Nokea
The nurse is teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering calcium channel blockers?
- A. Atrial fibrillation
- B. Hypertension
- C. Peripheral vascular disease
- D. Systolic heart failure
Correct Answer: D
Rationale: Calcium channel blockers, especially non-dihydropyridines, are contraindicated in systolic heart failure due to their negative inotropic effects. They may be used in atrial fibrillation, hypertension, or peripheral vascular disease.
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The nurse is caring for a client with the following clinical data. Based on the vital signs, which medications would the nurse clarify with the primary healthcare provider (PHCP) prior to administration? See the exhibit. Select all that apply.
- A. Atenolol 50 mg PO Daily
- B. Spironolactone 50 mg PO Daily
- C. Albuterol 2.5 mg via nebulizer Daily
- D. Fentanyl 50 mcg IV Push q 6 hours PRN Pain
- E. Modafinil 100 mg PO Daily
Correct Answer: A
Rationale: Without specific vital signs provided, atenolol (a beta-blocker) may need clarification if the client has low heart rate (bradycardia) or low blood pressure, as it can exacerbate these conditions. Spironolactone, albuterol, fentanyl, and modafinil are less likely to require clarification based solely on vital signs unless specific contraindications (e.g., severe hypotension or respiratory distress) are present.
The nurse is counseling a client with congestive heart failure (CHF) about newly prescribed torsemide. The nurse determines that the teaching has been effective when the client plans to
- A. decreases their dietary potassium.
- B. record their daily urinary output.
- C. measure their weight daily.
- D. take their blood pressure and pulse daily.
Correct Answer: C
Rationale: Torsemide, a loop diuretic, requires daily weight monitoring to assess fluid status in CHF. Decreasing potassium is incorrect (risk of hypokalemia), and urinary output or vital signs monitoring is less critical.
A nurse is caring for a client receiving digoxin. The client's most recent digitalis level was 2.5 ng/mL (0.5-2 ng/mL). The nurse should take which action? Select all that apply.
- A. Withhold the client's scheduled dose
- B. Administer the dose, as prescribed
- C. Assess the client's 24-hour urinary output
- D. Assess the client's most recent sodium level
- E. Assess the client's heart rate and rhythm
- F. Obtain a prescription for an echocardiogram
Correct Answer: A,E
Rationale: A digitalis level of 2.5 ng/mL indicates toxicity, so the nurse should withhold the dose (A) and assess heart rate and rhythm (E) for signs like bradycardia. Urinary output, sodium levels, and echocardiograms are not directly related to immediate toxicity management.
The clinic nurse is caring for a 38-year-old male
Item 2 of 6
Nurses' Notes
1456 - 38-year-old male reports to the clinic for an annual physical examination and to establish care. The client reports no acute concerns but does admit to gaining a few pounds over the past several months. The client reports having decreased physical activity. He reports his dietary habits have changed because of his job, where he relies on fast food for breakfast and lunch. On assessment, the client is alert and completely oriented to person, place, and situation. The skin is warm and dry—patches of darkening and thickening of the skin around the skin folds. Lung sounds are clear; S1/S2 heart tones are auscultated. Peripheral pulses palpable, 2+. Bowel sounds are active in all quadrants. He denies any dysuria and reports his sex drive has decreased over the past several months. He reports occasional constipation, which causes him to use stool softeners. He reported no medical or surgical history besides an appendectomy four years ago. His parents are living, his mother is being treated for ovarian cancer, and his father has hypothyroidism and had a myocardial infarction two years ago. He recently started taking daily over-the-counter aspirin because of his father's cardiovascular disease. He takes a multivitamin 'when he remembers.' He is separated from his wife and currently going through what he describes as a bitter divorce which has been 'stressing him out.' He has one child. He denies using tobacco products but drinks one to two glasses of wine weekly. Current weight 269 pounds (122.27 kilograms); Body Mass Index 29; 40 inches (102 cm) waist size. Oral temperature 98.6°F (37° C) Pulse 92 Respiratory Rate 17 Blood Pressure 141/92 mm Hg Pulse oximetry 96% on room air
The nurse reviews the nurses' notes and vital signs. Select the additional diagnostic data necessary to help interpret the findings
- A. Basic metabolic panel (BMP)
- B. Lipid panel
- C. Colonoscopy
- D. Thyroid panel
- E. Prostate-specific antigen (PSA)
- F. 24-hour urine collection
Correct Answer: A,B,D
Rationale: BMP (to assess glucose and electrolytes), lipid panel (to evaluate cardiovascular risk), and thyroid panel (due to family history of hypothyroidism) are necessary to interpret findings like hypertension, obesity, and skin changes. Colonoscopy, PSA, and 24-hour urine collection are not directly relevant.
The nurse is teaching a client who has hypertension about the newly prescribed medication, diltiazem. Which of the following should the nurse include in the teaching?
- A. A nagging cough can occur as a side effect of the medication.
- B. This medication may cause you to go to the bathroom more often.
- C. Avoid taking the medication with grapefruit juice.
- D. You will need to increase your dietary intake of potassium-rich foods.
Correct Answer: C
Rationale: Diltiazem, a calcium channel blocker, interacts with grapefruit juice, which can increase drug levels. Cough, increased urination, and potassium intake are not associated with diltiazem.