NR293_ Pharmacology for Nursing Practice Week 4 Concepts. Clotting Coagulation Modifiers, Chamberlai

Week 4 Concepts: Clotting Stuvia.com - The Marketplace to Buy and Sell your Study Material

Coagulation Modifiers Prepare: Coagulation Modifiers

Coagulation Modifiers Coagulation modifiers are a group of medications that both promote and prevent clot formation as well as lysing a preforme clot and reversing the action of anticoagulants.

Warfarin Warfarin is an anticoagulant medication whose mechanism of action is to prevent clot formation by inhibiting particular clott factors.

Coagulation Modifier Drugs Coagulation modifier drugs is a class of medication that includes medications? heparin aspirin acetaminophen warfarin

Self Check: Hemostasis Review

Coagulation Cascade System The coagulation cascade system is triggered by an injury to a blood vessel, which then triggers either an intrinsic or an extrinsic pathway of intricate steps, each step triggering the next when clotting factors are/is activated. The ultimate result o this system is a large concentration of fibrin.

Reverse of the Coagulation Process The reverse of the coagulation process is the fibrinolytic system. Fibrinolysis is the breakdown of thrombi. This is an import part of hemostasis in order to prevent excessive coagulation, blocked blood vessels, or mobilized thrombi called an embolu

Self Check: Coagulation Modifier Drugs

Coagulation Modifiers The coagulation modifier drugs are broken down into several subclasses or categories based on their hemostasis reversal or promotion action. Which items are mechanisms of action for this class of drug? Select all that apply.

Thrombus prevention Thrombus mobilization Lysing of a preformed thrombus Anticoagulation reversal Thrombus promotion Antiplatelet reversal

Self Check: Mechanism of Action Mechanism of Action Which one of these coagulation modifier drugs has a mechanism of action that is to lyse a thrombus that has already formed? Match it to its subclass.

Mechanism of Action

Medication

Subclass

Alteplase

Thrombolytic

Reversal Drug Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply. aminocaproic acid apixaban Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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protamine sulfate vitamin K

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Reflect: Coagulation Modifiers Antifibrinolytics What is another term for antifibrinolytics?

Antithrombotics Antiplatelets Hemorheologics Hemostatics Promoting Coagulation A coagulation modifier drug whose mechanism of action is to promote coagulation of the blood is called a(n) ___________ and is used to _________. antifibrinolytic, manage excessive bleeding anticoagulant, prevent clot formation thrombolytic, lyse clots that have already formed antiplatelet, interfere with platelet function Anticoagulants What is another term for anticoagulant?

Hemostatics Antiplatelets Hemorheologics Antithrombotics Antifibrinolytics Coagulation Modifier Drugs and Subclasses Match the coagulation modifier drug’s subclass to the correct medications. Note: Several of the subclasses have more than one medication listed as correct choices.

Anticoagulants

● ● ● ● ●

Enoxaparin Heparin Warfarin Dabigatran etexilateapixaban

Antiplatelets

● ●

clopidogrel bisulfate abciximab

Thrombolytics

●

alteplase

Antifibrinolytics

●

aminocaproic acid

Hemorheologics

●

pentoxifylline

Reversal Drugs

● ● ● ●

coagulation factor Xa (recombinant) idarucizumab protamine sulfate phytonadione

Reversal and Coagulation Modifier Drugs Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs Protamine sulfate is the reversal drug for heparin.

Phytonadione is the reversal drug for warfarin.

Idarucizumab is the reversal drug for dabigatran etexilate.

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Coagulation factor Xa (recombinant) is the reversal drug for rivaroxaban.

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Indications for Use Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct description.

Antiplatelet drugs inhibit platelet aggregation and formation of platelet plugs, which are helpful in preventing heart attacks a strokes.

Hemorrhagic drugs alter platelet function without interfering with normal platelet activity.

Thrombolytic drugs are a classification of drugs that are used to break down clots or thrombi that have formed.

Antifibrinolytic drugs are hemostatic drugs that promote blood coagulation for conditions of excessive bleeding.

Hemostasis Vocabulary From the drop-down menu, select the term that best fits the definition.

The process of thrombi formation – Coagulation A clot forming substance that is the result of the coagulation system, which also triggers the fibrinolysis system – Fibrin The process of thrombi breakdown – Fibrinolysis A rare genetic disorder in which certain factors needed for coagulation and hemostasis are inadequate or nonexistent – Hemophilia Any process that stops bleeding – Hemostasis Use of compression to achieve hemostasis – xxxMechanical means of hemostasis Use of clamping or cauterization to achieve hemostasis – xxxSurgical means of hemostasis Use of coagulation modifier drugs to achieve hemostasis – xxxPharmacologic means of hemostasis A mobilized thrombus – Embolus Blood clot – Thrombus Subclasses Match the coagulation modifier drug’s subclass to its mechanism of action.

Prevent clot formation by inhibiting particular clotting factors

Anticoagulants

Prevent clot formation by interfering with platelet function

Antiplatelets

Lyse clots that have already formed

Thrombolytics

Promote the coagulation of blood

Antifibrinolytics

Reduce blood viscosity

Hemorheologics

Act as antagonists to the other medications

Reversal drugs

Anticoagulants (warfarin; heparin) Prepare: Anticoagulants Actions of Anticoagulants Anticoagulants perform which of the following actions?

Act directly on platelet aggregation Prevent thrombosis Breakdown fibrin Lyse pre-formed clots Anticoagulant Subclasses Which of these anticoagulants belongs to the subclass heparins? clopidogrel warfarin rivaroxaban enoxaparin Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Coumarins How do coumarins prevent thrombus formation?

Working with other drug classes to decrease the thickness of blood Inhibiting vitamin K-dependent clotting factors Directly impacting platelet aggregation Breaking down the fibrin in clots

Self Check: Thromboembolic Event Which of the following patients is least at risk of a thromboembolic event?

Someone on a direct flight from Detroit, Michigan to Sydney, Australia Someone who has been in a coma for a week following a stroke Someone who has a broken foot and is learning to walk with an orthopedic boot Someone who has a mechanical heart valve Someone recovering from a bilateral knee replacement

Self Check: Heparin Heparin Toxicity Which of the following statements are correct regarding heparin toxicity? Select all that apply.

Heparin toxicity may be treated intravenously with the reversal drug protamine sulfate in severe cases Because of heparin’s long half life, the toxic effects of heparin cannot reversed by discontinuing heparin alone The heparin must be stopped immediately The toxic effects of heparin may be reversed by discontinuing heparin alone

Increased Anticoagulants Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleedi risk)?

Aspirin and other NSAIDs, oral anticoagulants, antiplatelets, and thrombolytics Antithrombotics, oral antibiotics, and prothrombins Acetaminophen, oral anticoagulants, and antithrombotics Aspirin and other NSAIDs, oral antibiotics, and antithrombotics

Self Check: Warfarin (Coumandin) Warfarin Which of the following statements regarding warfarin are accurate? Select all that apply.

It takes several days to reach therapeutic levels It is the most commonly prescribed parenteral anticoagulant There is a black box warning regarding bleeding risk specific to warfarin To treat warfarin toxicity, high doses of diluted vitamin K intravenously can reverse the effects within 6 hours

Self Check: Black Box Warnings Match the following anticoagulants with its black box warning.

Premature discontinuation of the medication because it can lead to increased thrombi

dabigatran

For patients with an epidural catheter (may cause spinal hematomas)

Apixaban / Rivaroxaban / Enoxaparin

Serious bleeding risk

warfarin

Reflect: Anticoagulants

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idarucizumab vitamin K prothrombin complex concentrate (human) Direct thrombin inhibitors protamine sulfate

About Anticoagulant Medications Match each anticoagulant medication or subclass/category to its true statement.

The first oral selective Xa inhibitor to become available

rivaroxaban

Requires frequent monitoring of serum bleeding times (such as aPTT and INR) to determine if therapeutic level has been reached and if toxicity is present

heparin

When taken with warfarin causes a 50% or higher increase in INR

cordarone

Inhibit thrombin (clotting factor IIa)

Direct thrombin inhibitors

When taken with heparins can cause an increased bleeding risk due to decreased platelet activity

Non-steroidal anti-inflammatory (NSAID)

Direct thrombin inhibitor

dabigatran

Do not require frequent monitoring of serum bleeding times due to its more predictable anticoagulant response

Low-molecular-weight heparins (LMWHs)

Adverse Effects What are the most common adverse effects for anticoagulants in general? Select all that apply.

Hypokalemia Peripheral edema Bleeding Thrombocytopenia Necrosis of the skin and “purple toes” syndrome Thrombocytosis Abdominal cramps Statements About Heparin Drag the below statements into the correct column, indicating which are true and which are false, regarding the subclass of anticoagulants known as heparins?

True Statements

Statements About Heparin

● ● ●

False Statements

Heparin used therapeutically requires frequent monitoring of serum bleeding times Unfractionated heparin is commonly known as simply “heparin” Enoxaparin has a higher degree of bioavailability and longer elimination half-life than heparin

●

●

●

Heparin when used as a DVT prophylactic and as a catheter flush require additional monitoring of serum bleeding times Low-molecular weight heparins (LMWHs) require frequent monitoring of serum bleeding times Dalteparin is a type of unfractionated heparin

Selective Xa Inhibitors Which of these medications is an oral selective Xa inhibitor that is used for prevention of strokes in patients with atrial fibrillation (a-fib)? fondaparinux sodium apixapan rivaroxaban

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enoxaparin

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Indications of Use Given their general mechanism of action, anticoagulants are indicated for which of these uses? Select all that appl Treat deep vein thrombosis Prevention thrombus formation that may result from a long plane ride Dissolving thrombi that have formed Prevention of emboli associated with ambulation following surgery Prevent stroke Preventing thrombi formation Promote thrombus formation on and/or around mechanical heart valves Treat pulmonary embolism Prevent myocardial infarction Treatment of unstable angina Categories of Heparins Which of the following are categories of heparins? Select all that apply.

Direct thrombin inhibitors Unfractionated heparin Selective factor Xa inhibitors Coumarins Low molecular-weight heparins (LMWHs)

Antiplatelets (clopidogrel) Prepare: Antiplatelets Antiplatelets How do antiplatelets prevent clot formation?

Preventing platelet adhesion at the site of the thrombus Preventing platelet adhesion at the site of the blood vessel injury Preventing platelet production Preventing platelet mobilization

Mechanism of Action Which of the following statements is true regarding acetylsalicylic acid’s antiplatelet mechanism of action? Select that apply.

It alters the platelet membrane so that it can no longer receive the signal to aggregate and form a clot It inhibits platelet aggregation by preventing the release of adenosine diphosphate (ADP), platelet factor IV, and TXA all substances that stimulate platelets to aggregate or form a clot It irreversibly prevents platelets from regenerating a necessary enzyme It prevents platelet adhesion Indications of Use for clopidogrel Which of the following are indications for use of clopidogrel? Select all that apply.

Reduce the risk of stroke resulting from a thrombus Transient ischemic attack (TIA) prophylaxis Prevention of thrombus following a myocardial infarction (MI) Improve exercise tolerance in the elderly

Self Check: Mechanism of Action Which of the following is true regarding the mechanism of action of antiplatelets?

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They prevent platelets from mobilizing Stuvia.com - The Marketplace to Buy and Sell your Study Material They inhibit clotting factors that are needed for fibrin

Self Check: Aspirin

Acetylsalicylic acid Acetylsalicylic acid prevents platelet aggregation by permanently blocking the platelet’s ability to regenerate an enzyme cal cyclooxygenase for the entire seven (7) day lifespan of a platelet. This enzyme is needed in a process that leads to platelet aggregation and vasoconstriction. Therefore, acetylsalicylic acid results in vasodilation and the prevention of platelet aggregation/clot formation.

Self Check: Antiplatelet Subclass Antiplatelet Subclass Which of the following statements are accurate regarding the antiplatelet subclass glycoprotein (GP) IIb/IIIa inhibitors? Select all that apply.

Used to treat unstable angina and MI Used during procedures such as angioplasty, typically in ICU or cardiac catheterization lab settings They are administered orally Eptifibatide, tirofiban, and abciximab are GP IIb/IIIa inhibitors

Self Check: clopidogrel (Plavix) Clopidogrel Which of the following statements is true regarding clopidogrel?

It has a black box warning for patients with hypertension It is used for the reduction of thrombotic stroke risk, transient ischemic attack (TIA) prophylaxis, and the postmyocardial infarction (MI) prevention of thrombosis It is administered by subcutaneous injection It works by altering the platelet membrane to signal platelets to aggregate and form a clot Adverse Effects Which of the following are common adverse effects of clopidogrel? Select all that apply.

Chest pain Flu-like symptoms Joint pain Constipation Edema Abdominal pain Fatigue Hypotension Epistaxis

Reflect: Antiplatelets

Adenosine Diphosphate (ADP) Receptor Inhibitor Medications Which of the following statements are true regarding ADP Inhibitor medications clopidogrel, prasugrel, and ticagrelor? Select all that apply.

Ticagrelor has a black box warning related to increased bleeding risk and use of aspirin in doses over 100 mg Dipyridamole is used for patients who do not respond to clopidogrel Prasugrel has a black box warning of an increased bleeding risk in clients with a history of stroke and those who we less than 60 kg They are all similar except that prasugrel is used primarily after interventional cardiac procedures Unlike prasugrel and ticagrelor, clopidogrel does not have a black box warning

Platelet Adhesion and Aggregation Place the steps of the platelet aggregation process in order, from the point of the damaged blood vessel to the poi Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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of clot formation.

Stuvia.com - The Marketplace to Buy and Sell your Study Material 1. Blood vessel is damaged by some sort of trauma or a rupture of plague from the vessel wall 2. Hemostasis and blood flow is disrupted 3. Collagen from the damaged vessel stimulates platelet adhesion 4. Stimulation of platelet aggregation (accumulation) at the site of the damage 5. The accumulation of platelets form a platelet plug 6. The platelets change shape and release the substances they contain (platelet recruiters and vasoconstriction) 7. The coagulation cascade is triggered so that fibrin can form a clot to stop the bleeding

Dipyridamole Which of the following statements is true regarding dipyridamole? Select all that apply.

Used in the prevention of various thromboembolic complications, including as a postoperative adjunct to warfarin When used with clopidogrel, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs (NSAIDs) produces additive antiplatelet activity and increased bleeding potential A glycoprotein (GP) IIb/IIIa inhibitor which is administered intravenously to treat acute unstable angina and myocard infarction (MI) Prevents platelet aggregation by blocking the formation and/or release of several platelet stimulators (such as adenosine diphosphate (ADP) and thrombin) that cause platelets to aggregate Clopidogrel Clopidogrel is a(n) oral medication in the adenosine diphosphate (ADP) receptor inhibitor subclass whose mechanism of action is to alter the platelet membrane preventing it from receiving the signal to aggregate.

Antiplatelet Choose which antiplatelet corresponds with each statement.

Effectiveness of clopidogrel Which of the following medications can reduce the effectiveness of clopidogrel? Select all that apply. acetylsalicylic acid amiodarone calcium channel blockers heparin nonsteroidal anti-inflammatory drugs (NSAIDs) proton pump inhibitors Adverse Effects Antiplatelets are contraindicated in patients with which of the following? Select all that apply.

Ulcer disease Severe liver or kidney disease

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Vitamin K deficiency Leukemia Uncontrolled hypertension Active bleeding Hemophilia Recent stroke Pregnancy Recent surgery

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Contraindications for acetylsalicylic acid Acetylsalicylic acid is contraindicated in which of the following scenarios? Select all that apply.

In patients who are at risk for stroke or myocardial infarction (MI) In combination with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with a known allergy to acetylsalicylic acid In combination with steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) Older adults who exhibit flu-like symptoms

Nursing Application: Coagulation Modifiers Prepare: Nursing Application for Coagulation Modifiers Black Box Warnings The nurse should be aware that black box warnings are present for which antiplatelet medications? Select all that apply. clopidogrel rivaroxaban prasugrel ticagrelor Therapeutic Effects Which assessment findings indicate a therapeutic response to coagulation modifying drugs? Select all that apply.

Improved circulation Decreased blood pressure Improved tissue perfusion Increased pain

Main Complication Which of the following is a main complication of all anticoagulant and antiplatelet therapy that the nurse caring for patient receiving coagulation modifier drugs should assess for?

Abdominal cramping Bleeding Hypertension Hypotension

Self Check: Indications of Use Anticoagulants are prescribed to prevent or treat which conditions? Select all that apply.

Dysrhythmias after myocardial infarction (MI) Hypertension during pregnancy Clotting associated with atrial fibrillation Thromboembolic events Clotting associate with venous access devices After coronary artery bypass grafting

Self Check: Nursing Assessment for Coagulation Modifiers Thromboembolic Events Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Which assessment finding is an unreliable measure of thrombosis?

Stuvia.com - The Marketplace to Buy and Sell your Study Material Positive Homan’s sign Normal heart sounds Decreased pedal pulses Confusion

Physical Assessment Results The nurse is assessing a client who has been taking anticoagulant medication for the past six (6) months. Based o the assessment findings what is the next action the nurse should take? ● BP 80/52 (baseline is 118/74) ● HR 110 at rest ● Diana reports feeling cold and dizzy ● Pedal pulses are week ● Lab results show high prothrombin time and international normalized ratio (PT/INR) Notify the healthcare provider Suggest meditation to calm down Provide an extra blanket Check temperature

Self Check: Regular Lab Tests

A client who recently began anticoagulation medication asks the nurse why they need to get their laboratory value checked so often. What is the best response by the nurse? Select all that apply.

Lower test results indicate a risk for clotting Laboratory tests are assessing for signs of an infection Higher test results indicate a risk for bleeding Laboratory results monitor for a therapeutic drug level

Self Check: Warfarin What information should be included on a teaching plan for clients taking warfarin?

Increase intake of foods containing vitamin K Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) Take a baby aspirin daily to help the anticoagulant work It is safe to take St. John’s wort for nausea

Reflect: Nursing Assessment for Coagulation Modifiers Preventing Bruising, Bleeding, and Tissue Injury When planning discharge teaching for a client on coagulation modifying drugs, the nurse should include which information? Select all that apply.

Use a disposable razor rather than an electric razor Use a soft toothbrush to prevent bleeding gums Avoid walking barefoot outside Increase activity, such as playing football Risk Factors and Contraindications Match the assessment findings associated assessment criteria with the reason behind it.

Indicate the degree of anticoagulation and therefore indicate therapeutic levels of these medications

Coagulation times and platelet counts

An indication of good circulation and perfusion

Peripheral pulses

Indicate general heart function which can be impacted by a thromboembolic event, also indications of bleeding would be reflected by in these findings

Blood Pressure and Heart Rate

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Subjective and Objective Data The nurse recognizes which assessment findings as contraindications to coagulation modifying drugs? Select all that apply.

Lab results including prothrombin time and international normalized ratio (PT/INR) and activated partial thromboplas time (aPTT) History of glaucoma Oral mucous membranes, gums, urine and stool for bleeding Positive Homan's sign Antidote to Heparin When caring for a client receiving heparin, the nurse assures that which antidote is readily available? phytonadione cordarone dipyridamole protamine sulfate Safety While Taking warfarin Which images below should be provided to a client with low literacy skills to help them remain safe while taking warfarin? Select all that apply.

Main Complication Clients taking anticoagulation modifying drugs should immediately report which symptoms to their healthcare provider? Select all that apply.

Fever Unexplained nosebleeds Abnormally heavy menstrual bleeding Blood in the stool Rash

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Blood in the urine Bleeding gums Hematoma Irritability

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Mechanism of Action and Nursing Implications Which statements are true regarding clopidogrel? Select all that apply.

It is a widely used oral drug It reduces the risk of thrombotic stroke It is an antiplatelet which prevents clot formation Nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors may reduce its effectiveness Adverse effects include gastrointestinal (GI) distress, epistaxis, and abdominal pain It has a black box warning for clients with certain genetic abnormalities Drug Classes Match the drug name to its drug class.

If you can’t see the picture well Anticoagulants: Prevent clot formation by inhibiting particular clotting factors ● heparin ● enoxaparin ● warfarin ● dabigatran etexilate ● rivaroxaban Antiplatelets: Prevent clot formation by interfering with platelet function ● clopidogrel bisulfate ● abciximab Thrombolytics: Lyse clots that have already formed ● alteplase Antifibrinolytics: Promote the coagulation of blood (used in the management of excessive bleeding) ● aminocaproic acid Hemorheologics: Reduce blood viscosity (thickness) ● pentoxifylline Reversal Drugs: Antidotes ● protamine sulfate (heparin antagonist) ● phytonadione (warfarin antagonist) ● idarucizumab - (dabigatran antagonist) ● coagulation factor Xa (recombinant) - (rivaroxaban)

Week 4 Concepts: Perfusion Antihypertensives Prepare: Antihypertensives Medications in Class Which medication is used to treat hypertension? acyclovir losartan prednisone gabapentin Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Prevalence of Hypertension Which statements about hypertension in the United States are supported by facts? Select all that apply.

An estimated 31 million adults taking medication for high blood pressure are not taking the right dose Nearly 1 in 10 adults have hypertension About 30 million adults with known hypertension are not being treated Most adults with hypertension do not have their hypertension under control All individuals with hypertension require prescription medication to reduce risk of complications Goals of Treatment What are the goals of antihypertensive therapy? Select all that apply.

Protect the kidneys Prevent stroke Reduce organ damage Normalization of blood pressure Alleviate early symptoms

Self Check: Medication Classes and Drugs in the Class Complete each sentence by selecting the word or phrase that makes the sentence true from the drop down menu.

Drugs in the Angiotensin II Receptor Blockers (ARBs) class include losartan, olmesartan, and valsartan.

Drugs in the Vasodilators class include hydralazine, diazoxide, and minoxidil.

Drugs in the Alpha-1 Blockers class include doxazosin, prazosin, and terazosin.

Self Check: Life-Threatening Effects of Antihypertensive

Indicate which listed side/adverse effects may be caused by the listed antihypertensive medication class by placin a check in the appropriate column.

Self Check: Antihypertensive Therapy During Pregnancy Which antihypertensive medications are contraindicated during pregnancy and lactation? Select all that apply. angiotensin II receptor blockers (ARBs) methyldopa angiotensin converting enzyme (ACE) inhibitors hyralazine clonidine

Self Check: Antihypertensive Contraindications Which antihypertensive medication is contraindicated for an older adult with an esophageal stricture? doxazosin terazosin losartan minoxidil

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Doxazosin Contraindications Stuvia.com - The Marketplace to Buy and Sell your Study Material Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with doxazosin by placing a check in the appropriate column. Select all that apply for the interaction.

Reflect: Antihypertensives

Therapeutic Use When counseling a 68-year-old male who is taking doxazosin and denies any history of hypertension, the health ca provider asks if he has history of which other condition?

Benign prostatic hypertrophy Lymphoma Gout Psoriasis Antihypertensive Drugs and Classes Drag the medications to the classification in which each belongs.

If can’t read Alpha-1 Blockers ● doxazosin ● terazosin Angiotensin II Receptor Blockers (ARBs) ● losartan ● valsartan Vasodilators ● diazoxide ● minoxidil

Complications of Hypertension Mr. James, an older adult with hypertension and chronic kidney disease, is talking with a group of young men new diagnosed with hypertension about coping with the diagnosis of a lifelong alteration in health. When a participant asks Mr. James what he would do differently if he had the chance, which statement from Mr. James reinforces the importance of medication compliance?

Senior man connecting peritoneal dialysis with catheter at home “I would not have ignored my wife nagging me to take my medicines.”

“I would have improved my diet and taken herbal supplements when I was still healthy.”

“I would have started taking antihypertensives when my doctor first said I needed them.”

“I would have talked to my health care provider about how the medications made me feel.”

Mechanism of Action Which effects of angiotensin II do angiotensin II blocking medications (ARBs) stop in order to decrease blood pressure? Select all that apply.

Remodeling cardiac cells Direct vasoconstriction Increase peripheral catecholamine release

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Release of aldosterone Hypertrophy vascular cells

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Adverse Effect/Event OR Contraindications Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with losartan by placing a check in the appropriate column. Select all that apply for each interaction.

Safe Administration While reviewing the health history of an individual taking an antihypertensive, the health care provider is concerne that which over-the-counter product may interfere with blood pressure medicine? Select all that apply.

Multivitamin with iron Calcium supplement Appetite suppressant Nasal decongestant Nonsteroidal anti-inflammatory drugs (NSAIDs)

Adherence An individual diagnosed with hypertension six months ago is frustrated that their blood pressure is still elevated despite having tried several medications. When asked what is taking so long, what is the best response by the hea care provider?

“Hypertension is the type of illness that develops over time, so it is expected that finding the right treatment will also take time. We just need to be patient and keep trying.”

“Trial and error is the best way to determine how your body will respond, unfortunately. But there are a lot more drug we can try.” ”Hypertension is a complex disease with multiple causes, so it can take time to discover which medication, or combination of medications, works best for each person.”

“There are so many medications, we just need to find the right one for you.”

Angiotensin II Blockers (ARBs) When providing hypertension screening and education a health care professional shares that which medications a in the ARB class? Select all that apply. eprosartan valsartan propranolol doxazosin losartan atenolol

Adrenergics (carvedilol, clonidine, doxazosin) Prepare: Adrenergics Medications in Class Which medications are included in the adrenergic antihypertensives class? Select all that apply. clonidine acetaminophen methyldopa diphenhydramine carvedilol Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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Adverse Effects of clonidine Which condition may result from stopping clonidine therapy abruptly?

Rebound hypertension Stevens-Johnson syndrome Severe bronchospasms Cardiomyopathy

Carvedilol Indications In addition to hypertension, carvedilol is also prescribed to treat heart failure and impaired left ventricular function after a myocardial infarction (MI).

Self Check: Indications and Interactions

Indications for carvedilol and clonidine Select the indications for use of carvedilol and clonidine by placing marks the appropriate column(s). Select all tha apply for each medication.

Interactions with carvedilol The beta blocking effects of carvedilol are responsible for causing hyperglycemia by interfering with receptors in the pancreas.

Self Check: Classes and Dosing Classes and Medications of Adrenergic Antihypertensives Match the medication to the class in which it belongs.

Medications

Alpha-2 Adrenergic Stimulators

Dual-action alpha-1 & Beta receptor blockers

methyldopa / clonidine

dilevalol / labetalol / carvedilol

Dosing for clonidine Use the drop down menus to fill in the missing information related to dosing of clonidine.

Dosing for carvedilol Use the drop down menus to fill in the missing information related to dosing of carvedilol.

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Reflect: Adrenergics Response to Treatment During a follow up visit with the health care provider a person taking carvedilol reports the following information.

Which indicates a possible complication due to the medicine?

Experiencing insomnia Heart rate in the morning averaging 64 bpm Shortness of breath with mild exertion Blood pressure readings averaging 120/66 Safe Administration of clonidine In which individual should clonidine be used with caution?

26-year-old with hypertension in the 27th week of gestation 58-year-old with essential hypertension 87-year-old with heart failure and hypertension 14-year-old with ADHD

Metabolism of carvedilol An individual taking carvedilol for the last three weeks is reporting an increasingly dry mouth, unusual issues with constipation, and becoming extremely dizzy within five minutes of jogging for exercise. When asked, the person confirms that these symptoms started after the medication was prescribed and have been increasing since.

The health care provider suspects a genetic enzyme disorder as the reason for the current symptoms and recommends the individual discontinue the dose of carvedilol slowly.

Adverse Effect/Event Or Contraindications A client calls the health care provider at 2 p.m. stating, “I forgot to take my daily blood pressure pill at 8 a.m. like I usually do. Should I take it now?” Which of response by the healthcare provider is best?

“Why did you forget to take it today?”

“It would be best to simply take 2 pills tomorrow.”

“No, too much time has gone by so just skip that dose.”

“Yes, it is important to take the medication each day.”

Linking Side Effects to Medications An individual with diabetes and hypertension is seen in urgent care with severe hypoglycemia. She is concerned that her usual symptoms of low blood sugar were not present, allowing her levels to drop to the point she became faint. Which of her current medications may contribute to the masking of her hypoglycemia? doxazosin labetalol clonidine losartan Pharmacokinetics of clonidine Use the drop down menus to fill in the missing pharmacokinetic information of clonidine.

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Pharmacokinetics of Carvedilol Use the drop down menus to fill in the missing pharmacokinetic information of carvedilol.

Side Effects of carvedilol While caring for a client with hypertension who has recently started taking carvedilol, the client reports, “This medication seems to give me a rash.” Which of the following statements by the health care provider is best?

“That is common with your new medication. You should continue to take the medication to help control your blood pressure.”

“That’s too bad. You could try taking half a pill twice a day.”

“That is unusual with this medication. Have you noticed any muscle twitching or facial numbness?”

“I am glad you mentioned this. Does this rash itch or hurt?”

Angiotensin-Converting Enzyme (ACE) Inhibitors (enalapril) Prepare: ACE Inhibitors Indications for Use – Angiotensin Converting Enzyme Inhibitors Which of the angiotensin converting enzyme (ACE) inhibitors have been shown to reduce the risk of death or development of heart failure (HF) following a myocardial infarction (MI)? Select all that apply. trandolapril captopril enalapril lisinopril quinapril Therapeutic Effects of Angiotensin Converting Enzyme (ACE) Inhibitors In addition to hypertension, ACE Inhibitors are also prescribed to prevent left ventricular hypertrophy after a myocardial infarction and decrease the morbidity and mortality associated with heart failure.

Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors Which of the oral ACE inhibitor medications are ready to be used by the body as soon as they are absorbed? Selec all that apply. lisinopril ramipril benazepril fosinopril captopril

Self Check: Indications, Mechanism of Action, and Expected Results Therapeutic Effects of ACE Inhibitors Click on the cells that contain the therapeutic effects of ACE inhibiting medications. Select all that apply.

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Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors By which mechanisms do ACE inhibitors cause systemic vasodilation and lower blood pressure? Select all that apply.

Prevent the breakdown of bradykinin Stop the conversion of angiotensin I to angiotensin II Decrease plasma renin levels Increase aldosterone levels Directly cause the excretion of sodium and water through the kidneys

Self Check: Contraindications, Adverse Effects, and Interactions

Effectiveness of Angiotensin Converting Enzyme (ACE) Inhibitors Indicate which medications will increase or decrease the effectiveness of ACE inhibitors by clicking the radio butto in the correct column.

Self Check: Safety Considerations, Routes of Administration, and Other Meds in Class Contraindications of Angiotensin Converting Enzyme (ACE) Inhibitors ACE inhibitors should be used cautiously in individuals with liver disease and those with a family history of angioedema.

Self Check: Pharmacokinetics and Dosing Dosing for captopril Use the drop down menus to fill in the missing information related to dosing of captopril.

Reflect: ACE Inhibitors Safe Administration of captopril Which statement by an individual taking prescribed captopril indicates further teaching is required?

“Sitting in bed for a couple of minutes before getting up has helped with my morning dizziness.”

“My pharmacy sends email reminders so I don’t forget to refill me prescriptions. Takes a load off my mind.” ”I take the first dose each day with breakfast, then space them out evenly until bedtime.”

“The soluble fiber I take before bedtime really keeps me regular.”

Linking Side Effects to Medications A person is prescribed an Angiotensin Converting Enzyme (ACE) Inhibitors after experiencing a myocardial

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infarction. What effects on the body will this medication achieve? Select all that apply.

Stuvia.com - The Marketplace to Buy and Sell your Study Material Increases SVR and blood pressure Decreases SVR (systemic vascular resistance) and blood pressure Constriction of the venous blood vessels Kidneys will excrete water and sodium Kidneys will retain potassium Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors How does captopril impact the vasoconstriction, aldosterone secretion, and renin release that occur as a result of the renin-angiotensin-aldosterone system? Select all that apply.

Inhibits vasoconstriction Promotes renin release Blocks aldosterone secretion Binds to renin and bradykinins Destroys angiotensin I

Side Effects of Angiotensin Converting Enzyme (ACE) Inhibitors A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an AC inhibitor. The patient is not experiencing any other signs and symptoms. What is the best response by the health care provider?

Tell the patient to immediately stop taking the medication and seek medical treatment Recommend the patient start taking the medication at night to decrease the coughing Explain that this is a known, harmless side effect of the medication Reassure the patient that the cough will disappear within 6 months of taking the medication Benefits of Angiotensin Converting Enzyme (ACE) Inhibitors Which individual would benefit most from an ACE inhibitor?

54-year-old male with hypovolemic shock 48-year-old male with severe renal failure 50-year-old female with systolic dysfunction heart failure 35-year-old female with chronic hepatitis Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors Which ACE inhibitor is not metabolized by the liver and is eliminated unchanged in urine? enalapril moexipril ramipril lisinopril Pharmacokinetics of Enalapril Use the drop down menus to fill in the missing pharmacokinetic information of enalapril.

Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors An individual taking an ACE inhibitor for the last three weeks reports swelling of the lips, eyes, and tongue that started about 30 minutes before they called the prescribing health care provider.

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call 911 immediately.

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Nursing Application: Antihypertensives Prepare: Nursing Application for Antihypertensives

Indications While reviewing the medication list for a newly admitted patient the nurse notes they are taking a calcium channel blocker. Based on knowledge of the medication, the nurse inquires if the patient has a history of which conditions?

Select all that apply.

Angina pectoris Left ventricular hypertrophy Myocardial infarction Hypertension Cardiac dysrhythmia Initial Assessment – Hypertension The initial nursing assessment of a patient diagnosed with hypertension should including questions about which underlying causes? Select all that apply.

Kidney disease Pheochromocytoma Pneumonia Lactose intolerance Hepatic dysfunction

Goals of Treatment What teaching point is a priority when the nurse is teaching a client who is taking an angiotensin converting enzym (ACE) inhibitor?

Limit foods high in potassium Take the medications with food Decrease salt intake Avoid consuming alcoholic beverages

Self Check: Assessing Risks During Antihypertensive Therapy

While obtaining subjective assessment data from a patient with hypertension whose blood pressure has not reach goal after three months of therapy, the nurse asks the patient about changes they have made to their diet and exercise. What is the rationale for this question?

Assess patient's adherence to recommended lifestyle changes Determine if the person really wants to be healthier Understand what motivates the patient Shame the patient to comply with the treatment plan

Self Check: Monitoring Side Effects of Antihypertensives

An hour after administering the daily dose of an antihypertensive to a 64-year-old patient the nurse is asked to help them to the bathroom. What priority action will the nurse take before completing the request?

Assist the patient to put on slippers Assess the orthostatic blood pressure Listen to breath sounds Ask for assistance

Self Check: Patient Education – Risk for Side Effects of Antihypertensives

The nurse volunteering at a community picnic on a hot, humid day is treating an older adult experiencing dizziness and hypotension. After the patient is feeling better and their blood pressure has returned to normal, what

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information will the nurse provide to help the patient avoid a recurrence?

Stuvia.com - The Marketplace to Buy and Sell your Study Material “You should drink a lot more water on days that are this hot.”

“This happens to a lot of people. Just make sure stay near the first aid tent in the future.”

“Perhaps you are too old and should stop attending these outdoor events.”

“Hot weather can increase the effects of your medication. Try to limit your time outside on days like this.”

Self Check: Evaluating Antihypertensive Therapy Select the values from the drop down menus that accurately complete the sentence.

Blood pressure control is achieved when the systolic pressure is 120-139 millimeters of mercury (mm Hg) with a diastolic pressure of 80-89 mm Hg, or at lowest level tolerated by the individual.

Reflect: Nursing Application for Antihypertensives Adherence and Antihypertensives Many individuals who are aware they have hypertension are not being treated. The nurse understands that which factors can impact how well a patient adheres to the prescribed treatment plan? Select all that apply.

They tried medications and did not like how they felt Cost of medications They may not feel sick Challenges getting to a health care provider Do not care about their health Dosing A client with newly discovered hypertension has an average blood pressure (BP) reading of 158/98 millimeters of mercury (mm Hg) after 3 months of exercise and diet modifications. Which management strategy will be a priority this patient?

More changes in the patient’s lifestyle are needed for a longer time before starting drug therapy Lifestyle changes can be stopped since they were not effective, and drugs will be started Drug therapy will be needed because the BP is still not at goal BP monitoring should continue for 3 months to confirm a diagnosis of hypertension Side Effects A patient who has a prescription for methyldopa is being tapered off the medication. The nurse includes which statement in the patient teaching?

“Patients usually only take this drug for 1–2 weeks before switching to another medication.”

“I bet you’re glad to be getting off this medication since it is so expensive.”

“Stopping this medication suddenly can be very dangerous, so it is important that you follow the taper schedule carefully.”

“By slowly weaning you from this drug, the risk of rebound headaches is reduced.”

Adjusting Dosage A hypertensive client who has been prescribed captopril states, “The doctor keeps changing my pills and none are working. I feel like a guinea pig.” Which response by the nurse would be most appropriate?

“The doctor is just trying to help you control your blood pressure.”

“The action of this drug is to work on both the arteries and to remove excess fluids.”

“It often takes a while before the right medication is found.”

“This drug is used when all other drugs have failed.”

Drug-Drug Interaction A patient has a new prescription for an angiotensin converting enzyme (ACE) inhibitor. During a review of the patient’s list of current medications, which would cause concern for a possible interaction with this new prescription? Select all that apply.

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Opioid used for occasional severe pain Stuvia.com - The Marketplace to Buy and Sell your Study Material Antihistamines taken as needed for allergies Nonsteroidal anti-inflammatory drugs (NSAIDs) taken as needed for headaches

Mechanism of Action The nurse is providing discharge instructions to a patient who will be taking an adrenergic antihypertensive at hom Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply.

“I will regularly check my blood pressure and pulse rate while taking this medication and report any significant chang to my doctor.”

“I will avoid using salt substitutes that contain potassium.”

“I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication.”

“If I feel unwell, it is okay that I miss a dose.”

“I have been walking every day and no longer smoke cigars. I am starting to enjoy exercise, but really do miss the cigars, though.”

Assessing for Adverse Effects The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients?

Dry mouth Restlessness Hypotension Constipation Safe Administration When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs?

Antilipemics, such as simvastatin Diuretics, such as furosemide Angiotensin converting enzyme (ACE) inhibitors, such as captopril Vasodilators, such as hydralazine

Antianginals Prepare: Antianginals Medications in Class – Beta-Adrenergic Blockers Which antianginal medications belong to the classification of beta-adrenergic blockers? metoprolol propranolol pyrogallol atenolol Nadolol Mechanism of Action of Antianginals Some medications used to treat angina work by slowing the heart rate to allow the myocardial cells to receive oxygen.

Causes of Angina Match the type of angina to the pathophysiologic processes that causes it.

Caused by complete blockage of one or more coronary arteries resulting in cell death

Heart Attack

Pain that occurs at rest due to narrowing of the coronary arteries

Unstable angina

Results from spasms in the smooth muscle layer of the coronary arteries

Prinzmetal angina

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Angina pectoris

Self Check: Preventing Angina Which antianginal medications are used to prevent future episodes of angina? Select all that apply. nitroglycerin nonsteroidal anti-inflammatory drugs (NSAIDs) biguanides isosorbide dinitrate isosorbide mononitrate

Self Check: Treatment Outcomes What are the goals of antianginal therapy? Select all that apply.

Decrease intensity of anginal pain Protect the brain Reverse coronary artery disease Prevent myocardial infarction Minimize frequency of angina

Self Check: Contraindications for Antianginals Which medical conditions are considered contraindications to antianginal therapy? Select all that apply.

Presence of a pacemaker Hypotension Low dose aspirin therapy Acute myocardial infarction Second degree atrioventricular (AV) block

Self Check: Dosing for Metoprolol Use the drop down menus to fill in the missing information related to the dosing of metoprolol.

Self Check: Pharmacokinetics of Ranolazine Use the drop down menus to fill in the missing information related to the pharmacokinetics of ranolazine.

Reflect: Antianginals Adam’s Angina Answer the following questions about Adam’s knowledge and experience with his angina.

Question 1 / 3 Adam, who has a history of stable angina, is getting ready to walk in a local park. Which preparations indicate the understands self-care actions related to his health condition? Select all that apply.

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Question 2 / 3 During his walk, Adam experiences chest pain similar to past anginal episodes. Which actions should he take now Select all that apply.

Keep walking at a slower pace Return to the car and rest Sit down right away Take the antianginal as directed Call 911

Question 3 / 3 Adam’s chest pain is not changed after taking their antianginal medication to the maximum dose prescribed. What action should he take next?

Drive himself to the closest hospital Wait 15 minutes and take another dose of his medication Call his partner to pick them up Call 911 to request assistance

Side Effects of Beta Blockers Which signs and symptoms would demonstrate a person is experiencing an overdose of a beta blocker medication Select all that apply.

Blood pressure 200/110 Patient is hyperactive Dyspnea Patient is very drowsy Heart rate 35 beats per minute Metoprolol Administration Metoprolol is available for administration by which routes? Select all that apply.

Transdermal Subcutaneous Oral Intravenous Rectal suppository

Over-the-counter and ranolazine Which over-the-counter item should not be consumed by an individual taking ranolazine for unstable angina? Sele all that apply.

Kiwi Grapefruit juice St. John’s Wort Dark chocolate Cured pork (bacon or ham) Dosing for ranolazine Use the drop down menus to fill in the missing information related to the dozing of ranolazine.

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Pharmacokinetics of metoprolol Use the drop down menus to fill in the missing information related to the pharmacokinetics of metoprolol.

Nitrates and Nitrites (isosorbide dinitrate, nitroglycerin) Prepare: Nitrates

nitroglycerin Safety When teaching an individual with angina to administer translingual nitroglycerin, which information regarding safe should be included?

Wash your hands before taking the cap off the medication Measure their heart rate for a full minute Direct the spray carefully Stay standing when using this medication Preparations of nitroglycerin Select the routes by which nitroglycerin may be administered.

Indications for Nitrates In addition to angina, for what condition is isosorbide dinitrate indicated? Select all that apply.

Hypertension Heart failure Renal insufficiency Diabetes mellitus

Self Check: isosorbide dinitrate (Isordil) Therapeutic Effects of isosorbide dinitrate Which statement provides subjective data that the recently prescribed isosorbide dinitrate is having the desired therapeutic effect on the individual speaking? Select all that apply.

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averaging.”

Stuvia.com - The Marketplace to Buy and Sell your Study Material “My angina is about the same as it has been. Not better. Not worse.”

“I was able to walk around the block twice last night with my partner. First time in years we’ve done that.”

“I have been sleeping so well these past few nights.”

Administration Routes for isosorbide dinitrate By what routes can isosorbide dinitrate be administered? Select all that apply.

Intravenous Oral Rectal Buccal Sublingual

Pharmacokinetics of isosorbide dinitrate Use the drop down menus to fill in the missing information related to the pharmacokinetics of isosorbide dinitrate.

Safe Administration of isosorbide dinitrate In which individuals should caution be used when administering isosorbide dinitrate? Select all that apply.

An individual having a heart attack involving the right ventricular muscle An older adult experiencing chest pain for the first time An individual with glaucoma A middle-aged adult who is dehydrated A diabetic with chronic heart failure

Self Check: Administration Schedule for Nitrates

An individual taking three doses of isosorbide dinitrate asks the health professional why this medication is taken once every six hours, rather than in the morning, with lunch, and before going to bed like another medication they take. What is the best response by the health professional?

“This timing assures the medication levels are highest during the day when you are most active and likely to have angina.”

“That is how your health care provider prescribes it for all their patients.”

“A nitrate free period allows your cells to be responsive to the medication.”

“That is just how this medication is given.”

Reflect: Nitrates Evaluating Effectiveness: rapid acting nitrate A nurse is monitoring a patient with angina for therapeutic effects of a rapid-acting nitrate given for chest pain.

Which assessment finding indicates that the medication has been effective?

Client stating that pain is 0 out of 10 Heart rate 70 beats per minute Blood pressure 120/80 mm Hg ECG without evidence of ST changes Adverse Effects: isosorbide dinitrate The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information to lower potential side effects of the medication will the nurse include?

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Avoid alcohol consumption Stuvia.com - The Marketplace to Buy and Sell your Study Material Limit exercise to 30 minutes twice per week Monitor intake and output Pharmacokinetics of nitroglycerin Use the drop down menus to fill in the missing information related to the pharmacokinetics of nitroglycerin.

Managing Nitrate Tolerance Scheduling a daily nitrate free period allows plasma and tissue nitrate levels to fall, allowing cells to recover to a responsive state when the next dose is administered. These nitrate free periods are used to offset tolerance that can develop with long term continuous administration of nitrates.

Adverse Effects: Nitrates The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to t development of which condition?

Urinary retention Tolerance Hypertension Tachycardia Safe Administration: nitroglycerin What precautions does the nurse take to protect themselves when preparing and administering nitroglycerin ointment?

Apply gloves Carefully measure the dose Adhere to the rights of medication administration Document vital signs prior to applying the ointment

Dosing: nitroglycerin An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10. Five minute later, the chest pain is 4/10. What action should be taken next?

The person should take another sublingual nitroglycerine tablet The individual should take a warm shower Have a family member call 911 Wait an additional 10 minutes before taking any action Safe Administration: nitroglycerin After the nurse has finished teaching a patient about the use of sublingual nitroglycerin, which patient statement indicates that the teaching has been effective?

"I can expect some nausea as a side effect of nitroglycerin.“ "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”

"I should only take the nitroglycerin if I start to have chest pain.“ "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart.“

Calcium Channel Blockers (diltiazem, amlodipine, verapamil) Prepare: Calcium Channel Blockers (CCB) Chemical Classifications of calcium channel blockers (CCBs) Select the chemical classifications of calcium channel blockers by clicking on the correct answers.

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Calcium and Muscle Contraction Extracellular calcium is required for the contraction of cardiac and smooth muscle cells.

Indication for Calcium Channel Blockers (CCBs) In addition to angina, for what conditions are calcium channel blocker medications indicated? Select all that apply Renal insufficiency Hypertension Arrhythmia Diabetes mellitus Heart failure

Self Check: Calcium Channel Blockers

Mechanism of Action for Calcium Channel Blockers (CCBs) By decreasing the systemic vascular resistance, calcium channel blockers decrease the workload of the heart and myocard demand for oxygen.

Drug-Drug Interactions for Calcium Channel Blockers An individual taking nifedipine for blood pressure regulation has a new prescription for digoxin. The health care provider anticipates that this combination of medications may have which effects? Select all that apply.

Increased digoxin levels Heart failure Hypertension Low heart rate Increased elimination of digoxin Renal toxicity

Self Check: Administration Routes for diltiazem By what routes can diltiazem be administered? Select all that apply.

Intravenous Oral Rectal Buccal Sublingual

Self Check: Pharmacokinetics of verapamil Use the drop down menus to fill in the missing information related to the pharmacokinetics of verapamil.

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Self Check: Dosing Considerations for amlodipine

Which individuals may require a lower dose of amlodipine? Select all that apply.

An individual with renal insufficiency An emaciated 49-year-old A person with chronic cirrhosis A 54-year-old with a yeast infection A 79-year-old with vasospastic angina

Reflect: Calcium Channel Blockers (CCB) Mechanism of Action Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply. diltiazem nifedipine felodipine verapamil amlodipine Generic and Trade Names or Classes Drag the medications to the classification in which each belongs.

Medication

Benzothiazepines

Dihydropyridines

Phenylalkylamines

diltiazem

nifedipine / amlodipine

verapamil

Indications for Use A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class drugs is used to treat which type of angina?

Prinzmetal Crescendo Unstable Vasospastic Safe Administration A patient taking diltiazem to treat an irregular heart rhythm should not take their medication and notify the prescribing health care provider if which conditions are present when checking his pulse and blood pressure?

Select all that apply.

Heart rate is 1366 beats per minute Blood pressure 198/102 Heart rhythm is irregular A new rash has developed Last bowel movement was two days ago Indications for Use: Calcium Channel Blockers (CCBs) Which calcium channel blockers are indicated for cardiac dysrhythmias? amlodipine nifedipine diltiazem Verapamil isradipine Adverse Effects: Calcium Channel Blockers (CCBs)

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Routine oral hygiene is necessary to prevent which adverse effect associated with calcium channel blocker therap Stuvia.com - The Marketplace to Buy and Sell your Study Material Bad breath Oral candidiasis Gingival hyperplasia Dental caries Mechanism of Action An individual asks how their diltiazem works to help their angina. What is the best response by the health professional?

“It prevents cardiac dysrhythmias.” ”It blocks calcium channels allowing the arteries to dilate.”

“It increases excretion of sodium and water through the kidneys.”

“It blocks the renin-angiotensin-aldosterone cycle.”

Side Effects The nurse is counseling a client who is to start taking amlodipine for hypertension. Which statement by the client indicates that further teaching is needed?

“I need to call the doctor if my pulse is less than 50 beats in a minute.”

“It is important that I take this medication on an empty stomach.”

“I need to check with the doctor before taking any new over-the-counter cold medicines.”

“I’ll get up slowly since I may be a little dizzy if I get up too fast.”

Nursing Application: Antianginals Prepare: Nursing Application for Antianginals Initial Assessment for Angina The initial nursing assessment of a patient diagnosed with angina should including questions about which underlying causes? Select all that apply.

High blood pressure Allergies to medications Depression Tobacco use Diabetes mellitus

Indications for Use for Antianginals In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed sho acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?

"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.”

"I will check my pulse rate before I take any nitroglycerin tablets.”

"I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin.”

"I will put the nitroglycerin patch on as soon as I get any chest pain.”

Goals of Treatment for Angina The teaching plan for a client being started on long-acting nitroglycerin includes the drug’s mechanism of action.

The nurse teaches that this drug relieves chest pain by which action?

Dilating just the coronary arteries Decreasing the blood pressure Increasing contractility of the heart Dilating arteries and veins

Self Check: Ongoing Assessment

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chest pain have decreased only marginally after three months of treatment with sublingual nitroglycerin, the nurse Stuvia.com - The Marketplace to Buy and Sell your Study Material asks the patient if they are having any difficulty placing the small tablet beneath the tongue. What is the rationale f this question? Select all that apply.

Assess for physical limitations that may affect medication use Determine if the person really wants to be healthier Shame the patient to comply with the treatment plan Evaluate the patient’s understanding of how and when to take the medication Understand what motivates the patient Expected Outcomes: Acute Anginal Attack Which action is the first priority of care for a client exhibiting signs and symptoms of angina?

Enhance myocardial oxygenation Educate the client about their symptoms Decrease anxiety Administer sublingual nitroglycerin

Self Check: Nursing Diagnosis and Outcomes Identification

Assessment and Planning for Angina Which assessment data collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by angina?

The pain is reproducible when the patient raises the arms The pain increases with deep breathing The pain has lasted longer than 30 minutes The pain is relieved after the patient takes nitroglycerin

Self Check: Patient Education

Patient Education: Risk for Side Effects of Antianginals While attending a community picnic on a hot day, and older adult with stable angina had an episode of chest pain and took a sublingual nitroglycerine tablet, which relieved the pain. Thirty minutes later, the individual experienced dizziness and hypotension and was brought to the first aid tent for care. After the patient is feeling better and their blood pressure has returned to normal, what information will the nurse provide to help the patient avoid a recurrence?

“This happens to a lot of people. Just make sure to stay near the first aid tent in the future.”

“You should drink a lot more water on days that are this hot.”

“Hot weather can increase the effects of your medication. Try to limit your time outside on days like this.”

“Perhaps you are too old and should stop attending these outdoor events.”

Self Check: Evaluation of Antianginals

Evaluating Antianginal Therapy Select the values from the drop down menus that accurately complete the sentence.

Control of angina is achieved when the severity and frequency of episodes decreases and the patient’s tolerance of increas activity occurs.

Reflect: Nursing Application for Antianginals

Risk for Complications While assessing a patient with angina with a new prescription for selective beta-1 blocker therapy, the nurse is awa that the presence of which conditions may place this person at risk for complications? Select all that apply.

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Exertional angina Diabetes mellitus

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Drug-Drug Interactions: isosorbide dinitrate The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate as treatment for anginal pain. Which substances could result in a drug-drug interaction? Select all that apply. a glass of wine metformin carvedilol erectile dysfunction medication levothyroxine

Assessing for Side Effects A patient with diabetes, hypertension, and stable angina is being discharged home. The patient will be taking a non selective beta blocker and insulin per sliding scale. Which statement by the patient demonstrates they require additional education about the side effects of the beta blocker?

"I will monitor my heart rate and blood pressure every day while taking this medication.”

“I will be checking my blood sugar level twice a day, and when I think it may be getting low.”

"I will report to my health care provider if I develop shortness of breath, weight gain, or swelling in my feet.”

"While taking this medication, I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low.”

Calcium Channel Blockers A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class drugs is used to treat which type of angina?

Crescendo Effort Unstable Vasospastic

Patient Education Which statement by the patient reflects the need for additional patient education about the calcium channel blocke diltiazem?

“I can take this drug to stop an attack of angina.”

“I understand that food and antacids alter the absorption of this oral drug.”

“This drug may cause my blood pressure to drop, so I need to be careful when getting up.”

“When the long-acting forms are taken, the drug cannot be crushed.”

Safe Administration A male patient admitted to the emergency department with intermittent chest pain provides a list of prescription medications to the nurse. Concurrent use of which medications has the most immediate implications for the patient's care? Select all that apply. captopril furosemide warfarin aspirin sildenafil Mechanism of Action A patient is prescribed metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly?

"I take this medication with my breakfast every morning.”

"I will change positions slowly while I'm taking this medication.”

“If I stop taking this medication, I will let my physician know.”

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“I am getting pretty good with monitoring my heart rate.”

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Withholding Antihypertensive The nurse is preparing to administer a morning dose of atenolol to a patient with hypertension and angina. The nurse withholds the medication and notifies the prescribing health care provider based on which cues discovered during the focused assessment? Select all that apply.

Headache with a pain level of 4/10 Crackles in lung fields Swelling in bilateral lower extremities Blood pressure 102/76 mmHg Heart rate 120 beats per minute Dyspnea

Heart Failure Medications Prepare: Heart Failure Medications

Goals of Treatment: Heart Failure Select the conditions outside the heart for which heart failure medications may be prescribed. Select all that apply

Cardiac Function Terminology Match the term related to cardiac function to its definition.

Alter impulse conduction in the myocardium

Dromotropic drugs

Amount of blood in the left ventricle just before each contraction

End-diastolic volume

Effect force of myocardial contractions

Inotropic drugs

Effect heart rate

Chronotropic drugs

Amount of blood ejected from the left ventricle with each contraction

Ejection fraction

Mechanism of Action: Phosphodiesterase Inhibitors Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure. These drugs cause a positi inotropic effect and what other effect?

Vasodilation z Vasoconstriction Platelet inhibition Bronchodilation

Self Check: Impact of Heart Failure

Based on the Framingham Heart Study, the mortality rate after diagnosis of heart failure (HF) in the USA was around 10% a 30 days, 20-30% at 1 year, and 45-60% over 5 years of follow-up.

Self Check: Last Use for Heart Failure Which medication to treat heart failure is used after all other medications have been prescribed? milrinone dobutamine amiodarone Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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digoxin

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Self Check: Dosing for Sacubitril/Valsartan Use the drop down menus to fill in the missing information related to dosing of sacubitril/valsartan.

Self Check: Safe Administration of Milrinone While administering milrinone to a person with heart failure monitor, which clinical response to treatment is most important?

Level of sedation Cardiac rhythm Urine output Serum glucose

Self Check: Pharmacokinetics for Ivabradine Use the drop down menus to complete the pharmacokinetic information for ivabradine.

Reflect: Heart Failure Medications Adverse Effects: milrinone Which adverse cardiac conduction alteration is most likely to occur in a patient who is receiving intravenous milrinone?

Bradycardia Ventricular tachycardia Atrial fibrillation Tachycardia

Effects of Medication for Heart Failure Which effects do medications used to treat heart failure have on the heart and blood vessels? Select all that apply.

Positive inotropic Reduced ejection fraction Negative chronotropic Alter impulse conduction Improve uptake of oxygen Therapeutic Effects: milrinone The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? Select all that apply.

Decreased heart rate Positive inotropic effects Increased blood pressure Vasodilation Increased urine output

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Therapeutic Effects: Beta Blockers Which beneficial cardiovascular effects are anticipated when metoprolol is used to treat heart failure? Select all th apply.

Reduced heart rate Decreased myocardial automaticity Increased heart rate Increased myocardial contractility Delayed AV node conduction Outcomes of Heart Failure Therapy Holistic therapy provided to individuals with heart failure is aimed at decreasing the likelihood of which events?

Select all that apply.

Contraindications: sacubitril/valsartan Administration of sacubitril/valsartan is contraindicated for use with individuals whose health history includes whi conditions? Select all that apply.

End stage liver failure Spontaneous abortion Angioedema Anorexia Glaucoma Medications for Heart Failure Match the medications to the classification in which each belongs.

If you can’t see Angiotensin Converting Enzyme (ACE) Inhibitors: lisinopril; captopril Angiotensin II Receptor Blockers (ARBs): valsartan Beta Blockers: carvedilol; metoprolol Loop Diuretics: furosemide Aldosterone Inhibitors: spironolactone Population Specific Heart Failure Medication Which heart failure medication was developed specifically for use by a specific ethnic group? milrinone sacubitril/valsartan digoxin hydralazine/isosorbide dinitrate

Nursing Application: Heart Failure Medications Prepare: Nursing Application for Heart Failure Medications

Medications for Heart Failure These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the workload of the heart and allows the kidneys to secrete sodium. However, some patients can Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal

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develop a nagging cough with these types of drugs. This description describes: Stuvia.com - The Marketplace to Buy and Sell your Study Material Angiotensin II receptor blockers Vasodilators Angiotensin-converting-enzyme inhibitors Beta-blockers Priority Assessment: Heart Failure Medications The nurse includes which parameters in ongoing focused assessment of patients receiving positive inotropic medication for heart failure? Select all that apply.

Monitor serum electrolytes Check apical pulse Review red blood cell count Obtain daily weights Auscultate lung sounds Contraindication: milrinone The nurse would question the use of milrinone in a patient with which condition?

Acute renal failure Systolic heart failure Aortic regurgitation Mitral valve prolapse

Self Check: Pre-Assessment Data for Heart Failure Medications Select the data collected by the nurse prior to administering a dose of a prescribed medication to a patient with chronic heart failure.

Self Check: Implementation of Heart Failure Medications Nursing Interventions for Heart Failure Drugs You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking hydralazine and isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?

Measure and record the urine voided Assist the patient up slowly and gradually Place the call light in the patient's reach while in the bathroom Provide privacy for the patient

Treating Heart Failure Select all the correct statements about educating the patient with heart failure.

Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.

It is important that patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week.

Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine Patients with heart failure should limit exercise because of the risks.

Heart failure patients should limit sodium intake to 2-3 grams per day.

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Self Check: Patient Teaching for Heart Failure Medications Stuvia.com - The Marketplace to Buy and Sell your Study Material Patient Education for Heart Failure Medications Which topics will the nurse include in discharge teaching for a patient newly diagnosed with heart failure taking valsartan/sacubitril? Select all that apply.

Date and time of next health care provider appointment How to check and record weight daily Symptoms that heart failure is getting worse How to check food labels for potassium and fat content To skip exercise when feeling tired

Evaluating Patient Understanding The nurse is providing diet education to a patient with a history of heart failure. Which statement made by the patie indicates they understood the diet teaching?

"I will limit my sodium intake to 5-6 grams a day.”

"I will be sure to incorporate canned vegetables and fish into my diet.”

"I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches.”

"I will limit my consumption of frozen meals.”

Reflect: Nursing Application for Heart Failure Medications

Patient Education A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may n be adhering to their prescribed medication regimen? ”My shoes are tighter than they were last week.”

“I haven’t noticed any swelling in my feet or hands lately.”

“While I sleep I have to prop myself up with a pillow so I can breathe.”

“I’ve noticed that I’ve gain six pounds in one week.”

“I have to urinate every one to two hours, even at night.”

Safe Administration of Heart Failure Drugs What priority assessment data will the nurse caring for a patient receiving nesiritide monitor?

Urine output Lung sounds Respiratory rate Blood pressure Evaluation of Risk for Heart Failure Exacerbation Which patient living with heart failure is most at risk for exacerbation of the disease?

A patient who limits sodium and fluid intake regularly The person with a health history of eczema and cystic fibrosis The patient who reports not taking amiodarone for one month and is experiencing atrial fibrillation One who is being discharged home from heart valve replacement surgery Heart Failure Medications and Critical Adverse Effects A stable patient prescribed valsartan/sacubitril to treat acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, which priority function will the nurse assess?

Heart rhythm Blood pressure Urine output Breath sounds

Indications for Heart Failure Medications The nurse is caring for a client who has heart failure and has a new prescription for sacubitril/valsartan. Which clie information is most important to discuss with the health care provider before administration of the medication?

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Oxygen saturation 92% Stuvia.com - The Marketplace to Buy and Sell your Study Material Current BP is 150/90 millimeters of mercury (mm Hg) Serum potassium of 3.4 milliequivalents per litre (mEq/L) Safety for Heart Failure Medications A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider.

What should this patient be taught to avoid?

High-potassium foods Nonsteroidal antiinflammatory drugs Over-the-counter histamine (H2) receptor blockers Drugs to treat erectile dysfunction Adverse Effects of Heart Failure Medications A client with stable angina has a prescription for ranolazine 500 mg twice a day. Which client finding is most important for the nurse to discuss with the health care provider?

Irregular heart rhythm Currently prescribed carvedilol Allergy to grapefruit History of chronic constipation

Nursing Implications for Heart Failure Medications The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be most important to monitor?

Alkaline phosphatase Serum potassium Blood urea nitrogen (BUN) Extracellular sodium level

Antilipemics Prepare: Antilipemics Exogenous Lipids Exogenous lipids originate outside of the body.

Protein Lipoprotein is a protein, synthesized in the liver, that contains varying amounts of triglycerides, cholesterol and phospholipid Hypercholesterolemia Hypercholesterolemia is a condition of high Low-density lipoprotein (LDL).

Self-Check: Cholesterol Levels

Which factors are considered to support the use of pharmacotherapy to reduce low-density lipoprotein (LDL)? Sel all that apply.

Low-density lipoprotein (LDL) levels greater than or equal to 100 mg/dL Low-density lipoprotein (LDL) levels greater than or equal to 190 mg/dL Client history of diabetes Client gender Client history of atherosclerotic cardiovascular disease Client age Clients with high risk for cardiovascular disease

Self-Check: Antilipemic Drugs What drug decreases the rate of cholesterol production?

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Fibric acid derivatives Stuvia.com - The Marketplace to Buy and Sell your Study Material Bile acid sequestrant Beta-Hydroxy Beta-methylglutaryl-CoA (HMG-CoA) reductase agents

Self-Check: Client Education on Antilipemic Drugs Which statement by the client on long-term antilipemic therapy indicates the need for further education?

“I avoid eating for 12 hours before my lab tests.”

“Once my cholesterol levels are normal, I can stop taking the medication.”

“I increased my water and fiber intake to avoid constipation.”

“I started exercising 5 days a week.”

Reflect: Antilipemics Side Effects: Antilipemics What are issues that can occur with antilipidemics with long term use?

Altered vitamin absorption Constipation Gout Biliary issues Antilipemics Drugs Which factors are assessed when antilipemics drugs are prescribed? Select all that apply.

Cause of hyperlipidemia Hyperthyroidism Family history Gender Menopausal status Age Hyperlipidemia When referring to hyperlipidemia, what is phenotyping?

Charactering a patient's liver function Tracking a patient family history of hyperlipidemia Charactering a patient's specific lipid profile Charactering lipid compositions Good Cholesterol High-density lipoprotein (HDL) are considered good cholesterol.

Fat Soluble Vitamins Which of the following are fat soluble vitamins?

Vitamin C Vitamin A Vitamin K Vitamin D Antilipemic Drugs Classes What drug lowers low-density lipoprotein (LDL) by activating lipase to breakdown cholesterol?

Bile acid sequestrant Beta-Hydroxy Beta-methylglutaryl-CoA (HMG-CoA) reductase agents Niacin Fibric acid derivatives Antilipemic Drugs Classes Niacin will lower plasma concentrations of all lipoproteins.

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Antilipemic Drugs Classes Bile acid sequestrant prevents the resorption of the bile acids from the small intestine.

Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors (atorvastatin) Prepare: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors β-hydroxy β-methylglutaryl Coenzyme A (HMG-CoA) reductase inhibitors are metabolized by which enzyme? lipase pepsin troponin cytochrome P-450 Adverse Effect β-hydroxy β-methylglutaryl Coenzyme A Reductase inhibitors have an adverse effect of rhabdomyolysis. β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors β-hydroxy β-methylglutaryl Coenzyme A (HMG-COA) reductase inhibitors are considered statins.

Self-Check: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors Statins The client was recently prescribed a statin medication.

Question 1 / 2 The therapeutic effect of statin medications is a reduction in which value?

Serum low-density lipoprotein (LDL) Serum platelets Hepatic enzymes Serum high-density lipoprotein (HDL) Question 2 / 2 What high-priority lifestyle change should the nurse discuss with this client? Heart-healthy diet Contraindications What are the contraindications of β-hydroxy β-methylglutaryl Coenzyme A (HMG-CoA) reductase inhibitors?

Myocardial infarction Hepatic disease Pregnancy Cardiac disease

Self-Check: atorvastatin What is the ideal time for a client to take atorvastatin?

Take with 32 ounces of water At night Take with meals only Only before eating fried foods Cholesterol Drugs What drug decreases cholesterol production by the liver?

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Reflect: β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors Atorvastatin When atorvastatin is prescribed what laboratory values should be assessed? Select all that apply.

Hepatic enzymes White blood cells (WBCs) Cholesterol levels Troponin Renal panel Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors HMG-CoA reductase inhibitors raise High-density lipoprotein (HDL) levels.

Use of β-hydroxy β-methylglutaryl Coenzyme A Reductase Inhibitors What are issues that can occur with β-hydroxy β-methylglutaryl Coenzyme A (HMG-COA) reductase inhibitor use?

Coughing Sore muscles Nausea Elevated liver enzymes

Atorvastatin A client called the clinic to report blood in the urine and muscle soreness three (3) months after starting atorvastat How should the nurse respond?

“This indicates the medication is working very well.”

“This is a side effect of the medication.”

“You have a kidney stone. Go see your nephrologist.”

“Stop your atorvastatin and come to the clinic in the morning.”

Routes of Administration Which of the following is the route of administration for atorvastatin?

Oral Inhalation Intramuscular (IM) Intravenous (IV) Patient Education Which statement by the patient indicates a need for more education about atorvastatin?

“I will avoid grapefruit juice in excess.”

“I can take this medication on an empty stomach.”

“I will not chew the extended release tablets.”

“I will notify the healthcare provider if there are any changes in my urine color.”

Effect of atorvastatin What is the overall treatment goal for a client taking atorvastatin?

Muscles soreness Lower high-density lipoprotein (HDL) levels Increased triglyceride levels Slowing of the progression of coronary artery disease Patient Teaching A patient has been prescribed atorvastatin. Which of the following statements indicates that more teaching is needed?

“I will notify my healthcare provider before consuming any herbal medication.”

“I cannot skip a dose.”

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“I will be cured of my cholesterol problem.”

Stuvia.com - The Marketplace to Buy and Sell your Study Material “I will call my doctor if I get pregnant.”

Nursing Application: Antilipemics Prepare: Nursing Application: Antilipemics

Priority Assessment: Antilipemic Medications Which priority assessments should be completed before administering antilipemic medications to a patient? Selec all that apply.

Immunization history Baseline vital signs Drug-drug interactions Last bowel movement Known allergies

Side Effects: Antilipemics A client has started taking niacin (nicotinic acid) as part of treatment for high cholesterol levels. After the first dose he tells the nurse that he feels “hot” and that his face and neck are flushed. He says that he thinks he is having an allergic reaction. What is the nurse’s best response?

“I will inform the prescribing health care provider today. Stop taking the medications until you hear back from someone.”

“This is a common reaction. Most people get used to it.”

“Please have someone call 911 while I stay on the line with you.”

“If you have some available, take an aspirin now.”

Classification of Antilipemic Medications Place each antilipemic drug into the correct class.

Medications

Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors

Bile Acid Sequestrants

Fibric Acid Derivatives

lovastatin / simvastatin

colesevelam / cholestyramine

gemfibrozil / fenofibrate

Self-Check: Pre-Assessment Data: Medications for Heart Failure Pre-Assessment: Medications for Cholesterol Select the data collected by the nurse prior to administering the first dose of a prescribed antilipemic medication.

Self-Check: Complications: Antilipemic Therapy

A patient taking an antilipemic for three months calls the health care provider’s office to report their abdomen is so and their eyes appear to have a yellowish color this morning. The nurse asks about specific cues that may indicate which adverse effect of medications in this class?

Gastric perforation Hepatic dysfunction Acute renal failure Adrenal insufficiency

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Self-Check: Medication Instruction: Stuvia.com - TheAntilipemics Marketplace to Buy and Sell your Study Material

The nurse is working with a patient who has elevated triglyceride levels despite dietary changes. The health care provider has ordered fenofibric acid daily. Which information should the nurse include in the teaching?

“This medicine sometimes causes stomach pain and fatty, clay-colored stools, so if you experience that you shouldn worry.”

“Since you take warfarin, you will need to have your bleeding labs checked more frequently for a while.”

“This medicine will really help you lose weight, just be sure you’re drinking enough water.”

“This will be much easier than following all of those dietary restrictions; I know how hard that can be.”

Self-Check: Dietary Changes: cholestyramine

A client taking cholestyramine asks the nurse which foods should be restricted while taking this medication. Whic foods does the nurse recommend? Select all that apply.

Carbohydrates Cholesterol Potassium Sodium Fat Sugar

Self-Check: Antilipemic Therapy

Evaluating Effectiveness of Antilipemic Therapy While providing care to a 68-year-old man taking gemfibrozil, the nurse determines that treatment has been effectiv base on which laboratory result?

The patient has lost four pounds in the past two weeks.

The patient’s high-density lipoprotein (HDL) dropped and remains at an acceptable level.

The patient’s cholesterol decreased.

The patient’s low-density lipoprotein (LDL) remained elevated.

Reflect: Nursing Application: Antilipemics

Contraindications: Atorvastatin The nurse contacts the health care provider to question a new prescription for atorvastatin for a patient who is als taking which medication?

Erythromycin Oral contraceptives B-complex vitamins Potassium sparing diuretics

Safe Administration: Antilipemics The nurse providing patient education about cholestyramine will include which statements in the education? Selec all that apply.

“Notify the physician if your stool becomes frothy or foul smelling.”

“It is still important to follow a low-fat, low-cholesterol diet.”

“Diarrhea may occur.”

“This medication may cause dry mouth or a rapid heart rate; that is normal.”

“It can be mixed with water, milk, juice, or another noncarbonated beverage.”

“This medication should be taken before meals.”

Antilipemic Medications and Pregnancy A woman with known hyperlipidemia being treated with simvastatin is planning to start a family. Which lipid loweri agent does the nurse anticipate the health care provider prescribing?

New prescription for a cholesterol absorption inhibitor.

Continue the simvastatin.

New prescription for a bile acid sequestrant.

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New prescription for a phosphodiesterase inhibitor.

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Indications for Use: Ezetimibe The nurse is reviewing the home medication list for a client with identified hypercholesterolemia. The client reports taking ezetimibe daily. The nurse understands this medication is designed to reduce the client’s risk for which condition?

Deep vein thrombosis Atherosclerosis Gastric ulceration Angina

Dosing Schedule: Simvastatin The nurse determines a patient who was recently prescribed simvastatin determines that the patient understands t dosing schedule when they make which statement? ”I take this at night since my liver processes lipids in the early morning hours.”

“Since the timing does not matter with this medication, I take it with my noon meal.”

“I wait until 2 hours after I’ve finished a meal to take the simvastatin.”

“I make sure to stir my juice until the powder is completely absorbed.”

Omega-3 Fatty Acids: Patient Education The nurse is advising a patient whose triglyceride levels remain elevated despite three months of following a low-f low-cholesterol diet. The client is started on omega-3 acid ethyl esters. Which statements would the nurse include the teaching? Select all that apply.

“You still need to follow a low-fat diet while you’re taking this medication.”

“This medication may be taken with meals.”

“Limiting cholesterol intake is not as critical as limiting intake of carbohydrates.”

“Diabetes contributes to elevated triglyceride levels, so it is important to maintain good control or your diabetes.”

“It is important to establish an exercise routine that works with diet and medication to help control your weight.”

“You probably inherited this from one of your parents, so aside from medication, there isn’t much you can do.”

Safety: Beta-Hydroxy Beta-methylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors The nurse expects which laboratory studies will be ordered for a client who has been taking simvastatin for six (6) months? Select all that apply.

Total cholesterol Triglycerides High-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels Liver function studies Complete blood count Mechanism of Action of Antilipemic Drugs Match the mechanism of action on the right to the antilipemic drug classification on the left.

Bile Acid Sequestrants

Bind to bile, which is needed for the absorption of cholesterol from the small intestine.

This stimulates the liver to absorb more serum cholesterol to synthesize bile acids, which leads to decreased serum low-density lipoprotein (LDL).

Fibric Acid Derivatives

Activate lipoprotein lipase, an enzyme responsible for breaking down cholesterol.

Beta-Hydroxy Betamethylglutaryl-Coenzyme A (HMG-CoA) Reductase Inhibitors

Inhibit the enzyme needed to synthesize cholesterol, effectively decreasing serum cholesterol levels

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