Questions and Answers
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 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?
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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?
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Which condition indicates an excessive dose of digoxin?
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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?
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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.
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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.
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Beta blockers increase the patient's urine output.
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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?
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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?
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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?
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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?
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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?
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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?
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Which two functions are associated with diuretics?
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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?
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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?
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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?
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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)
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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)
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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?
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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?
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Which mechanism of action describes how digoxin immune Fab works?
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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?
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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)?
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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?
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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?
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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?
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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)
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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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