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A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving the therapeutic effect based on which of the following results?
2. Activated partial thromboplastin time of 60 seconds
718. A nurse provides discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching?
4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
719. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. A physician prescribes a digoxin level to rule out digoxin toxicity. A nurse checks the results, knowing that which of the following is the therapeutic serum level (range) for digoxin?
1. 0.5 to 2 ng/mL
720. A client is being treated with procainamide (Procanbid) for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?
4. Auscultate the client's apical pulse and obtain a blood pressure.
721. A nurse is monitoring a client who is taking propranolol (Inderal). Which assessment data would indicate a potential serious complication associated with propranolol?
2. The development of audible expiratory wheezes
722. A nurse is caring for a client receiving a heparin intravenous (IV) infusion. The nurse anticipates that which laboratory study will be prescribed to monitor the therapeutic effect of heparin?
4. Activated partial thromboplastin time
723. A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which of the following is a priority nursing intervention?
3. Monitor for signs of bleeding.
724. A nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. The nurse understands that which of the following are concerns related to the administration of this medication?
3. Hypokalemia, hyperglycemia, sulfa allergy
725. A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education?
4. "I'll continue my nicotinic acid from the health food store."
726. A client is on nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client would indicate an understanding of the instructions?
4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."
727. A 66-year-old client complaining of not feeling well is seen in a clinic. The client is taking several medications for the control of heart disease and hypertension. These medications include atenolol (Tenormin), digoxin (Lanoxin), and chlorothiazide (Diuril). A tentative diagnosis of digoxin toxicity is made. Which of the following assessment data would support this diagnosis?
3. Double vision, loss of appetite, and nausea
728. A client is being treated for acute congestive heart failure with intravenously administered bumetanide (Bumex). The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment?
3. Monitoring blood pressure
729. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit?
1. Protamine sulfate
730. A client is receiving thrombolytic therapy with a continuous infusion of streptokinase (Streptase). The client suddenly becomes extremely anxious and complains of itching. A nurse hears stridor and on examination of the client notes generalized urticaria and hypotension. Which of the following should be the priority action of the nurse?
2. Stop the infusion and call the physician.
731. A client is admitted with pulmonary embolism and is to be treated with streptokinase (Streptase). A nurse would report which of the following assessments to the physician before initiating this therapy?
3. Blood pressure of 198/110 mm Hg
1. A newly admitted client takes digoxin 0.25 mg/day. The nurse knows that which is the serum therapeutic range for digoxin?
b.0.5 to 2.0 ng/mL
2. The client's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level?
a.It is in the high (elevated) range
3. The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
d.Pulse below 60 beats/min and irregular rate
4. The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?
a. The beta blocker should be abruptly stopped when another cardiac drug is prescribed.
5. When a client first takes a nitrate, the nurse expects which symptom that often occurs?
6. The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
c.Decrease heart rate and decrease myocardial contractility
7. The health care provider is planning to discontinue a client's beta blocker. What instruction should the nurse give the client regarding the beta blocker?
b. The beta blocker should NOT be abruptly stopped; the dose should be tapered down.
8. The beta blocker acebutolol (Sectral) is prescribed for dysrhythmias. The nurse knows that what is the primary purpose of the drug?
c.To block the beta1-adrenergic receptors in the cardiac tissues
1. A client is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. What type of electrolyte imbalance does the nurse expect to occur?
3. A nurse is teaching a client who has diabetes mellitus and is taking hydrochlorothiazide 50 mg/day. The teaching should include the importance of monitoring which levels?
d. Serum glucose (sugar)
4. A client has heart failure and is prescribed Lasix. The nurse is aware that furosemide (Lasix) is what kind of drug?
c.High-ceiling (loop) diuretic
6. For the client taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?
b. To increase the serum potassium level
7. The client has been receiving spironolactone (Aldactone) 50 mg/day for heart failure. The nurse should closely monitor the client for which condition?
8. A client who has angina is prescribed nitroglycerin. The nurse reviews which appropriate nursing interventions for nitroglycerin? (Select all that apply.)
a.Have client lie down when taking a nitroglycerin sublingual tablet.
b.Teach client to repeat taking a tablet in 5 minutes if chest pain persists.
e.Warn client against ingesting alcohol while taking nitroglycerin.
1. A client's blood pressure (BP) is 145/90. According to the guidelines for determining hypertension, the nurse realizes that the client's BP is at which stage?
c.Stage 1 hypertension
2. The nurse acknowledges that the first-line drug for treating this client's blood pressure might be which drug?
4. The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?
5. The nurse explains that which beta blocker category is preferred for treating hypertension?
a. Beta1 blocker
6. Captopril (Capoten) has been ordered for a client. The nurse teaches the client that ACE inhibitors have which common side effects?
d.Constant, irritating cough
7. A client is prescribed losartan (Cozaar). The nurse teaches the client that an angiotensin II receptor blocker (ARB) acts by doing what?
b.Blocking angiotensin II from AT1 receptors
8. During an admission assessment, the client states that she takes amlodipine (Norvasc). The nurse wishes to determine whether or not the client has any common side effects of a calcium channel blocker. The nurse asks the client if she has which signs and symptoms? (Select all that apply.)
e. Ankle edema
1. When a newly admitted client is placed on heparin, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.)
b.Acute myocardial infarction
c.Deep vein thrombosis (DVT)
d.Cerebrovascular accident (CVA) (stroke)
2. A client who received heparin begins to bleed, and the physician calls for the antidote. The nurse knows that which is the antidote for heparin?
3. A client is prescribed enoxaparin (Lovenox). The nurse knows that low-molecular-weight heparin (LMWH) has what kind of half-life?
a.A longer half-life than heparin
4. The nurse is teaching a client about clopidogrel (Plavix). What is important information to include?
c. Bleeding may increase when taken with aspirin.
5. A client is prescribed dalteparin (Fragmin). LMWH is administered via which route?
6. A client is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?
7. A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ratio (INR) is 3.8. The nurse would consider the INR to be what?
b. Elevated INR range
8. Cilostazol (Pletal) is being prescribed for a client with coronary artery disease. The nurse knows that which is the major purpose for antiplatelet drug therapy?
d.To suppress platelet aggregation
9. A client is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following a coronary angioplasty?
10. A client is admitted to the emergency department with an acute myocardial infarction. Which drug category does the nurse expect to be given to the client early for the prevention of tissue necrosis following blood clot blockage in a coronary or cerebral artery?
c. Thrombolytic agent
1. A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate?
2. The nurse knows that the client's cholesterol level should be within which range?
a.150 to 200 mg/dL
3. A client's high-density lipoprotein (HDL) is 60 mg/dL. What does the nurse acknowledge concerning this level?
b.It is the desired level of HDL.
4. The nurse realizes that which is the laboratory test ordered to determine the presence of the amino acid that can contribute to cardiovascular disease and stroke?
5. A client is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?
6. The client is taking rosuvastatin (Crestor). What severe skeletal muscle adverse reaction should the nurse observe for?
7. When a client is taking ezetimibe (Zetia), she asks the nurse how it works. The nurse should explain that Zetia does what?
a. Inhibits absorption of dietary cholesterol in the intestines.
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