NURS126: Pharmacology in Nursing Practice II - Exam 5
Questions With Complete Solutions
Describe tolerance to organic nitrates. Correct Answers
Develops after 24 hours; disappears when drug withheld
-> Develops with long-acting formulations (like Isosorbide
dinitrate)
Remove transdermal patch for 6 - 12 hours each day or withhold
nighttime oral drug to prevent it
-> Oxygen demand during sleep decreases = fewer anginal
episodes during this drug-free period/interval
-> Oral and topical are for long-term prophylactic use
What are nursing considerations for ACE inhibitors? Correct
Answers Obtain CBC before & during treatment
-> Hold medication if neutrophil count < 1,000/mm3
**Drug may cause neutropenia
Discontinue diuretic before initial ACE inhibitor administration
-> Prevents severe hypotension
---> Position patient supine & notify physician if present
What are nursing considerations for beta-adrenergic blockers (as
antianginal drugs)? Correct Answers Monitor VS
Monitor blood glucose levels (in diabetics)
-> Initial symptoms of hypoglycemia may not be evident (mask
effect)
-> Insulin doses may need adjustment (insulin drops blood
sugar)
,What are nursing considerations for beta-adrenergic blockers (as
heart failure drugs)? Correct Answers Administration
-> Initial dose too high or ↑ rapidly can worsen HF
Monitor for S & S of worsening HF
-> Chest pain, edema in ankles/feet, & SOB
What are nursing considerations for calcium channel blockers?
Correct Answers Monitor BP (lying/sitting/standing) & P;
obtain weight
Observe for S & S of HF (dyspnea, frothy pink-tinged sputum,
rales in lungs, profound fatigue, or swelling of extremities =
retaining fluid)
Avoid grapefruit juice
-> Reduces drug metabolism → possible toxicity
Assess bowel function
-> Constipation
What are nursing considerations for cardiac glycosides? Correct
Answers Measure apical pulse rate
-> Withhold dose & notify physician if < 60 or > 100
-> Apical pulse at Point of Maximal Impulse (PMI)
Assess potassium levels
-> Hypokalemia may precipitate digoxin toxicity
Ensure normal therapeutic drug levels are 0.5 to 2 ng/mL
, -> If higher than 2, withhold drug and notify prescriber.
Administer digoxin immune Fab (digibind) as antidote for
severe overdose (i.e. more than 10 mg in adults)
-> One vial binds 0.5 mg of digoxin
What are nursing considerations for class I sodium channel
blockers? Correct Answers Assess BP
Monitor for changes in ECG
Observe serum drug levels
-> procainamide: 4 - 8 mcg/mL is therapeutic
What are nursing considerations for class III potassium channel
blockers? Correct Answers Assess VS
-> Withhold drug if P < 60 or SBP < 90 mm Hg
Monitor ECG
Obtain baseline chest x-ray & pulmonary function tests
-> Possible lung toxicity
What are nursing considerations for class IV calcium channel
blockers? Correct Answers Obtain thorough drug history
-> May interact with others, causing additive (combined effect
of two drugs is equal to sum of each drug given alone) effects on
BP & P (beta-adrenergic blockers)
Monitor VS
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