Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has variant angina and is prescribed verapamil. Which of the following are expected outcomes of this medication? (Select all that apply.)
A. Decreased heart rate
Verapamil decreases heart rate, not increases it. This can help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
B. Increased contractility
Verapamil decreases contractility, not increases it. This can also help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
C. Dilated coronary arteries
Verapamil is a calcium channel blocker that is used to treat variant angina by dilating the coronary arteries and relieving the chest pain caused by spasms.It also reduces blood pressure and heart rate, but these are not the expected outcomes for variant angina.
D. Reduced blood pressure E.
Verapamil reduces blood pressure, not increases it. This can help lower the workload of the heart, but it is not the main goal of therapy for variant angina.
E. Relieved chest pain.
Verapamil is a calcium channel blocker that is used to treat variant angina by dilating the coronary arteries and relieving the chest pain caused by spasms.It also reduces blood pressure and heart rate, but these are not the expected outcomes for variant angina.
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Full Explanation
Verapamil is a calcium channel blocker that is used to treat variant angina by dilating the coronary arteries and relieving the chest pain caused by spasms. It also reduces blood pressure and heart rate, but these are not the expected outcomes for variant angina.
Choice A is wrong because verapamil decreases heart rate, not increases it. This can help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
Choice B is wrong because verapamil decreases contractility, not increases it. This can also help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
Choice D is wrong because verapamil reduces blood pressure, not increases it. This can help lower the workload of the heart, but it is not the main goal of therapy for variant angina.
Normal ranges for heart rate are 60 to 100 beats per minute, for blood pressure are 120/80 mm Hg or lower, and for contractility are measured by ejection fraction, which is normally 55% or higher.
Similar Questions
A patient is receiving heparin therapy during hemodialysis for chronic renal failure and develops heparin-induced thrombocytopenia (HIT). The nurse anticipates that which medication will be ordered for this patient?
A. Warfarin
Choice A is wrong because warfarin is a vitamin K antagonist that interferes with the synthesis of clotting factors II, VII, IX, and X. Warfarin is contraindicated in patients with HIT because it can worsen the thrombotic complications and cause skin necrosis. Warfarin should only be started after the platelet count has recovered and the patient is adequately anticoagulated with a non-heparin agent.
B. Clopidogrel
Choice B is wrong because clopidogrel is an antiplatelet agent that inhibits the ADP receptor on platelets, preventing their aggregation. Clopidogrel is not effective for the treatment of HIT, as it does not target the underlying mechanism of thrombin generation. Clopidogrel may also increase the risk of bleeding in patients with HIT.
C. Argatroban
This is because argatroban is a direct thrombin inhibitor that can be used as an alternative anticoagulant for patients with heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated disorder that occurs when antibodies form against heparin and platelet factor 4, leading to platelet activation and thrombosis. The diagnosis of HIT is based on clinical criteria and laboratory tests.
D. Alteplase.
Choice D is wrong because alteplase is a fibrinolytic agent that converts plasminogen to plasmin, which breaks down fibrin clots. Alteplase is not indicated for the treatment of HIT, as it does not prevent further thrombosis and may cause severe bleeding complications. Alteplase may be used as a last resort for life-threatening thrombosis in patients with HIT who do not respond to other therapies.
Full Explanation
This is because argatroban is a direct thrombin inhibitor that can be used as an alternative anticoagulant for patients with heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated disorder that occurs when antibodies form against heparin and platelet factor 4, leading to platelet activation and thrombosis. The diagnosis of HIT is based on clinical criteria and laboratory tests.
Choice A is wrong because warfarin is a vitamin K antagonist that interferes with the synthesis of clotting factors II, VII, IX, and X. Warfarin is contraindicated in patients with HIT because it can worsen the thrombotic complications and cause skin necrosis. Warfarin should only be started after the platelet count has recovered and the patient is adequately anticoagulated with a non-heparin agent.
Choice B is wrong because clopidogrel is an antiplatelet agent that inhibits the ADP receptor on platelets, preventing their aggregation. Clopidogrel is not effective for the treatment of HIT, as it does not target the underlying mechanism of thrombin generation. Clopidogrel may also increase the risk of bleeding in patients with HIT.
Choice D is wrong because alteplase is a fibrinolytic agent that converts plasminogen to plasmin, which breaks down fibrin clots. Alteplase is not indicated for the treatment of HIT, as it does not prevent further thrombosis and may cause severe bleeding complications. Alteplase may be used as a last resort for life-threatening thrombosis in patients with HIT who do not respond to other therapies.
A patient who has atrial fibrillation is taking warfarin and has an INR of 2.5.The patient reports having frequent headaches and asks for an over-the-counter pain reliever.The nurse will recommend which medication?
A. Ibuprofen
Choice A is wrong because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can enhance the anticoagulant effect of warfarin and increase the likelihood of harmful bleeding. NSAIDs can also cause stomach ulcers, kidney damage, and high blood pressure.
B. Naproxen
Choice B is wrong because naproxen is another NSAID that has the same risks as ibuprofen. Naproxen should be avoided by patients taking warfarin.
C. Acetaminophen
The patient reports having frequent headaches and asks for an over-the-counter pain reliever. The nurse will recommend acetaminophen, which is the safest pain reliever while taking warfarin. Acetaminophen does not interfere with the anticoagulant effect of warfarin and does not increase the risk of bleeding.
D. Aspirin.
Choice D is wrong because aspirin is also an anticoagulant that can increase the risk of bleeding when taken with warfarin. Aspirin can also cause stomach irritation, ulcers, and allergic reactions. The normal range for INR is 2 to 3 for patients with atrial fibrillation who are taking warfarin. An INR of 2.5 indicates that the patient’s blood is taking longer to clot than normal, but not too long. The patient should have regular blood tests to monitor their INR and adjust their warfarin dose if needed.
Full Explanation
The patient reports having frequent headaches and asks for an over-the-counter pain reliever. The nurse will recommend acetaminophen, which is the safest pain reliever while taking warfarin. Acetaminophen does not interfere with the anticoagulant effect of warfarin and does not increase the risk of bleeding.
Choice A is wrong because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can enhance the anticoagulant effect of warfarin and increase the likelihood of harmful bleeding.
NSAIDs can also cause stomach ulcers, kidney damage, and high blood pressure.
Choice B is wrong because naproxen is another NSAID that has the same risks as ibuprofen.
Naproxen should be avoided by patients taking warfarin.
Choice D is wrong because aspirin is also an anticoagulant that can increase the risk of bleeding when taken with warfarin.
Aspirin can also cause stomach irritation, ulcers, and allergic reactions.
The normal range for INR is 2 to 3 for patients with atrial fibrillation who are taking warfarin.
An INR of 2.5 indicates that the patient’s blood is taking longer to clot than normal, but not too long.
The patient should have regular blood tests to monitor their INR and adjust their warfarin dose if needed.
A nurse is caring for a client who has pulmonary embolism and is receiving alteplase via continuous IV infusion.The nurse should monitor for which adverse effects of this medication? (Select all that apply.)
A. Hypotension
Choice A is wrong because hypotension is not a common adverse effect of alteplase. Hypotension may occur due to blood loss from bleeding or other causes, such as dehydration, sepsis, or cardiac dysfunction.
B. Bleeding
Alteplase is a fibrinolytic agent that dissolves blood clots and restores blood flow. However, it also increases the risk of bleeding from any site, such as the nose, gums, injection sites, or internal organs. Therefore, the nurse should monitor the client for signs of bleeding, such as bruising, hematuria, hematemesis, melena, or decreased hemoglobin and hematocrit levels.
C. Dysrhythmias
Choice C is wrong because dysrhythmias are not a common adverse effect of alteplase. Dysrhythmias may occur due to pulmonary embolism itself, which can cause hypoxia, acidosis, and increased pulmonary artery pressure.
D. Nausea
Choice D is wrong because nausea is not a common adverse effect of alteplase. Nausea may occur due to other factors, such as anxiety, pain, or medications.
E. Fever.
Choice E is wrong because fever is not a common adverse effect of alteplase.Fever may occur due to infection, inflammation, or other causes.
Full Explanation
Alteplase is a fibrinolytic agent that dissolves blood clots and restores blood flow. However, it also increases the risk of bleeding from any site, such as the nose, gums, injection sites, or internal organs. Therefore, the nurse should monitor the client for signs of bleeding, such as bruising, hematuria, hematemesis, melena, or decreased hemoglobin and hematocrit levels.
Choice A is wrong because hypotension is not a common adverse effect of alteplase. Hypotension may occur due to blood loss from bleeding or other causes, such as dehydration, sepsis, or cardiac dysfunction.
Choice C is wrong because dysrhythmias are not a common adverse effect of alteplase. Dysrhythmias may occur due to pulmonary embolism itself, which can cause hypoxia, acidosis, and increased pulmonary artery pressure.
Choice D is wrong because nausea is not a common adverse effect of alteplase. Nausea may occur due to other factors, such as anxiety, pain, or medications.
Choice E is wrong because fever is not a common adverse effect of alteplase. Fever may occur due to infection, inflammation, or other causes.