B261: Exam 3 REVIEW SESSION

What are some early signs of toxicity to digoxin (Lanoxin) What are some early signs of toxicity to digoxin (Lanoxin)? Select all that apply Nausea, loss of appetite Dizziness Confusion Bradycardia

Early signs of toxicity to digoxin (Lanoxin) include: Nausea, loss of appetite Dizziness Bradycardia Confusion is a sign of more advanced toxicity.

What is the intended action of Heparin? To dissolve blood clots To prevent the formation of blood clots

The intended action of Heparin is: To prevent the formation of blood clots It will not dissolve existing clots.

When using inhaled corticosteroids, there is a risk for: Tachycardia Constipation Oral fungal infections Headache

When using inhaled corticosteroids, there is a risk for: Oral fungal infections These will look like a whitish or fuzzy coating in the inside of the mouth.

You can prevent an oral fungal infection by: Taking anti-fungal medications Rinsing the mouth well after using an inhaled corticosteroid

You can prevent an oral fungal infection by: Rinsing the mouth well after using an inhaled corticosteroid

Beta-blockers include which one of the following: Digoxin (Lanoxin) Nifedipine (Procardia) Lisinopril (Zestril) Propanolol (Inderal)

Beta-blockers include which one of the following: Propanolol (Inderal) is a beta-blocker. You can often tell because the generic name ends with -olol

Beta-blockers have many uses, but they should not be used in patients with: Asthma Congestive heart failure Hypertension Migraine headaches

Beta-blockers have many uses, but they should not be used in patients with: Asthma Blocking the effects of beta adrenergic receptors in the lungs can worsen bronchiole restriction and are contraindicated in persons with chronic, obstructive pulmonary diseases.

The most important vital sign to check for administration of Verapamil (Calan) is: Respiratory rate Blood pressure Heart rate Temperature

The most important vital sign to check for administration of Verapamil (Calan) is: Blood pressure If you can only check on thing, then BP is the most important thing to check as calcium channel blockers lower BP.

The most important vital sign to check for administration of Digoxin (Lanoxin) is: Respiratory rate Blood pressure Heart rate Temperature

The most important vital sign to check for administration of Digoxin (Lanoxin) is: Heart rate Apical heart rate for a full minute is the recommended vital sign to check before administration. Hold the dose for anything less than 60 bpm!

The most significant vital sign for giving a beta-blocker such as propanolol is: Respiratory rate of 22 per minute Blood pressure of 148/86 Heart rate of 54 Temperature of 99.1

The most significant vital sign for giving a beta-blocker such as propanolol is: Heart rate of 54 Beta-blockers should not be given if the heart rate is less than 60, or if the BP is very low.

The most significant vital sign for giving an inhaled beta-adrenergic agonist such as albuterol (Proventil)is: Respiratory rate of 28 per minute Blood pressure of 148/86 Heart rate of 88 Temperature of 99.1

The most significant vital sign for giving an inhaled beta-adrenergic agonist such as albuterol (Proventil)is: Respiratory rate of 28 per minute These medications are used to treat respiratory distress such as wheezing and bronchiole constriction

Which categories of medications can lower BP? (Select all that apply) Diuretics Angiotensin Converting Enzyme Inhibitors Anti-lipidemics Anti-coagulants Calcium Channel Blocker

Which categories of medications can lower BP? (Select all that apply) Diuretics Angiotensin Converting Enzyme Inhibitors Calcium Channel Blockers Drugs that lower cholesterol or triglycerides or that prevent coagulation have no significant effects on BP

Patients who take anticoagulants at home should: Avoid herbal remedies such as gingko biloba Use regular safety razors to shave Avoid eating iceberg lettuce in salads

Patients who take anticoagulants at home should: Avoid herbal remedies such as gingko biloba Safety razors should be avoided and electric razors should be used to reduce bleeding injuries. Lettuce salads are not very high in Vitamin K.

What is the most rapid-acting treatment for an asthma attack? An inhaled anti-cholinergic drug such as ipratropium (Atrovent) An inhaled beta adrenergic drug such as albuterol (Proventil) An inhaler steroid such as salmeterol/fluticasone (Advair)

What is the most rapid-acting treatment for an asthma attack? An inhaled beta adrenergic drug such as albuterol (Proventil) While inhaled anti-cholinergic drugs and steroids will likely be used, they are not as rapid in onset and are not the first treatment option.

Is warfarin (Coumadin) safe to use in pregnancy? Yes No

Is warfarin (Coumadin) safe to use in pregnancy? No Clients should be counseled to avoid pregnancy if they are taking Warfarin (Coumadin) and other treatment options, e.g. Enoxaparin (Lovenox) can be considered.

Nitrates include the following drugs: Nitroprusside IV Nitroglycerin sublingual tablets Nitrodur skin patch Losartan (Cozaar) Amlodipine (Norvasc)

Nitrates include the following drugs: Nitroprusside IV Nitroglycerin sublingual tablets Nitrodur skin patch

A common side effect of a nitrate is: Stomachache Angina Headache Shortness of breath

A common side effect of a nitrate is: Headache Headaches are common side effects of nitrates and clients should be taught to expect them. Acetominophen is generally safe to use PRN.

When should a PRN sublingual nitrate be given? Every morning “just in case” When anginal pain persists for at least 10 minutes Immediately at the onset of anginal pain.

When should a PRN sublingual nitrate be given? Immediately at the onset of anginal pain. Always treat angina seriously and aggressively to avoid having cardiac muscle damage (cardiomyopathy).

Other than medications, what actions can a nurse take when a client has angina?

Other than medications, what actions can a nurse take when a client has angina? Apply oxygen Put the patient on bedrest (limit activity) Start an IV for emergency care Keep the patient warm (vasodilation) Help to reduce anxiety through deep breathing activities Minimize stimulation in the environment: Turn down lights and television Limit visitors

A packed red blood cell transfusions An injection of Vitamin K If a client starts bleeding from too much Heparin, the client may initially be given: A packed red blood cell transfusions An injection of Vitamin K An injection of Protamine sulfate

If a client starts bleeding from too much Heparin, the client may initially be given: An injection of Protamine sulfate Protamine and Heparin are competitive drugs and will inactivate one another.

A packed red blood cell transfusions An injection of Vitamin K If a client starts bleeding from too much warfarin (Coumadin), the client may initially be given: A packed red blood cell transfusions An injection of Vitamin K An injection of Protamine sulfate

If a client starts bleeding from too much warfarin (Coumadin), the client may initially be given: An injection of Vitamin K Since warfarin works by blocking the activity of Vitamin K, the antidote to excessive warfarin is to administer a high dose of Vitamin K by injection.

Potassium (for hypokalemia) Glucose (for hypoglycemia) Clients who take diuretics such as furosemide (Lasix) or hydrochlorothiazide (HCTZ) should have this lab monitored closely: Potassium (for hypokalemia) Glucose (for hypoglycemia) Albumin (for hypoproteinemia) Red blood cells (for anemia)

Clients who take diuretics such as furosemide (Lasix) or hydrochlorothiazide (HCTZ) should have this lab monitored closely: Potassium (for hypokalemia) Potassium should be watched for hypokalemia. Other electrolyte monitoring is also important (Na, Ca, and Mg).

Clients who take furosemide or hydrochlorothiazide should be counseled to eat more foods containing potassium. True False

Clients who take furosemide or hydrochlorothiazide should be counseled to eat more foods containing potassium. True A simple thing to do at home is to eat more bananas, potatoes and potassium containing food.

Nephropathy Cardiomyopathy Cardiac Arrthymias Hepatitis Ototoxicity Toxicity related to furosemide (Lasix) includes which of the following (Select all that apply): Nephropathy Cardiomyopathy Cardiac Arrthymias Hepatitis Ototoxicity

Toxicity related to furosemide (Lasix) includes which of the following (Select all that apply): Cardiac Arrthymias Ototoxicity Furosemide can cause cardiac arrhythmias due to electrolyte disturbances, and hearing loss with high dose or chronic usage.

Fill in the blanks: Dextromethorphan (Robitussin) _______, while Guaifenesin _______ .

Fill in the blanks: Dextromethorphan (Robitussin) suppresses the cough reflex. Guaifenesin makes sputum easier to mobilize and expectorate.

Match labs with drug (can use drug more than once): Heparin Warfarin (Coumadin) Enoxaparin (Lovenox) Clopidogrel (Plavix) PTT INR and PT None needed White blood cells (neutrophils) Platelets

Match labs with drug (can use drug more than once): Heparin Warfarin (Coumadin) Enoxaparin (Lovenox) Clopidogrel (Plavix) PTT INR and PT None needed White blood cells (neutrophils) Platelets

What are some common side effects of all antihypertensive drugs? Increased blood pressure Orthostatic hypotension Reduction in heart rate Dizziness Irritating and persistent cough Swelling around the face and neck

What are some common side effects of all antihypertensive drugs? Orthostatic hypotension Reduction in heart rate Dizziness Antihypertensives should lower, not raise, BP. Swelling around the face, mouth and neck is a serious adverse reaction called “Angioedema” and is only seen in Angiotensin related drugs esp. losartan (Cozaar)

Angioedema

Which of the following drugs is a “statin”? Omega-3 Fatty Acid (Fish Oil) Losartan (Cozaar) Ezetimide (Zetia) Atorvastatin (Lipitor)

Which of the following drugs is a “statin”? Atorvastatin (Lipitor)

Fill in the Blank: Atorvastatin (Lipitor) works in the ________ to prevent the synthesis of cholesterol, while Ezetimide (Zetia) works in the __________ to reduce the absorption of cholesterol.

Fill in the Blank: Atorvastatin (Lipitor) works in the liver to prevent the synthesis of cholesterol. Ezetimide (Zetia) works in the gastrointestinal tract to reduce the absorption of cholesterol.

Match Drug with Side Effect: Atorvastatin (Lipitor) Ezetimide (Zetia) Diarrhea and GI cramps Muscle cramps

Fill in the blank: Albuterol (Proventil) is: ________________ while ipratropium (Atrovent) is: ____________ . Adrenergic Anti-cholinergic

Fill in the blank: Albuterol (Proventil) is adrenergic while ipratropium (Atrovent) is anti-cholinergic.

Parasympathetic Nervous System Sympathetic Nervous System Nervous System Review Parasympathetic Nervous System Sympathetic Nervous System CHOLINERGIC Many drugs are antagonists (anti-cholinergic) and cause: Relaxation of bronchiole smooth muscle Decreased GI Motility ADRENERGIC Fight-or-flight Vasoconstriction Bronchiole dilation Increased BP Increased HR Increased Respirations

What is a common side effect of an anti-histamine? Drowsiness Tachycardia Lowered blood pressure Increase in salivation

What is a common side effect of an anti-histamine? Drowsiness Drowsiness is the most common side effect of antihistamines. Because of this, routine daily dosing should begin in the evenings.

Identify if the following risk factors for stroke are modifiable (through medications, diet or behavioral changes) or are not modifiable. High fat diet Lack of exercise/Sedentary life style Genetics Ethnicity/race Hypertension Smoking

Identify if the following risk factors for stroke are modifiable (through medications, diet or behavioral changes) or are not modifiable. High fat diet – Modifiable Lack of exercise/Sedentary life style – Modifiable Genetics – NOT Modifiable Ethnicity/race – NOT Modifiable Hypertension – Modifiable Smoking - Modifiable

What are some signs of a DVT?

What are some signs of a DVT? Five signs of inflammation: Unilateral dull, aching pain Swelling Redness Mild loss of mobility Heat

What are some nursing interventions to reduce the risk of developing a DVT?

What are some nursing interventions to reduce the risk of developing a DVT? Compression stockings Encouraging movement and activity Range of motion Teach patient not to cross her legs at the knees

What are some nursing interventions to treat DVT?

What are some nursing interventions to treat DVT? Do not massage the affected area. Limit activity – Maintain client on bed rest Administer anti-coagulants and monitor for bleeding side effects.

A venous clot (emboli) that travels (thrombus) can cause: (Select all that apply): A cerebrovascular accident (stroke) A myocardial infarction Gangrene of an extremity Pulmonary emboli

A venous clot (emboli) that travels (thrombus) can cause: (Select all that apply): Gangrene of an extremity Pulmonary emboli Clots from the venous system typically either go into smaller vessels in the periphery, or through the right-side of the heart to the lungs.

In an EKG (ECG), what does a P-wave signify?

In an EKG (ECG), what does a P-wave signify? Atrial Depolarization

In an EKG (ECG), what does the QRS complex signify?

In an EKG (ECG), what does the QRS complex represent? A single heart beat

What does a radial pulse feel like in the presence of Atrial Fibrillation?

What does a radial pulse feel like in the presence of Atrial Fibrillation? The pulse will be very irregular. This is why it should be counted for a full minute and not just 6, 15 or 30 seconds.

That’s all, Folks!