The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement made by the client
... [Show More] reflects the need for further teaching?
A. "I will take my pills every day at the same time."
B. "I will be certain to avoid alcohol consumption."
C. "I have already called my family to pick up a Medic-Alert bracelet."
D. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." - D. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."
Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.
A client is receiving digoxin (Lanoxin) daily. The nurse suspects digoxin toxicity after collecting data noting which signs and symptoms? Select all that apply.
A. Visual disturbances
B. Nausea and vomiting
C. Serum digoxin level of 2.3 ng/mL
D. Serum potassium level of 3.9 mEq/L
E. Apical pulse rate of 63 beats per minute - A. Visual disturbances
B. Nausea and vomiting
C. Serum digoxin level of 2.3 ng/mL
Signs and symptoms of digoxin toxicity include gastrointestinal signs, bradycardia, visual disturbances, and hypokalemia. A therapeutic serum digoxin level ranges from 0.5 to 2 ng/mL. The serum potassium level should be 3.5 mEq/L or higher. The apical pulse must be 60 or higher beats per minute.
Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level?
A. Prothrombin time (PT) of 21 seconds
B. Thrombocyte count of 100,000 cells/mm3
C. International normalized ratio (INR) of 2.3
D. Activated partial thromboplastin time (aPTT) of 55 seconds - D. Activated partial thromboplastin time (aPTT) of 55 seconds
The aPTT will assess the therapeutic effect of Heparin sodium. The PT and INR will assess for the therapeutic effect of warfarin sodium (Coumadin). A decreased thrombocyte count can cause bleeding.
The nurse is monitoring a client who is taking propranolol (Inderal LA). Which data collection finding would indicate a potential serious complication associated with propranolol?
A. The development of complaints of insomnia
B. The development of audible expiratory wheezes
C. A baseline blood pressure of 150/80 mm Hg, followed by a blood pressure of 138/72 mm Hg after two doses of the medication
D. A baseline resting heart rate of 88 beats/min, followed by a resting heart rate of 72 beats/min after two doses of the medication - B. The development of audible expiratory wheezes
Audible expiratory wheezes may indicate a serious adverse reaction: bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.
Isosorbide mononitrate (Imdur) is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action should the nurse suggest to the client?
A. Cut the dose in half.
B. Discontinue the medication.
C. Take the medication with food.
D. Contact the health care provider (HCP). - C. Take the medication with food.
Isosorbide mononitrate is an antianginal medication. Headache is a frequent side effect of isosorbide mononitrate and usually disappears during continued therapy. If a headache occurs during therapy, the client should be instructed to take the medication with food or meals. It is not necessary to contact the HCP unless the headaches persist with therapy. It is not appropriate to instruct the client to discontinue therapy or adjust the dosages.
A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention?
A. Monitor for renal kidney failure.
B. Monitor psychosocial status.
C. Monitor for signs of bleeding.
D. Have heparin sodium available. - C. Monitor for signs of bleeding.
Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin is given after thrombolytic therapy, but the question is not asking about follow-up medications.
A client with coronary artery disease complains of substernal chest pain. After checking the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg, sublingually. After 5 minutes, the client states, "My chest still hurts." Which appropriate actions should the nurse should take? Select all that apply.
A. Call a code blue.
B. Contact the registered nurse.
C. Contact the client's family.
D. Collect more data on the client's pain level.
E. Check the client's blood pressure.
F. Administer a second nitroglycerin, 0.4 mg, sublingually. - B. Contact the registered nurse.
D. Collect more data on the client's pain level.
E. Check the client's blood pressure.
F. Administer a second nitroglycerin, 0.4 mg, sublingually.
The usual guideline for administering nitroglycerin tablets for a hospitalized client with chest pain is to administer one tablet every 5 minutes PRN for chest pain, for a total dose of three tablets. The registered nurse should be notified of the client's condition, who will then notify the health care provider immediately. In this situation, because the client is still complaining of chest pain, the nurse would administer a second nitroglycerin tablet. The nurse would assess the client's pain level and check the client's blood pressure before administering each nitroglycerin dose. There are no data in the question that indicate the need to call a code blue. In addition, it is not necessary to contact the client's family unless the client has requested this.
The 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 statement made by the client indicates the need for further teaching?
A. "Constipation and bloating might be a problem."
B. "I'll continue to watch my diet and reduce my fats."
C. "Walking a mile each day will help the whole process."
D. "I'll continue my nicotinic acid from the health food store." - D. "I'll continue my nicotinic acid from the health food store."
Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin is to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.
A client is on nicotinic acid (niacin) for hyperlipidemia, and the nurse reinforces instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions?
A. "It is not necessary to avoid the use of alcohol."
B. "The medication should be taken with meals to decrease flushing."
C. "Clay-colored stools are a common side effect and should not be of concern."
D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid should decrease the flushing." - D. "Ibuprofen (Motrin IB) taken 30 minutes before the nicotinic acid should decrease the flushing."
Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti-inflammatory drug can be taken 30 minutes before taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals; this will decrease gastrointestinal upset. Taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).
The nurse is planning to administer hydrochlorothiazide (HydroDIURIL) to a client. Which are concerns related to the administration of this medication?
A. Hypouricemia, hyperkalemia
B. Increased risk of osteoporosis
C. Hypokalemia, hyperglycemia, sulfa allergy
D. Hyperkalemia, hypoglycemia, penicillin allergy - C. Hypokalemia, hyperglycemia, sulfa allergy
Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.
A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia?
A. Sweating
B. Tachycardia
C. Nervousness
D. Low blood glucose level - D. Low blood glucose level
β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms of acute hypoglycemia, which would include nervousness, increased heart rate, and sweating. Therefore, the client receiving this medication should adhere to the therapeutic regimen and monitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.
A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started on triamterene (Dyrenium) as well. The client asks the nurse why both medications are required. Which response is the most accurate to give to the client?
A. Both are weak potassium-excreting diuretics.
B. The combination of these medications prevents renal toxicity.
C. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective.
D. Triamterene is a potassium-retaining diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic. - D. Triamterene is a potassium-retaining diuretic, whereas hydrochlorothiazide is a potassium-excreting diuretic.
Potassium-retaining diuretics include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-excreting diuretics. This combination is useful when medication and dietary supplement of potassium is not appropriate. The use of two different diuretics does not prevent renal toxicity. Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification of diuretics.
A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse that he cannot taste food normally since beginning the medication 2 weeks ago. Which suggestion would provide the best support for the client?
A. Tell the client not to take the medication with food.
B. Suggest that the client taper the dose until taste returns to normal.
C. Inform the client that impaired taste is expected and generally disappears in 2 to 3 months.
D. Tell the client that a request will be made to the health care provider (HCP) to change the prescription. - C. Inform the client that impaired taste is expected and generally disappears in 2 to 3 months.
ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nurse can tell the client that this effect usually disappears in 2 to 3 months, even with continued therapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and 4 are inappropriate actions. Taking this medication with or without food does not affect absorption and action. The dosage should never be tapered without HCP approval, and the medication should never be stopped abruptly.
The nurse is planning to administer amlodipine (Norvasc) to a client. The nurse should plan to check which before giving the medication?
A. Respiratory rate
B. Blood pressure and heart rate
C. Heart rate and respiratory rate
D. Level of consciousness and blood pressure - B. Blood pressure and heart rate
Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiac contraction. Before administering a calcium channel blocking agent, the nurse should check the blood pressure and heart rate, which could both decrease in response to the action of this medication. This action will help to prevent or identify early problems related to decreased cardiac contractility, heart rate, and conduction.
The nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?
A. Heart rate
B. Temperature
C. Respirations
D. Blood pressure - A. Heart rate
Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force of myocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse counts the apical heart rate for 1 full minute before administering the medication. If the pulse rate is less than 60 beats/minute in an adult client, the nurse would withhold the medication and report the pulse rate to the registered nurse, who would then contact the health care provider.
The nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoring for adverse effects associated with this medication. Which should the nurse recognize as potential adverse effects? Select all that apply.
A. Nausea
B. Tinnitus
C. Hypotension
D. Hypokalemia
E. Photosensitivity
F. Increased urinary frequency - B. Tinnitus
C. Hypotension
D. Hypokalemia
Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency. Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional side effect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur as a result of sudden volume depletion.
The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil) orally daily. The nurse evaluates the need for further teaching when the client makes which statement?
A. "I can skip a dose once a week."
B. "I need to change my position slowly."
C. "I take the pill after breakfast each day."
D. "If I get a bad headache, I should call my health care provider immediately." - A. "I can skip a dose once a week."
Lisinopril is an antihypertensive angiotensin-converting enzyme inhibitor. The usual dosage range is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatic hypotension, tachycardia, and angioedema. Specific client teaching points include taking one pill a day, not stopping the medication without consulting the health care provider (HCP), and monitoring for side effects and adverse reactions. The client should notify the HCP if side effects occur.
A 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 a beta blocker, digoxin (Lanoxin), and a diuretic. A tentative diagnosis of digoxin toxicity is made. Which assessment data supports this diagnosis? [Show Less]