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Silvestri Chapter 51MM

Silvestri Chapter 51MM

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 051 (edited file)—"Cardiovascular Medications"10/14/08, Page 1 of 17, 0 Figure(s), 0 Table(s), 21 Box(es)
51: Cardiovascular Medications
PRACTICE QUESTIONS
1. A nurse reinforces discharge instructions to a postoperative client taking warfarin sodium(Coumadin). Which statement by the client indicates the need for further teaching?1. “I will take Ecotrin for my headaches because it is coated.”2. “I will be certain to limit my alcohol consumption.”3. “I will take my pills every day at the same time.”4. “I have already called my family to pick up a Medic Alert bracelet.”Answer: 1Rationale: Ecotrin is an aspirin-containing product and should be avoided. Excessive alcoholconsumption should be avoided when taking warfarin sodium. Taking prescribed medication atthe same time increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.Test-Taking Strategy: Use the process of elimination. Note the key words,
need for further teaching 
. These words indicate a false response question and that you need to select theincorrect client statement. Recalling that warfarin sodium is an anticoagulant and that Ecotrin isan aspirin-containing product will direct you to option 1. Review client teaching points relatedto warfarin sodium if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process/EvaluationContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005
.Philadelphia: W.B. Saunders, p. 1122.2. A client taking digoxin (Lanoxin) has a serum potassium level of 3.0 mEq/L and iscomplaining of anorexia. The physician orders a digoxin level to be obtained to rule out digoxintoxicity. The nurse checks the results of the test, knowing that the therapeutic serum level for digoxin is which of the following?1. 0.1 to 0.5 ng/mL2. 0.3 to 0.8 ng/mL3. 0.5 to 2 ng/mL4. 1 to 3 ng/mLAnswer: 3Rationale: The therapeutic serum digoxin level ranges from 0.5 to 2.0 ng/mL.Test-Taking Strategy: Knowledge of the therapeutic serum digoxin level is necessary to answer the question. Review this level if you had difficulty with this question.Level of Cognitive Ability: KnowledgeClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: PharmacologyReferences: Chernecky, C., & Berger, B. (2004).
 Laboratory tests and diagnostic procedures
(4th ed.). Philadelphia: W.B. Saunders, p. 477.
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 051 (edited file)—"Cardiovascular Medications"10/14/08, Page 2 of 17, 0 Figure(s), 0 Table(s), 21 Box(es)
Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005
. Philadelphia: W.B.Saunders, p. 326.3. Heparin sodium (Liquaemin) by subcutaneous injection is prescribed for a client. Whenadministering the medication, the nurse would:1. Use a 23- to 25-gauge, 1-inch needle.2. Aspirate before injection.3. Apply heat after the injection.4. Administer with a 25- to 27-gauge, ⅝-inch needle.Answer: 4Rationale: For subcutaneous heparin sodium injection, a 25- to 27-gauge, ⅜- to ⅝-inch needle isused to prevent tissue trauma and inadvertent intramuscular injection. A 1-inch needle wouldinject the heparin sodium into the muscle. The application of heat may affect the absorption of the heparin. Aspiration prior to injection is avoided with heparin sodium.Test-Taking Strategy: Use the process of elimination. Recalling the anatomy of muscle andsubcutaneous layers of tissue will assist in directing you to option 4. If you had difficulty withthis question, review the principles related to heparin administration.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: PharmacologyReference: McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St.Louis: Mosby, p. 625.4. A client is taking hydrochlorothiazide (HydroDIURIL, HCTZ) without taking any form of electrolyte supplement. The nurse would encourage intake of which of the following foods?1. Canned pears2. Oranges3. Cranberry juice4. ApplesauceAnswer: 2Rationale: Hydrochlorothiazide is a potassium-losing diuretic, and clients are at risk for hypokalemia. Potassium is found in many foods, especially unprocessed foods, manyvegetables, fruits and fresh meats. Because potassium is very water-soluble, foods that are prepared in water are often lower in potassium than the same foods cooked another way (e.g., boiled versus baked potato). Clients who need potassium added to the diet are encouraged totake in these foods. Many salt substitutes are also high in potassium.Test-Taking Strategy: Focus on the name of the medication to assist in determining that it is adiuretic. Evaluating food choices in terms of their water content and according to how highly processed they are may be a helpful approach for some questions related to potassium. In thisquestion, note that each of the incorrect options is processed to some degree and has a high water content. Review foods high in potassium if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Adult Health/Cardiovascular 
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 051 (edited file)—"Cardiovascular Medications"10/14/08, Page 3 of 17, 0 Figure(s), 0 Table(s), 21 Box(es)
References: Lehne, R. (2004).
 Pharmacology for nursing care
(5th ed.). Philadelphia: W.B.Saunders, p. 409. Nix, S. (2005).
Williams
 
basic nutrition and diet therapy
(11th ed.). St. Louis: Mosby, p. 137.5. A 51-year-old client is admitted to the hospital with a diagnosis of myocardial infarction andis started on streptokinase (Streptase) therapy. The nurse determines that the client’s wifeunderstands the purpose of the medication if she states that it is used to:1. Thin the blood.2. Slow the clotting of the blood.3. Dissolve any clots in the coronary arteries.4. Prevent further clots from forming in the coronary arteries.Answer: 3Rationale: Streptokinase converts plasminogen in the blood to plasmin. Plasmin is an enzymethat digests or dissolves fibrin clots wherever they exist. Option 1, 2, and 4 describe mechanismsof action of heparin sodium (Liquaemin) and warfarin sodium (Coumadin).Test-Taking Strategy: Focus on the name of the medication, recalling that it is a thrombolytic.Remember that streptokinase dissolves clots. This will direct you to option 3. Review thismedication if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/EvaluationContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005
.Philadelphia: W.B. Saunders, p. 989.6. A client is being treated for moderate hypertension and has been taking diltiazem (Cardizem)for several months. The client is seen by the physician, and Prinzmetal's angina is diagnosed.The nurse planning care for the client understands that which action of the medication will provide a therapeutic effect for this new diagnosis?1. Increases oxygen demands within the myocardium2. Prevents influx of calcium ions in vascular smooth muscle3. Leads to an increase in calcium absorption in the vascular smooth muscle4. Increases the force of contraction of ventricular tissuesAnswer: 2Rationale: Diltiazem is a calcium channel blockers that inhibits calcium influx through the slowchannels of the membrane of smooth muscle cells. Calcium channel blockers decreasemyocardial oxygen demands and blocks calcium channels, thereby decreasing the force of contraction of the ventricular tissue.Test-Taking Strategy: Focus on the name of the medication and recall that it is a calcium channel blocker. Note the relation of the medication classification and option 2. Review the action of calcium channel blockers if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/PlanningContent Area: PharmacologyReference: Hodgson, B., & Kizior, R. (2005).
Saunders nursing drug handbook 2005.

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