MILESTONE - CARDIO #2

When administering nitroprusside by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity?

• Hyperglycemia

• Fever

• Hypotension

• Wheezing

Answer explanation

The main symptom of sodium nitroprusside overdose or toxicity is excessive hypotension.

Which statement by the patient demonstrates a need for further education regarding nitroglycerin sublingual tablets?

• “I can take up to four tablets at 5-minute intervals for chest pain.”

• “If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache.”

• “I should change positions slowly to avoid getting dizzy from the drug’s effect on my blood pressure.”

• “I should keep my nitroglycerin in a cool, dry place.”

Answer explanation

Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.

To prevent the development of tolerance to nitroglycerin transdermal patch, the nurse instructs the patient to perform which action?

• Apply the nitroglycerin patch in the morning and remove it at night for 8 hours.

• Use the nitroglycerin patch for acute episodes of angina only.

• Apply a new nitroglycerin patch every other day.

• Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.

Answer explanation

To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.

Before administering isosorbide mononitrate sustained-release tablet to a patient, what is the priority nursing intervention?

• Obtain a blood pressure reading.

• Advise the patient that Tylenol is used to treat headache.

• Emphasize that the patient should swallow the tablet whole.

• Remind the patient to take the tablet before meals.

Answer explanation

Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

The nurse understands that a patient receiving nitroglycerin would be monitored for which common adverse effects associated with this medication? (Select all that apply.)

• Blurred Vision

• Flushing

• Dizziness

• Headache

• Hypotension

Answer explanation

The common adverse effects of nitroglycerin include flushing of the face, dizziness, fainting, headache, and hypotension.

A patient is receiving lidocaine by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition?

• Sinus Bradycardia

• Atrial Fibrillation

• 1st Degree Heart Block

• Ventricular Dysrhythmias

Answer explanation

Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias.

The nurse is reviewing the protocol for administration of IV adenosine. What is the most important nursing intervention to remember when giving this medication?

• Flush the IV catheter with normal saline.

• Administer it as a fast IV push.

• Monitor the infusion site for hematoma.

• Assess for burning sensation at the IV site.

Answer explanation

Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push.

To prevent the occurrence of cinchonism in a patient prescribed quinidine, which instruction is most important for the nurse to provide for this patient?

• Increase dietary intake of potassium.

• Remind the patient to change positions slowly.

• Advise the patient to wear sunscreen every day.

• Avoid drinking grapefruit juice.

Answer explanation

Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism.

The nurse understands adenosine is used to treat which condition?

• Paroxysmal supraventricular tachycardia (PSVT)

• Atrial flutter

• Second-degree atrioventricular block

• Atrial fibrillation

Answer explanation

The only therapeutic indication of use for adenosine is the treatment of PSVT.

Sodium channel blockers are considered which class of antidysrhythmic drugs?

• Class I

• Class III

• Class IV

• Class II

Answer explanation

The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs.