1. B261: Exam 3
REVIEW SESSION

2. 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

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

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

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

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

7. 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.

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

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

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

11. 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

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

13. 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.

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

15. 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.

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

17. 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!

18. 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

19. 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.

20. 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

21. 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

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

23. 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

24. 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

25. 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.

26. 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)

27. 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.

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

29. 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.

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

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

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

33. 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.

34. 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.

35. 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).

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

37. 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

38. 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

39. 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.

40. 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

41. 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.

42. 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)

43. 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).

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

45. 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.

46. 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

47. 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.

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

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

50. 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

51. 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

52. 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

53. 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)

54. Angioedema

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

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

57. 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.

58. 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.

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

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

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

62. 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

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

64. 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.

65. 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

66. 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

67. What are some signs of a DVT?

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

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

70. 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

71. What are some nursing interventions to treat DVT?

72. 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.

73. 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

74. 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.

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

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

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

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

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

80. 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.

81. That’s all, Folks!