A patient receiving heparin postoperatively to prevent deep vein thrombosis has a blood pressure of 90/50 mm Hg and a heart rate of 110 beats/minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The provider will order what interventions initially? (Se...
The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for
treatment of heart failure. The morning assessment identifies an irregular heart rate of 86 beats/minute,
a respiratory rate of 22 breaths/minute, and a blood pressure of 130/82 mm Hg. Crackles are heard in
both lungs. Which laboratory result will be of greatest concern to the provider?
Blood glucose level of 120 mg/dL
Oxygen saturation of 90%
Potassium level of 3.4 mEq/L
Sodium level of 140 mEq/L - ANSWER ✔ - C. This patient has an irregular, rapid heartbeat that might be
caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias,
especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on
the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent
this complication. This patient's serum glucose and sodium levels are normal and of no concern at this
point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to
be monitored, although it will likely improve with diuresis.
Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which
adverse reaction?
AV blockade
Gingival hyperplasia
Migraine headaches
Reflex tachycardia - ANSWER ✔ - A. Verapamil and digoxin both suppress impulse conduction through the
AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival
hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used
to prevent migraine, although its use for this purpose is under investigation. Verapamil and digoxin both
suppress the heart rate, so tachycardia is not anticipated. The calcium channel blocker nifedipine, not
verapamil, causes reflex tachycardia.
Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis?
Captopril PO
, Hydralazine PO
Minoxidil PO
Sodium nitroprusside IV - ANSWER ✔ - D. Sodium nitroprusside, the drug of choice for hypertensive
emergencies, is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be
used but should be given IV instead of PO. Minoxidil is effective, but its severe side effects make it a
second-line drug.
A patient had a blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. This
is consistent with a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's
diagnostic tests are all normal. What will the patient's provider order to best manage the patient's
hypertension?
A β blocker
A loop diuretic and spironolactone
A thiazide diuretic
An α1 blocker - ANSWER ✔ - C. This patient has primary, or essential, hypertension as evidenced by systolic
pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out
another primary cause. Thiazide diuretics are first-line drugs for hypertension. β blockers are effective but
are most often used to counter reflex tachycardia associated with reduced blood pressure caused by
therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line
drugs. α1 blockers are not drugs of first choice.
A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to
treat hypertension in this patient?
Angiotensin-converting enzyme (ACE) inhibitors
β blockers
Direct-acting vasodilators
Thiazide diuretics - ANSWER ✔ - A. ACE inhibitors slow the progression of kidney injury in diabetic patients
with renal damage.
In Diabetes: No B blockers or Thiazides!
β blockers can mask signs of hypoglycemia
Direct-acting vasodilators are third-line drugs for HTN.
Thiazide diuretics promote hyperglycemia.
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