When administering an antiarrhythmic agent which of the following assessment parameters is the most important for the nurse to evaluate?

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1. Which of the following clients is at greatest risk for digital toxicity?

1. A 25-year-old client with congenital heart disease
2. A 50-year-old client with CHF
3. A 60-year-old client after myocardial infarction
4. An 80-year-old client with CHF

2. Which of the following is a contraindication for digoxin administration?

1. Blood pressure of 140/90
2. Heart rate above 80
3. Heart rate below 60
4. Respiratory rate above 20

3. The action of medication is inotropic when it:

1. Decreased afterload
2. Increases heart rate
3. Increases the force of contraction
4. Is used to treat CHF

4. Which is the MOST appropriate action for the nurse to take before administering digoxin?

1. Monitor potassium level
2. Assess blood pressure
3. Evaluate urinary output
4. Avoid giving with thiazide diuretic

5. The therapeutic drug level for digoxin is:

1. 0.1-2.0 ng/mg
2. 1.0-2.0 ng/mg
3. 0.1-0.5 ng/mg
4. 0.5-2.0 ng/mg

6. Blurred vision or halos are signs of:

1. Subtherapeutic digoxin levels
2. Digoxin toxicity
3. Nothing related to digoxin
4. Corneal side effects of digoxin

7. Amrinone (Inocor) is used for short term therapy for CHF and acts by which of the following mechanisms?

1. Increasing stroke volume and heart rate
2. Slowing ventricular rate and increasing cardiac output
3. Vasodilating and increasing peripheral vascular resistance
4. Increasing cardiac output and enhancing renal perfusion

8. Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the following nursing actions is necessary?

1. Record sodium level.
2. Administer loading dose over 15 minutes.
3. Assess CV status.
4. Review medication regimen to identify if client is on IV furosemide (Lasix).

9. Johanna has ventricular ectopy, which of the following drugs is the first line used to treat her condition?

1. quinidine (Cardioquin)
2. digoxin (Lanoxin)
3. procainamide ( Pronestyl)
4. lidocaine (Xylocaine)

10. Class IA antiarrhythmic agents have little effect on:

1. AV node
2. SA node
3. Purkinje fibers
4. Bundle of His

11. Which of the following drugs can cause severe hematologic disorders?

1. digoxin (Lanoxin)
2. quinidine (Cardioquin)
3. disopyramide (Norpace)
4. procainamide (Pronestyl)

12. Which of the following ECG findings alerts the nurse that the client needs an antiarrhythmic?

1. Normal sinus rhythm
2. Sinus bradycardia
3. Sinus arrhythmia
4. Frequent ventricular ectopy

13. When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate?

1. ECG
2. Pulse rate
3. Respiratory rate
4. Blood pressure

14. Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias?

1. Serum chemistries
2. Complete blood counts
3. Drug levels
4. None of the above

15. Which of the following drugs should be used only in situations in which the client can be very closely monitored, such as a critical care unit?

1. bretylium (Bretylol)
2. digoxin (Lanoxin)
3. quinidine (Cardioquin)
4. inderal (Propranolol)

16. The most toxic antiarrhythmic agent is:

1. digoxin (Lanoxin)
2. lidocaine (Xylocaine)
3. amiodarone (Cordarone)
4. quinidine (Cardioquin)

17. Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following actions?

1. Increased speed of conduction and gluconeogenesis
2. Bronchodilation and increased heart rate, contractility, and conduction
3. Increased vasodilation and enhanced myocardial contractility
4. Bronchoconstriction and increased heart rate

18. Following norepinephrine (Levophed) administration, it is essential to the nurse to assess:

1. electrolyte status
2. color and temperature of toes and fingers
3. capillary refill
4. ventricular arrhythmias

19. Norepinephrine (Levophed) is contraindicated in which of the following conditions?

1. Hypovolemic shock
2. Neurogenic shock
3. Blood pressures above 80-100 mmHg (systolic)
4. Decreased renal perfusion

20. When administering dopamine (Intropin), it is most important for the nurse to know that:

1. the drug’s action varies according to the dose.
2. the drug may be used instead of fluid replacement.
3. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline.
4. the lowest dose to produce the desired effect should be used.

21. Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the following conditions except:

1. septic shock
2. congestive heart failure
3. arrhythmias
4. pulmonary congestion

22. Conduction defects will most likely be an adverse associated with the use of:

1. verapamil
2. nifedipine
3. diltiazem
4. felodipine

23. Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator effect?

1. diltiazem
2. nifedipine
3. nimodipine
4. verapamil

24. Which of the following adverse reactions is found more often in volume-depleted elderly clients?

1. Bradycardia
2. Conduction defects
3. Ankle edema
4. Hypotension

25. Which of the following calcium channel blockers is used to counteract or prevent cerebral vasospasm?

1. verapamil
2. nimodipine
3. nifedipine
4. felodipine

26. Which of the following effects of calcium channel blockers causes a reduction in blood pressure?

1. Increased cardiac output
2. Decreased peripheral vascular resistance
3. Decreased renal blood flow
4. Calcium influx into cardiac muscles

27. Jason James is taking ß blockers, all of the following should be included in his assessment except:

1. Pulmonary function tests
2. Baseline ECG
3. Glucose level
4. Blood pressure

28. Routine laboratory monitoring in clients taking ß blockers should include:

1. Sodium
2. Glucose
3. Thyrotropin
4. Creatine phosphokinase

29. Competitive antagonism of which of the following occurs at ß receptor sites?

1. Catecholamines
2. Adrenergic sites
3. Acetylcholine
4. Norepinephrine

30. ß blockers should be avoided in which of the following conditions?

1. Bronchoconstriction
2. Hypertension
3. Angina
4. Myocardial infarction

31. As a knowledgeable nurse, you know that the action of nitrates is:

1. Smooth muscle contraction
2. Vasoconstriction
3. Smooth muscle relaxation
4. Increase preload

32. A 50-year-old client is prescribed to take nitrate each day for his condition. As a competent nurse, you know the result of nitrate administration is:

1. Decreased myocardial oxygen demand
2. Increased myocardial oxygen demand
3. Increased left ventricular end-diastolic volume
4. Increased atrial pressure

33. A student nurse is asked to give an example of a long-acting nitrate. He is correct by saying:

1. nitroglycerin sublingual
2. nitroglycerin IV
3. isosorbide PO
4. nitroglycerin transmucosal

34. When nitrates are administered early to the acute MI client, the effect is:

1. Hypotension
2. Bradycardia
3. Reduced mortality
4. Reduced morbidity

35. When teaching about nitrate administration, the nurse should instruct the client to:

1. Change position slowly.
2. Take pulse daily.
3. Reduce salt intake.
4. Chew the sustained-release tablets.

36. ACEs participate in the renin-angiotensin-aldosterone system to have which of the following physiologic effects?

1. Inhibit conversion of angiotensin II to angiotensin I
2. Vasoconstriction and sodium depletion
3. Promote sodium and water retention
4. Stimulate vasodilation and inhibit sodium depletion

37. Nurse Margie just administered an ACE inhibitor to her client. Before ambulating the client for the first time after administration, the nurse should monitor for:

1. Hypokalemia
2. Irregular heartbeat
3. Edema
4. Hypotension

38. Mira is managing her hypertension with an ACE inhibitor. Which of the following statements stated by her indicates a need for further instruction?

1. “I should not take my pills with food.”
2. “I need to increase my intake of orange juice, bananas, and green vegetables.”
3.  “I will avoid coffee, tea, and colas.”
4.  “I will use salt substitutes that are not high in potassium.”

39. Pepito is a hypertensive client who has been placed on captopril (Capoten). He states, “Dr. del Mundo keeps changing my pills and none are working. I feel like a guinea pig.” Which of the following responses by the nurse would be most appropriate?

1. “It often takes a while before the right medication is found.”
2. “The doctor is just trying to help you control your blood pressure.”
3. “The action of this drug is to work on both the arteries and to remove excess fluids.”
4. “This drug is used when other drugs have failed.”

40. The action of an ACE inhibitor interrupts the renin-angiotensin-aldosterone mechanism, thereby producing which of the following?

1. Reduced renal blood flow
2. Reduced sodium and water excretion
3. Increased peripheral vascular resistance
4. Increased sodium excretion and potassium reabsorption

41. Raymund is reviewing on cardiovascular drugs for his upcoming exam. For a well-prepared student, he should know that vasodilators are agents that:

1. Relax smooth muscles
2. Are used to treat hypotension
3. Stimulate the adrenergic receptors of peripheral sympathetic nerves
4. Cause respiratory depression

42. As a competent nurse, you are aware that vasodilators are used mainly to treat:

1. Diabetes
2. Hypertension
3. Atrial fibrillation
4. Hypotension

43. The drug/drugs used most commonly to treat peripheral or cerebral vascular obstructive disease is/are:

1. pentoxifylline (Trental)
2. cyclandelate (Cyclan)
3. isoxsuprine (Vasodilan)
4. All of the above

44. In a 50-year-old widower who had a transient ischemic attack, what is the most common vasodilator used for his treatment?

1. norepinephrine
2. dopamine (Intropin)
3. papaverine (Pavabid)
4. nitroprusside (Nitropress)

45. For a client taking drugs to treat peripheral vascular disease, it is important to provide health education about:

1. Smoking cessation
2. Developing a proper balance between rest and activity
3. Proper foot care
4. All of the above

46. A clinical instructor asks a nursing student about aldosterone antagonist. The student is correct by saying that aldosterone antagonists:

1. Create an osmotic gradient
2. Inhibit the exchange of sodium for potassium
3. Cause metabolic acidosis
4. Work poorly in the presence of endogenous aldosterone

47. Which of the following is a potential side effect of IV furosemide (Lasix)?

1. Drowsiness
2. Diarrhea
3. Cystitis
4. Hearing loss

48. A 68-year-old client with a history of mild CHF and glaucoma is receiving IV mannitol (Osmitrol) to decrease intraocular pressure. The nurse would monitor the client for signs and symptoms of:

1. Fluid volume excess
2. Fluid volume deficit
3. Hyperkalemia
4. Hypernatremia

49. All potassium-sparing diuretics:

1. Are required supplements during blood transfusion
2. Enhance aldosterone action
3. Cause hypokalemia
4. Are weak diuretics

50. Which of the following clients is most likely to experience adverse effects from treatment with diuretics?

1. A 21-year-old student
2. A 40-year-old unmarried man
3. A 60-year-old widower
4. A 75-year-old man

51. Kylie is reviewing drugs related to cardiovascular therapies. She should be aware that the desired action of lipid-lowering agents is to:

1. Decrease HDL
2. Increase TC
3. Increase LDL
4. Increase HDL

52. For lipid-lowering agents to be successful, drug therapy must lower:

1. HDL
2. LDL
3. Total fat
4. All of the above

53. As a competent nurse, you know that the most significant contraindication for therapy with lipid-lowering agent is:

1. Renal disease
2. Diabetes
3. Liver disease
4. Cardiac disease

54. Which of the following vitamins may not be absorbed properly when giving bile acid sequestrants?

1. Vitamin B
2. Vitamin C
3. Vitamin B12
4. Vitamin K

55. Which of the following lipid-lowering agents has the common side effect of constipation?

1. lovastatin (Mevacor)
2. colestipol (Colestid)
3. gemfibrozil (Lopid)
4. niacin (Nicotinic acid)

56. Parental anticoagulants work by disrupting:

1. Conversion of prothrombin to thrombin
2. Formation of thromboplastin
3. Vitamin K-dependent clotting factors
4. Conversion of prothrombin to fibrin

57. SC heparin should be administered in the:

1. Flank
2. Abdominal fat
3. Leg
4. Gluteal area

58. The half-life of heparin is:

1. 10 minutes
2. 1 to 1.5 hours
3. 8 to 12 hours
4. 1 to 2 days

59. Which drug is used to stop bleeding associated with heparin overdose?

1. urokinase (Abbokinase)
2. aminocaproic acid (Amicar)
3. vitamin K (AquaMEPHYTON)
4. protamine sulfate (Protamine)

60. During warfarin (Coumadin) administration, the nurse can expect that the initial extension of PT occurs within _____ hours after therapy begins.

1. 1 to 2
2. 4 to 6
3. 8 to 12
4. 12 to 24

61. A nurse is providing instructions to a client who is receiving warfarin sodium (Coumadin). Which statement made by the client indicates the need for further instruction?

1. “I will observe the color of my urine and stool”.
2. “I will take Ecotrin (Enteric coated aspirin) for my headaches”.
3. “I will avoid drinking alcohol”.
4. “I will take the medicine daily at the same time”.

62. A nurse is caring for a client receiving a heparin intravenous (IV) infusion. The nurse expects that which of the following laboratory will be prescribed to monitor the therapeutic effect of heparin?

1. Prothrombin time (PT).
2. Activated partial thromboplastin time (aPTT).
3. Hematocrit (Hgb).
4. Hemoglobin (Hct).

63. A client with atrial fibrillation is receiving a continuous heparin infusion at 1,000 units/hr. The nurse observes that the client is receiving the therapeutic effect based on which of the following results?

1. Activated partial thromboplastin time of 30 seconds.
2. Activated partial thromboplastin time of 60 seconds.
3. Activated partial thromboplastin time of 120 seconds.
4. Activated partial thromboplastin time of 15 seconds.

64. A client is receiving intravenous heparin therapy. The nurse ensures the availability in which of the following medication?

1. Acetylcysteine (Mucomyst).
2. Calcium gluconate.
3. Vitamin K (Mephyton).
4. Protamine sulfate.

65. A client is receiving a continuous infusion of streptokinase (Streptase). The client suddenly complaints of a difficulty of breathing, itchiness, and nausea.  Which of the following should be the priority action of the nurse?

1. Stop the infusion and notify the physician.
2. Administer protamine sulfate and provide oxygen therapy.
3. Administer antihistamine then continue the infusion.
4. Slow the infusion and administer oxygen.

66. A client with deep vein thrombosis is receiving Streptokinase (Streptase). The nurse would notify the physician if which of the following assessment is noted?

1. A temperature of 99.2° Fahrenheit.
2. A pulse rate of 99 beats per minute.
3. A respiratory rate of 25 breaths per minute.
4. A blood pressure of 185/110 mm Hg.

67. A client who is receiving streptokinase therapy suddenly had a nose bleeding. The nurse ensures the availability in which of the following medication?

1. Vitamin K (Mephyton).
2. Deferoxamine (Desferal).
3. Aminocaproic acid (Amicar).
4. Diphenhydramine (Benadryl).

68. A nurse is providing health teachings regarding antiplatelet medications. Which of the following is not true regarding the use of this medication?

1. Antiplatelet medication inhibits the aggregation of platelets in the clotting process, thereby prolonging bleeding time.
2. Antiplatelet medications cannot be used with anticoagulants.
3. Take the medication with food to prevent gastrointestinal upset.
4. A routine bleeding time is monitored during the therapy.

69. A client is receiving Procainamide (Procanbid) for the treatment of ventricular arrhythmia. The client suddenly complains of nausea and drowsiness. Which of the intervention should the nurse do first?

1. Check the blood pressure and heart rate.
2. Do a 12-lead electrocardiogram right away.
3. Measure the heart rate on the rhythm strip.
4. Give hydralazine (Apresoline) per orem.

70. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following?

1. Observe for neurological changes.
2. Monitor for any signs of renal failure.
3. Check the food diary.
4. Observe for signs of bleeding.

71. A nurse is caring a client who is taking digoxin (Lanoxin) 0.25mcg tab once a day. The client suddenly complaints of anorexia, nausea, vomiting, and diarrhea. The physician is ruling a digoxin toxicity. As a nurse, you know the therapeutic digoxin rate is?

1. 0.25-0.5 ng/ml.
2. 0.5-2 ng/ml.
3. 1.5-3 ng/ml.
4. 3.5-4.5 ng/ml.

72. A nurse is monitoring a client who is taking Carvedilol (Coreg CR). Which of the following assessment made by the nurse would warrant a possible complication with the use of this medication?

1. Baseline blood pressure of 160/100 mm hg followed by a blood pressure of 120/70 mm hg after 3 doses.
2. Baseline heart rate of 97 bpm followed by a heart rate of 62 bpm after 3 doses.
3. Complaints of nightmares and insomnia.
4. Complaints of dyspnea.

73. A nurse is interviewing a client who is about to receive metoprolol. Upon the history taking, the client is also taking insulin. Which of the following statements made by the nurse will correctly explain the possible interaction of these medications?

1. “This medication will maintain the blood sugar level on a normal range”.
2. “This medication will have no effect in the blood sugar level”.
3. “This medication may mask some of the symptoms of hypoglycemia such as tremor, palpitation, and rapid heartbeat.
4. “This medication may mask some of the symptoms of hyperglycemia such as headache, increased thirst, and blurred vision”.

74. A client is about to receive Metolazone (Zaroxolyn). The nurse in charge understands that which of the following laboratory results are related to the administration of the medication?

1. Hyperkalemia and hypocalcemia.
2. Hyperkalemia and hypoglycemia.
3. Hypouricemia and hypoglycemia.
4. Hypokalemia and hyperglycemia.

75. A client with congestive heart failure is being treated with Torsemide (Demadex). The nurse obtains the following vital signs: Blood pressure of 100/65 mm hg; pulse rate of 91 beats per minute; and respiration of 25 breaths per minute? Which of the following will be the priority assessment of the nurse after the initiation of the dose?

1. Urine output.
2. Serum potassium and calcium.
3. Blood pressure.
4. Weight.

76. A nurse is giving instruction to a client who is receiving Cholestyramine (Questran) for the treatment of hyperlipidemia. Which of the following statements made by the client indicates the need for further instructions?

1. “This medication comes in a powder that must be mixed with juice or water before administration”.
2. “I will avoid eating foods rich in saturated fats”.
3. “I will continue taking nicotinic acid as part of the treatment”.
4. “Constipation, belching and heartburn are some of the side effects”.

77. A nurse is providing instructions to a client who is on nicotinic acid for the treatment of hyperlipidemia. Which statement made by the nurse indicates a comprehension of the instructions?

1. “I should take aspirin 30 minutes before nicotinic acid”.
2. “I will drink alcohol in moderation”.
3. “Yellowing of the skin is a common side effect”.
4. “This medication is taken on an empty stomach”.

78. A nurse is monitoring a client who is taking Digoxin (Lanoxin). All of which are the side effects associated with the medication, except?

1. Anorexia.
2. Blurred vision.
3. Diarrhea.
4. Tremors.

79. A nurse is interviewing a patient who is about to receive bumetanide (Bumex). Which of the following is a concern related to the administration of the medication?

1. Penicillin allergy.
2. Sulfa allergy.
3. Soy containing allergy.
4. Cephalosporin allergy.

80. A client arrives in the emergency with complaints of chest pain and is diagnosed with acute MI. A morphine 4mg IV was given 5 minutes ago. Which of the following assessment made by the nurse indicates a further immediate action?

1. Respiratory rate from 20 bpm to 12 bpm.
2. Blood pressure from 120/70 to 100/60 mmHg.
3. The client still complains of chest pain with a pain scale of 2/10.
4. Cardiac rate of 103 bpm and a normal sinus rhythm of the ECG.

1. Answer: D. An 80-year-old client with CHF. Extremely old clients are at greater risk for digitalis toxicity. Remember when it comes to adversity, the very old and very young are always at highest risk.
2. Answer: C. Heart rate below 60. The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.
3. Answer: C. Increases the force of contraction. Inotropic drugs increase the force of contraction. Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an indication for use not an action of inotropic drug.
4. Answer: A. Monitor potassium level. Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.
5. Answer: D. 0.5-2.0 ng/mg. This is the correct therapeutic range for digoxin. Every nurse should know this information.
6. Answer: B. Digoxin toxicity. Halos is a hallmark sign of digoxin toxicity. A, C and D are incorrect because subtherapeutic digoxin levels have no such effects.
7. Answer: A. Increasing stroke volume and heart rate. The action of amrinone (Inocor) is to increase stroke volume, ejection fraction, and heart rate. Lanoxin, not amrinone, slows ventricular rate and increases cardiac output. The vasodilator effect of amrinone decreases peripheral vascular resistance. Any increase in cardiac output will enhance renal perfusion; this is not just specific to amrinone.
8. Answer: D. Review medication regimen to identify if client is on IV furosemide (Lasix). Milrinone (Primacor) is incompatible with IV furosemide (Lasix), and many clients with CHF are taking furosemide. Assessing potassium, not sodium, is essential. Choice B is not done before administration but during administration. Assessment of CV status is not specific for milrinone and is indicated for any drug that affects the circulatory system.
9. Answer: D. lidocaine (Xylocaine). Lidocaine is the only choice used to treat ventricular ectopy. A and C are class IA antiarrhythmics. Digoxin is a cardiac glycoside.
10. Answer: B. SA node. Class IA antiarrhythmics have little effect on the SA node.
11. Answer: D. procainamide (Pronestyl). Pronestyl is known for this serious side effect. Associate Pronestyl with plasma — P and P. This drug is known for its hematologic side effects.
12. Answer: D. Frequent ventricular ectopy. Ventricular ectopy can be a life-threatening arrhythmia; therefore, the client needs an arrhythmic. Other choices are not arrhythmias that need to be treated.
13. Answer: A. ECG. The ECG is the most important parameter to assess. B, C, and D need to be monitored, but the ECG is the most important.
14. Answer: C. Drug levels. Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect.
15. Answer: A. bretylium (Bretylol). Among the choices, this is the only agent that must be monitored this closely. B, C, and D are given to outpatients as oral preparations.
16. Answer: C. amiodarone (Cordarone). This is the most toxic drug and should be used only if other less toxic agents have been tried. Digoxin, on the other hand, is cardiotonic, not antiarrhythmic agent. B and D are not known for their toxicity.
17. Answer: B. Bronchodilation and increased heart rate, contractility, and conduction. Bronchodilation results from stimulated beta receptors, and cardiac effects result from the stimulation of ß1 receptors. Choice A does not address respiratory effects of medication. Choice C is incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not bronchoconstriction, results from ß2 activity.
18. Answer: B. color and temperature of toes and fingers. Because decreased perfusion is a side effect of norepinephrine (Levophed), the nurse must check circulation frequently. Capillary refill is not a reliable indication of perfusion in a shock state. Choices A and D are not specific for norepinephrine.
19. Answer: A. Hypovolemic shock. Norepinephrine (Levophed) is contraindicated in hypovolemia. Neurogenic shock is an indication for norepinephrine use. Norepinephrine is given to maintain a systolic blood pressure of 80-100 mmHG. Decreased renal perfusion is an adverse reaction.
20. Answer: C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline. The nurse is responsible for knowing compatible solutions before administering dopamine (Intropin). It is important to know that drug action varies by dose, but the physician is responsible for determining the dose. Dopamine should not be used instead of fluid replacement. Choice D is incorrect because, although it is true, it is not the nurse’s primary concern. It is a collaborative action in which the physician is involved in determining the rate.
21. Answer: C. arrhythmias. Dobutamine (Dobutrex) is not used to treat arrhythmias. Choices A, B, and D are conditions are conditions that respond to dobutamine.
22. Answer: A. verapamil. Verapamil (Calan) has the strongest chronotropic effect and will cause a delay in conduction at the SA and AV nodes.
23. Answer: B. nifedipine. Nifedipine has the strongest peripheral smooth muscle dilator effect of all the calcium channel blockers. Other choices have less of a vasodilator effect.
24. Answer: D. Hypotension. Hypotension is more likely to occur in the elderly. Choices A, B, and C may occur but are not necessarily increased in frequency in elderly clients.
25. Answer: B. nimodipine. Nimodipine is given in the neurologic client to prevent cerebral vasospasm. Choices A, C, and D are given in cardiac disease and in the management of hypertension only.
26. Answer: B. Decreased peripheral vascular resistance. One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.
27. Answer: A. Pulmonary function tests. Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers.
28. Answer: B. Glucose. ß blockers influence glucose metabolism. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed.
29. Answer: A. Catecholamines. Catecholamine receptor sites are blocked by the action of ß-blocking agents. Adrenergic sites may be blocked, but the more appropriate response is catecholamine receptors. Acetylcholine is not affected by ß blockers. Norepinephrine is a catecholamine.
30. Answer: A. Bronchoconstriction. ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.
31. Answer: C. Smooth muscle relaxation. Nitrates cause smooth muscle relaxation, vasodilation, reduction of preload, and improved blood flow to the myocardium. Other choices have opposite effect of nitrates.
32. Answer: A. Decreased myocardial oxygen demand. Nitrate administration will result in reduced preload and a decrease in myocardial oxygen demand and left ventricular end-diastolic volume.
33. Answer: C. isosorbide PO. Isosorbide is one of the most frequently administered long-acting nitrates. PO nitrates are longer acting than IV or SL agents.
34. Answer: C. Reduced mortality. Research has shown that when nitrates are administered early to the acute MI client, the effect is reduced mortality, infarct size, infarct extension, and related complications. Hypotension will result from nitrate administration, but it is not the reason for prescribing the drug. Tachycardia rather than bradycardia is more likely to occur with nitrate administration. The morbidity is already present because the client has the pain.
35. Answer: A. Change position slowly. Clients taking nitrates should change position slowly to avoid orthostatic hypotension. It is not necessary to take the pulse before taking this drug. It is also not necessary to change the diet while taking this drug. It is contraindicated to chew sustained-release tablets.
36. Answer: C. Promote sodium and water retention. Angiotensin is a potent vasoconstrictor that stimulate the release of aldosterone. Aldosterone release promotes sodium and water retention. The conversion of angiotensin I to II is not inhibited. Aldosterone promotes sodium retention not depletion. Vasoconstriction not vasodilation results.
37. Answer: D. Hypotension. ACE inhibitors prevent vasoconstriction and lower blood pressure, placing the client at greater risk for postural (orthostatic) hypotension. ACE inhibitors reduce potassium excretion placing the client at risk for hyperkalemia. ACE inhibitors do not affect heart rate. ACE inhibitor promote sodium excretion thereby decreasing edema.
38. Answer: B. “I need to increase my intake of orange juice, bananas, and green vegetables.”. The client needs to understand the risk of hyperkalemia and foods to eat in moderation. Taking medications with food will decrease therapeutic effects of ACE inhibitors. Excessive amounts of caffeine should be avoided. Avoidance of salt substitutes that are high in potassium decrease the risk of hyperkalemia.
39. Answer: D. “This drug is used when other drugs have failed.” This response provides accurate information about the medication. Choice A placates the client and provides no information about the new medication. Choice B is defensive. Although choice C is true, there is no information provided to motivate the client.
40. Answer: D. Increased sodium excretion and potassium reabsorption. The inhibition of aldosterone increases sodium excretion and reduces potassium excretion. ACE inhibitors increases renal blood flow. Excretion of sodium and water is enhanced by ACE inhibitors. Peripheral vascular resistance is decreased by vasodilation effect of ACE inhibitors.
41. Answer: A. Relax smooth muscles. Vasodilators relax smooth muscle. They are used to treat hypertension, not hypotension. Stimulating the adrenergic receptors of peripheral sympathetic nerves causes blood vessels to contract. Choice D is not an action of vasodilators.
42. Answer: B. Hypertension. Vasodilators are used to treat hypertension. They are not used to treat diabetes. Atrial fibrillation is not treated with vasodilators. Vasodilators are not used to treat hypotension.
43. Answer: D. All of the above. All are vasodilators used primarily to treat peripheral or cerebral vascular obstructive disease.
44. Answer: D. nitroprusside (Nitropress). Nitroprusside (Nitropress) is used in this situation. A and B are sympathomimetics used to treat hypotension. Papaverine is contraindicated in myocardial depressant states.
45. Answer: D. All of the above. An important component in the treatment of peripheral vascular disease is health education on preventing further injury to ischemic tissues. Medication therapy is only one aspect.
46. Answer: B. Inhibit the exchange of sodium for potassium. Aldosterone antagonists compete with endogenous aldosterone and prevent sodium reabsorption in exchange for potassium elimination. Aldosterone antagonists work on inhibiting the action of aldosterone rather than creating an osmotic gradient. Aldosterone antagonist do not cause metabolic acidosis. Aldosterone antagonists must work in the presence of endogenous aldosterone.
47. Answer: D. Hearing loss. Patients receiving large doses of loop diuretics are at risk for developing ototoxicity.
48. Answer: A. Fluid volume excess. Mannitol’s osmotic effect extends to the bloodstream, where increased osmotic pressure draws fluid into the vascular space, thus elevating intravascular volume.
49. Answer: D. Are weak diuretics. Potassium-sparing diuretics are not potent diuretics when used alone. They are used as adjunctive therapy with other diuretics to minimize potassium loss. Potassium-sparing diuretics given during blood transfusions tend to cause hyperkalemia because potassium is present in the transfusion. These drugs block aldosterone’s effects. These drugs cause hyperkalemia, not hypokalemia.
50. Answer: D. A 75-year-old man. Elderly clients are more sensitive to the effects of diuretics.
51. Answer: D. Increase HDL. The desired effect of lipid-lowering agents is to decrease cardiac risk by lowering TC, TG, and LDL and increasing or maintaining HDL.
52. Answer: B. LDL. An elevated LDL is the most significant risk factor for the development of atherosclerosis; therefore, for drug therapy to be effective, LDL must be reduced.
53. Answer: C. Liver disease. All lipid-lowering agents except the bile acid sequestrants are potentially hepatotoxic, so the most significant contraindication is liver disease.
54. Answer: D. Vitamin K. Vitamin K absorption may be reduced when giving these drugs. The only fat-soluble vitamin here is vitamin K, which is synthesized in the liver.
55. Answer: A. lovastatin (Mevacor). Mevacor is known to cause constipation.
56. Answer: A. Conversion of prothrombin to thrombin. Parenteral anticoagulants such as heparin work by disrupting conversion of prothrombin to thrombin. Tissue thromboplastin is formed in the extrinsic pathway as tissue is damaged. Oral anticoagulants work by interfering with vitamin K-dependent clotting factors. Prothrombin does not convert to fibrin.
57. Answer: B. Abdominal fat. Heparin should be given in the abdominal area around the umbilicus, deep into the fat.
58. Answer: B. 1 to 1.5 hours. The half-life of heparin is 60 to 90 minutes. This is important to know when bleeding occurs during heparin administration.
59. Answer: D. protamine sulfate (Protamine). Protamine is the drug used to reverse the adverse effects of bleeding that occurs with heparin administration.
60. Answer: C. 8 to 12. Initial extension of PT occurs within 8 to 12 hours after warfarin therapy begins.
61. Answer: B. “I will take Ecotrin (Enteric coated aspirin) for my headaches”. Ecotrin is an aspirin-containing product and should be avoided due to the risk of bleeding.
62. Answer: B. Activated partial thromboplastin time (aPTT). Activated partial thromboplastin time assess the therapeutic level of heparin.
    • Option A: Assess the therapeutic level of warfarin sodium (Coumadin).
    • Options C and D: Measures the aspect of the red blood cells.
63. Answer: B. Activated partial thromboplastin time of 60 seconds. The normal range for activated partial thromboplastin time is 20-36 seconds. The activated partial thromboplastin time must be 1.5 to 2.5 times the normal value, the client’s Appt would be considered therapeutic if it was 60 seconds.
64. Answer: D. Protamine sulfate. Protamine sulfate is the antidote that reverses the anticoagulant effects of heparin by binding to it.
    • Option A is the antidote for acetaminophen toxicity.
    • Option B is the antidote for magnesium sulfate toxicity.
    • Option C is the antidote for warfarin sodium toxicity.
65. Answer: A. Stop the infusion and call the physician. Severe allergic reaction to streptokinase requires immediate discontinuation of Streptokinase,then notify the physician and administer an adrenergic, antihistamine, and/or corticosteroid agents as ordered.
66. Answer: D. A blood pressure of 185/100 mm Hg. Thrombolytic therapy is contraindicated with uncontrolled hypertension (systolic BP >180 mm Hg and/or diastolic BP >110 mm Hg) because of the risk of cerebral hemorrhage.
    • Options A, B, and C may be present during the therapy but will not warrant the immediate knowledge of the physician before starting the therapy.
67. Answer: C. Aminocaproic acid (Amicar). Bleeding can be reversed with the use of aminocaproic acid as an antidote for streptokinase.
    • Option A is the antidote for warfarin sodium toxicity.
    • Option B is the antidote for iron toxicity.
    • Option D is an antihistamine that can be used for any allergic reaction.
68. Answer: B. Antiplatelet medications cannot be used with anticoagulants. Antiplatelet and anticoagulant therapies are effective in keeping a clot from forming or stopping the growth of one.
69. Answer: A. Check the blood pressure and heart rate. The client is experiencing signs of procainamide toxicity, the priority nursing action is to obtain vital signs immediately.
    • Options B and C are done after checking the vital signs.
    • Option D will cause hypotension.
70. Answer: D. Observe for signs of bleeding. Bleeding is the priority concern for a client taking thrombolytic medication.
    • Options A and B are monitored but are not the primary concern.
    • Option C is not related to the use of medication.
71. Answer: B. 0.5-2 ng/ml. The therapeutic level of digoxin is 0.5-2 ng/ml.
72. Answer: D. Complaints of dyspnea. Complaints of dyspnea is a sign of bronchospasm which is one of the serious complication of beta blockers.
    • Options A and B shows a decrease in the blood pressure and heart rate which are expected in this therapy.
    • Option C is a side effect of this medication.
73. Answer: C. “This medication may mask some of the symptoms of hypoglycemia such as tremor, palpitation, and rapid heartbeat. Beta-blockers such as metoprolol may increase the risk of hypoglycemia in patients receiving insulin. In addition, beta-blockers may mask some of the symptoms of hypoglycemia such as tremor, palpitation, and rapid heartbeat, making it more difficult to recognize an oncoming episode.
74. Answer: D. Hypokalemia and hyperglycemia. Metolazone is a thiazide diuretic that may put clients risk for hypokalemia, hyperglycemia, hyperlipidemia, hypercalcemia and hyperuricemia.
75. Answer: C. Blood pressure. The priority assessment in this situation will be the monitoring of the blood pressure because hypotension poses a risk in this medication.
    • Options A, B, and D are monitored but they are not the priority.
76. Answer: C. “I will continue taking nicotinic acid as part of the treatment”. A combination of Cholestyramine (Questran) and nicotinic acid damages the liver.
    • Options A, B, and D are true regarding this medication.
77. Answer: A. “I should take aspirin 30 minutes before nicotinic acid”. The use of aspirin or a nonsteroidal anti-inflammatory drug 30 minutes before decreases flushing which is a side effect of taking nicotinic acid.
    • Option B: Drinking alcohol will cause liver abnormalities.
    • Option C is a sign of liver dysfunction and should be immediately informed the physician.
    • Option D: This medication is taken with meals to decrease gastrointestinal upset.
78. Answer: D. Tremors. Signs of digoxin toxicity are as follows, anorexia, nausea, vomiting, diarrhea, and blurred vision.
79. Answer: B. Sulfa allergy. Loop diuretics such as bumetanide are sulfa-based medications, and a client with sulfa allergy is at risk for an allergic reaction.
80. Answer: C. The client still complains of chest pain with a pain scale of 2/10. The goal for the client with an acute myocardial infarction is to eliminate the pain. Even pain related at a level of 2/10 should be managed with an additional dose of morphine.
    • Options A, B, and D: although hypotension, respiratory depression, and tachycardia are the side effects of morphine but they do not require further action at this time.

What would you monitor when administering an antiarrhythmic?

When giving an antiarrhythmic medication which of the following assessment parameters is the most important for the nurse to evaluate?

What are the key nursing implementation considerations for patients receiving antiarrhythmic agents?

How are antiarrhythmic drugs administered?