Cardiovascular Pharmacology NCLEX RN

Cardiovascular Pharmacology NCLEX RN Related

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The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a client with septic shock
Item 1 of 1
Nurses' Notes
1400: Follow-up assessment after the infusion of 30 mL/kg of 0.9% saline bolus (1850 mL total) was infused. Vital signs: T 103.4° F (39.7° C), P 104, RR 22, BP 90/61, pulse oximetry reading 95% on room air.
1410: The physician was notified of the vital signs, and a verbal order for a dopamine drip was received for 5 mcg/kg/minute to titrate to a MAP of 65 mm Hg. The order was read back and verified.
1415: Dopamine infusion started in the client's right antecubital peripheral vascular access device.
1445: The client reports 'stinging' pain at the vascular access site. The site had erythema, swelling, and tenderness when touched. The infusion was stopped.

The nurse reviewed all nursing note entries and notified the physician of the vascular access device assessment findings. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress

  • A. Obtain a prescription for phentolamine, Flush the vascular access device, Aspirate any residual medication, Restart the infusion at a lower rate.
  • B. Extravasation, Hematoma, Infiltration, Phlebitis.
  • C. Urinary output, Neurovascular status of affected extremity, Drainage at vascular access site, Pain level.
Correct Answer: B, A, C

Rationale: The client is experiencing extravasation (B) due to dopamine causing stinging, erythema, and swelling. Actions include obtaining phentolamine (A, an antidote for vasopressor extravasation) and aspirating residual medication (A). Monitor neurovascular status (C) and pain level (C) to assess progress.

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The nurse is preparing to administer a prescribed dose of digoxin to an infant. The nurse should assess the apical heart rate to ensure it is at least

  • A. 70 beats-per-minute
  • B. 60 beats-per-minute
  • C. 90 beats-per-minute
  • D. 50 beats-per-minute
Correct Answer: C

Rationale: For infants, digoxin should be withheld if the apical heart rate is below 90-100 beats per minute to prevent toxicity, so 90 beats per minute is the minimum threshold.

The clinic nurse is caring for a 38-year-old male
Item 5 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]

Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.

Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.

Physician Orders
• 12-lead electrocardiogram (ECG)
• atenolol 25 mg by mouth daily
• pitavastatin 1 mg by mouth daily
• fenofibrate 45 mg by mouth daily with food

The nurse receives, reviews, and implements the physician orders. Complete the sentences below by choosing from the list of options. The nurse needs to obtain baseline ___ prior to administering atenolol because atenolol would be contraindicated if the client ___. The nurse understands that the prescribed fenofibrate is intended to ___. Prior to administering the prescribed pitavastatin, the nurse needs to obtain baseline ___.

  • A. electrocardiogram
  • B. had low liver enzymes.
  • C. had atrioventricular block.
  • D. reduce triglycerides.
  • E. urine analysis.
  • F. liver function tests.
  • G. c-reactive protein.
Correct Answer: A,C,D,F

Rationale: The nurse needs a baseline ECG (A) to check for atrioventricular block (C), a contraindication for atenolol. Fenofibrate is intended to reduce triglycerides (D). Baseline liver function tests (F) are needed for pitavastatin due to potential hepatotoxicity.

The nurse is caring for a client receiving a continuous infusion of norepinephrine. The nurse should plan to monitor which of the following for the client? Select all that apply.

  • A. Blood pressure
  • B. Intracranial pressure
  • C. Intravenous site
  • D. Urine output
  • E. Blood glucose
Correct Answer: A,C,D,E

Rationale: Norepinephrine, a vasopressor, requires monitoring blood pressure (to assess efficacy), IV site (for extravasation risk), urine output (to evaluate perfusion), and blood glucose (as it can cause hyperglycemia). Intracranial pressure is not typically monitored unless neurological issues are present.

The nurse is caring for a client with infective endocarditis. The nurse anticipates a prescription for which medication?

  • A. Nitroglycerin
  • B. Vancomycin
  • C. Atorvastatin
  • D. Aspirin
Correct Answer: B

Rationale: Vancomycin, an antibiotic, is used to treat infective endocarditis caused by bacterial infection. Nitroglycerin, atorvastatin, and aspirin are not indicated for this condition.

The nurse is caring for a client experiencing polyarthritis associated with rheumatic fever. The nurse anticipates a prescription for which medication?

  • A. Prazosin
  • B. Naproxen
  • C. Verapamil
  • D. Furosemide
Correct Answer: B

Rationale: Naproxen, an NSAID, is used to reduce inflammation and pain in polyarthritis associated with rheumatic fever. Prazosin, verapamil, and furosemide are not indicated for this condition.

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