.

Heart Failure Treatment

  • Diuretics, such as furosemide, are used as first-line therapy for reducing fluid volume.

Chronotropic Drugs

  • Affect the heart rate, increasing or decreasing it.

Sublingual Nitroglycerin Storage

  • Instruct the patient to store sublingual nitroglycerin tablets in a cool, dry place, away from light.

Nitroglycerin Patch Administration

  • Instruct the patient to remove the patch after 12-14 hours and apply a new one to prevent tolerance.

Beta Blockers and Angina

  • Reduce the frequency and severity of angina episodes by decreasing heart rate and blood pressure.

Angiotensin-Converting Enzyme (ACE) Inhibitors

  • Description: inhibit the conversion of angiotensin I to angiotensin II, reducing blood pressure.

Captopril Teaching

  • Instruct the patient to take captopril at the same time every day, with or without food.

Nonpharmacologic Methods for Blood Pressure Reduction

  • Lifestyle modifications, such as weight loss, exercise, and stress reduction, can help lower blood pressure.

Diuretics

  • Two functions: increase urine production and reduce blood pressure.
  • Normal potassium level range: 3.5-5.5 mmol/L.

Priority Assessment

  • Patients with a history of asthma, heart failure, or kidney disease require priority assessment when taking certain medications.

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