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Questions and Answers
Which patient being treated with a beta blocker for hypertension will receive priority assessment by the nurse?
Which patient being treated with a beta blocker for hypertension will receive priority assessment by the nurse?
Which rationale would the nurse provide when teaching a patient about how a calcium channel blocker lowers blood pressure?
Which rationale would the nurse provide when teaching a patient about how a calcium channel blocker lowers blood pressure?
Which side effect(s) would a nurse monitor for after administering lisinopril to a patient? Select all that apply.
Which side effect(s) would a nurse monitor for after administering lisinopril to a patient? Select all that apply.
Which patient parameter would cause the nurse to hold the dose of metoprolol?
Which patient parameter would cause the nurse to hold the dose of metoprolol?
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Which parameter does chronotropic drugs affect?
Which parameter does chronotropic drugs affect?
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Which concomitantly administered drug will cause the nurse to monitor serum potassium levels in a patient receiving digoxin?
Which concomitantly administered drug will cause the nurse to monitor serum potassium levels in a patient receiving digoxin?
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Which condition indicates an excessive dose of digoxin?
Which condition indicates an excessive dose of digoxin?
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Which effect do beta blockers have on classic stable angina?
Which effect do beta blockers have on classic stable angina?
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Which side effect is common with nitrates, beta blockers, and calcium channel blockers?
Which side effect is common with nitrates, beta blockers, and calcium channel blockers?
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Which phrase describes how a diuretic lowers blood pressure?
Which phrase describes how a diuretic lowers blood pressure?
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Which information would the nurse share when teaching a patient about the administration of furosemide? Select all that apply.
Which information would the nurse share when teaching a patient about the administration of furosemide? Select all that apply.
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Which action would the nurse perform first if a patient presents with leg cramps, nausea, and blurred vision?
Which action would the nurse perform first if a patient presents with leg cramps, nausea, and blurred vision?
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Beta blockers increase myocardial contractility.
Beta blockers increase myocardial contractility.
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Beta blockers increase the patient's urine output.
Beta blockers increase the patient's urine output.
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Beta blockers decrease sympathetic stimulation of the heart.
Beta blockers decrease sympathetic stimulation of the heart.
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Which statement made by a patient demonstrates a need for further instruction regarding the use of sublingual nitroglycerin?
Which statement made by a patient demonstrates a need for further instruction regarding the use of sublingual nitroglycerin?
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Based on the findings in the patient's chart, which action would the nurse take regarding digoxin?
Based on the findings in the patient's chart, which action would the nurse take regarding digoxin?
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Which food should the patient consume to increase serum potassium levels?
Which food should the patient consume to increase serum potassium levels?
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Which drug is a calcium channel blocker?
Which drug is a calcium channel blocker?
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Which results would the nurse expect to be decreased if reviewing a patient on hydrochlorothiazide?
Which results would the nurse expect to be decreased if reviewing a patient on hydrochlorothiazide?
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Which finding indicates a need to contact the health care provider if administering spironolactone?
Which finding indicates a need to contact the health care provider if administering spironolactone?
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Which intervention(s) would the nurse include for a patient taking spironolactone?
Which intervention(s) would the nurse include for a patient taking spironolactone?
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Which action would the nurse perform first after reviewing the patient's health record before administering furosemide?
Which action would the nurse perform first after reviewing the patient's health record before administering furosemide?
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Which nursing intervention is a priority for a patient receiving furosemide who has muscle weakness, leg cramps, and heart palpitations?
Which nursing intervention is a priority for a patient receiving furosemide who has muscle weakness, leg cramps, and heart palpitations?
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Which category of diuretics may cause hypotension, hyperglycemia, hearing impairment, and gout?
Which category of diuretics may cause hypotension, hyperglycemia, hearing impairment, and gout?
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Which range is considered normal for a potassium level?
Which range is considered normal for a potassium level?
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Which two functions are associated with diuretics?
Which two functions are associated with diuretics?
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Which description is accurate regarding the action of angiotensin-converting enzyme inhibitors (ACEIs)?
Which description is accurate regarding the action of angiotensin-converting enzyme inhibitors (ACEIs)?
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Which statement by the patient indicates a need for further instruction if the nurse is teaching about captopril?
Which statement by the patient indicates a need for further instruction if the nurse is teaching about captopril?
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Which nonpharmacologic method(s) can be used to decrease blood pressure?
Which nonpharmacologic method(s) can be used to decrease blood pressure?
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Which drug(s) block angiotensin II from the angiotensin I receptors?
Which drug(s) block angiotensin II from the angiotensin I receptors?
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Which drug(s) would the nurse expect the primary health care provider to prescribe for an African American patient diagnosed with low-renin hypertension?
Which drug(s) would the nurse expect the primary health care provider to prescribe for an African American patient diagnosed with low-renin hypertension?
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Which drug class is associated with a constant, irritated, and nonproductive cough in some patients?
Which drug class is associated with a constant, irritated, and nonproductive cough in some patients?
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Which symptom will a nurse monitor in a patient with suspected digoxin toxicity? (Select all that apply)
Which symptom will a nurse monitor in a patient with suspected digoxin toxicity? (Select all that apply)
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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)
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)
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Which adverse effect would the nurse educate a patient about who has been prescribed diltiazem?
Which adverse effect would the nurse educate a patient about who has been prescribed diltiazem?
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Which action will be the nurse's priority when noting that the patient has a history of asthma and is prescribed propranolol?
Which action will be the nurse's priority when noting that the patient has a history of asthma and is prescribed propranolol?
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Which intervention would the nurse implement immediately for a patient newly prescribed digoxin who is concurrently prescribed furosemide?
Which intervention would the nurse implement immediately for a patient newly prescribed digoxin who is concurrently prescribed furosemide?
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Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?
Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?
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Which mechanism of action describes how digoxin immune Fab works?
Which mechanism of action describes how digoxin immune Fab works?
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Which outcome is expected with calcium channel blockers (CCBs)?
Which outcome is expected with calcium channel blockers (CCBs)?
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Which formulation of nitroglycerin is likely to have a large first-pass effect?
Which formulation of nitroglycerin is likely to have a large first-pass effect?
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Which drug class is used as the first line of therapy for reducing fluid volume in patients with heart failure (HF)?
Which drug class is used as the first line of therapy for reducing fluid volume in patients with heart failure (HF)?
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Which action by a nurse would be taken if the nurse observes the patient’s serum digoxin level to be 0.9 ng/mL?
Which action by a nurse would be taken if the nurse observes the patient’s serum digoxin level to be 0.9 ng/mL?
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Which instruction does a nurse give a patient about storing sublingual nitroglycerin tablets while traveling?
Which instruction does a nurse give a patient about storing sublingual nitroglycerin tablets while traveling?
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Which assessment would a nurse make before administering digoxin?
Which assessment would a nurse make before administering digoxin?
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Which instruction does a nurse provide a patient who reports headaches associated with administration of sublingual nitroglycerin?
Which instruction does a nurse provide a patient who reports headaches associated with administration of sublingual nitroglycerin?
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Which instruction does a nurse provide a patient who is prescribed nitroglycerin patches to prevent the development of tolerance to nitrates?
Which instruction does a nurse provide a patient who is prescribed nitroglycerin patches to prevent the development of tolerance to nitrates?
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Which rationale explains why a nurse would ask a patient newly prescribed digoxin to stop taking licorice supplementation?
Which rationale explains why a nurse would ask a patient newly prescribed digoxin to stop taking licorice supplementation?
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Which class of drugs is used in the treatment of angina pectoris? (Select all that apply)
Which class of drugs is used in the treatment of angina pectoris? (Select all that apply)
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Which statement by a nurse about the use of medicinal nitrates indicates effective understanding?
Which statement by a nurse about the use of medicinal nitrates indicates effective understanding?
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Study Notes
Digoxin Toxicity Symptoms
- Monitor for anorexia, nausea, vomiting, cardiac dysrhythmias, and visual disturbances like halo vision.
- Dry cough is linked to ACE inhibitors, not digoxin.
Discharge Teaching for Digoxin and Hydrochlorothiazide
- Advise patients to check pulse before taking digoxin; hold if under 60 bpm.
- Recommend a diet rich in potassium due to the risk of hypokalemia from thiazide diuretics.
- Caution against taking OTC medications without consulting a healthcare provider.
Adverse Effects of Diltiazem
- Educate about potential fluid retention manifesting as peripheral edema.
- Hyperkalemia is associated with propranolol, not diltiazem.
Managing Patients with Asthma on Propranolol
- Switch to a cardioselective beta blocker due to the risk of bronchospasm with nonselective beta blockers like propranolol.
Monitoring Patients on Digoxin and Furosemide
- Regularly check potassium levels, as furosemide can lead to hypokalemia, increasing digoxin toxicity risk.
Transdermal Nitroglycerin Teaching
- Apply the patch to a nonhairy, nonfatty area for optimal absorption.
- Do not remove the patch for headaches; this is a common and transient side effect.
- Avoid applying a second patch for chest pain; sublingual nitroglycerin is preferred.
Mechanism of Digoxin Immune Fab
- Functions by binding to digoxin molecules, facilitating their excretion via urine.
Calcium Channel Blockers (CCBs) Functions
- Reduce cardiac workload and afterload by preventing muscle contraction.
- Not suitable for treating acute myocardial infarction.
First-Pass Effect of Nitroglycerin
- Oral nitroglycerin undergoes significant first-pass metabolism in the liver, reducing its efficacy.
- Sublingual formulations bypass this effect for rapid action.
Diuretics as First-Line Therapy in Heart Failure
- Serve as the primary treatment for reducing fluid volume in heart failure patients.
Serum Digoxin Level Monitoring
- A level of 0.9 ng/mL is within the therapeutic range (0.8 - 2 ng/mL); administer the prescribed dose.
Storing Sublingual Nitroglycerin
- Keep tablets in original amber container away from heat and light to prevent decomposition.
Pre-Digoxin Administration Assessment
- Measure the apical pulse for one full minute; it should exceed 60 bpm before administering digoxin.
Managing Nitroglycerin Headaches
- Headaches are common and can be treated with acetaminophen; do not discontinue nitroglycerin.
Preventing Tolerance to Nitrates
- Implement a nitrate-free period of 8-12 hours daily by removing the nitroglycerin patch overnight.
Licorice Interaction with Digoxin
- Licorice can cause hypokalemia, increasing the risk of digoxin toxicity and should be discontinued.
Treatment for Angina Pectoris
- Beta blockers, nitrates/nitrites, and calcium channel blockers are all effective for managing angina.
Side Effects and Adverse Effects of Medicinal Nitrates
- Induce generalized vascular dilation; associated adverse effects include tachycardia and postural hypotension.
Accurate Information About Beta Blockers
- Decrease sympathetic stimulation of the heart, thereby reducing heart rate and blood pressure.
Incorrect Instruction Needs Further Teaching
- Patients should take a maximum of three nitroglycerin tablets every 5 minutes and seek help if pain persists.### Assessment Data and Laboratory Results
- Patient is oriented x4 but reports headache and double vision.
- Apical heart rate is 47 beats/minute with an irregular rhythm.
- Blood pressure reading is 108/62 mm Hg; respiratory rate is 13 breaths/minute.
- Temperature is 98.2°F; oxygen saturation stands at 97% on room air.
- Patient experienced two vomiting incidents and one episode of loose stool today.
- Bowel sounds are hyperactive; peripheral pulses are rated 1+ bilaterally.
- Laboratory results show glucose at 82 mg/dL, sodium at 142 mEq/L, potassium at 2.9 mEq/L, chloride at 98 mEq/L, BUN at 15 mg/dL, and creatinine at 0.8 mg/dL.
Actions for Patient Care
- Signs of possible digoxin toxicity include nausea, vomiting, irregular heart rate.
- Contact the healthcare provider (HCP) to obtain a serum digoxin level.
- Hold scheduled digoxin dose until the level is obtained.
- Initiate continuous telemetry monitoring to observe heart rate.
- Supplemental oxygen is only needed if oxygen saturation declines.
Dietary Recommendations for Potassium
- Educate the patient to increase potassium intake due to digoxin-related hypokalemia.
- Foods high in potassium include potatoes and orange juice.
- Broccoli, eggplant, and cauliflower are low in potassium and not recommended for increasing levels.
Medications and Drug Classifications
- Diltiazem is identified as a calcium channel blocker.
- Hydrochlorothiazide usage may lead to decreased chloride, potassium, and magnesium levels.
- Lisinopril presents a risk for hyperkalemia when combined with spironolactone.
- Monitor patients on spironolactone with attention to renal function and serum electrolytes.
- Furosemide requires careful monitoring for potassium levels, holding the medication if levels drop below normal.
Patient Education on Medications
- For ACE inhibitors like lisinopril, caution patients about the possibility of dry cough and hyperkalemia.
- Advise against abruptly stopping beta blockers to prevent rebound hypertension.
- Explain that calcium channel blockers reduce blood pressure by promoting vasodilation.
Non-Pharmacologic Interventions
- Recommend lifestyle changes to decrease blood pressure, including stress reduction, exercise, dietary salt restriction, smoking cessation, and reduced alcohol consumption.
Drug Mechanisms and Side Effects
- ACE inhibitors block the formation of angiotensin II and the release of aldosterone to manage blood pressure.
- Monitor potential side effects such as dry cough, hyperkalemia, and renal function in patients taking ACE inhibitors.
- Recognize that chronic drug use can lead to tolerance and varying physiological responses.
Risk Factors and Patient Priority
- Assess for patient history of conditions that may contraindicate diuretic therapy, such as gout.
- Give priority to patients who have discontinued beta blockers due to financial reasons, as they are at risk for rebound effects.
Monitoring Parameters
- Regularly monitor blood pressure, heart rate, serum electrolytes, and renal function in patients on diuretics and antihypertensive medications.### Heart and Drug Types
- Chronotropic drugs influence heart rate.
- Vasopressor drugs affect blood pressure.
- Dromotropic drugs impact the conduction velocity of electrical impulses in the myocardium.
- Inotropic drugs alter the strength of myocardial contractions.
Monitoring Potassium Levels
- Furosemide, a loop diuretic, promotes potassium excretion, increasing digoxin toxicity risk.
- Digoxin toxicity may cause severe outcomes when potassium levels are low (hypokalemia).
- Lisinopril (ACE inhibitor), Valsartan (angiotensin II-receptor blocker), and Spironolactone (potassium-sparing diuretic) do not typically reduce potassium levels significantly.
Signs of Digoxin Toxicity
- Halo vision (seeing colored rings around lights) indicates excess digoxin dosage.
- Other symptoms include anorexia, diarrhea, nausea, vomiting, bradycardia, palpitations, and confusion.
- Older adults are more susceptible to digoxin toxicity.
Effects of Beta Blockers
- Beta blockers decrease heart rate and myocardial contractility.
- They have no effect on variant angina but may help in managing stable angina.
Common Side Effects
- Nitrates, beta blockers, and calcium channel blockers can cause hypotension.
- Nifedipine may result in heartburn and heart failure.
- Hyperkalemia may occur with the use of propranolol.
Diuretics’ Mechanism on Blood Pressure
- Diuretics lower blood pressure by blocking sodium and water reabsorption from kidney tubules.
- This leads to increased urine flow and removal of excess fluid from the body.
Patient Education on Furosemide
- Advise sunscreen application to mitigate photosensitivity.
- Instruct patients to change positions slowly due to potential fluid loss.
- Encourage consumption of potassium-rich foods, such as bananas, to counteract potassium loss.
- Recommend administering the dose in the morning to avoid nocturia and sleep disturbance.
- Warn against using licorice supplements as they can worsen potassium loss.
Addressing Patient Symptoms
- Leg cramps, nausea, and blurred vision can signify hypokalemia and possible digoxin toxicity.
- Prioritize correcting the potassium level over administering oral digoxin or other medications.
- Monitor digoxin levels once potassium is stabilized, delaying insulin administration if needed.
- Orthostatic blood pressure checks can be performed after addressing acute symptoms.
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