Which medication would the nurse expect to be used for the initial treatment for a client

admitted with deep vein thrombosis (DVT) of the lower left extremity? 

Heparin has a rapid on set of actions. Used primarily in the acute phase of a DVT

A physician orders a nitroglycerine (NTG) drip to be titrated. Which parameters should

the nurse assess when administering this medication?

Blood pressure and Pulse rate

The nurse is conducting teaching with a client who recently was diagnosed with
Prinzmetal's (variant) angina. The nurse would evaluate the session as being successful
if the client stated that this form of angina

Is treated with calcium channel blockers

Prinzmetal's angina results from spasm of the coronary vessels. Calcium
channel blockers are the medication prescribed for this condition. The risk factors are
unknown, and Prinzmetal's angina is relatively unresponsive to nitrates. Beta blockers
can worsen the spasm. Diet therapy is not indicated.

A client takes cholestyramine. For which vitamin deficiency should the nurse assess this
client?
Vitamins A and D

Which potential problems should the nurse monitor for in the client receiving
thrombolytic therapy?
Bruising, Hypotension, hematuria
 Headaches are not directly related to thrombolytic therapy.
 The client receiving thrombolytic therapy should be monitored closely for skin
bruising, which can be an indication of bleeding.
 Urine should be monitored the presence of occult or obvious blood; indications of
hemorrhage or bleeding.
 Bone pain is not directly related to thrombolytic therapy.
 When on thrombolytic therapy, the client’s blood pressure should be monitored
for dose-related or hemorrhage-related hypotension.

The nurse has begun a continuous infusion of nitroglycerin intravenously. Which finding
indicates that the client is experiencing an adverse reaction?

Blood pressure (BP) falling from 130/80 to 90/64

The nurse should review the results of which laboratory results to evaluate a client's
response to a lipid-lowering agent?
Liver function tests
A client taking warfarin tells the nurse about taking propoxyphene with aspirin to treat
pain related to an old back injury. What should the nurse respond to this client? 
Aspirin my interfere with warfarin theraby

A client is prescribed a continuous infusion of IV nitroglycerin. What consideration

should the nurse make in preparing to administer this medication?
Maintain the solution in a glass bottle

A client is being treated with alteplase in the Emergency Department following a

cerebrovascular accident (CVA or stroke). What is the priority nursing intervention
related to the care of a client receiving this drug therapy?
Place the client on a cardiac monitor, and observe for potential dysrhythmias, as
this medication can have cardiac effects.

A community health nurse is conducting a seminar for clients beginning warfarin

therapy.  Which dietary adjustment should the nurse instruct the clients to make?
Reduce intake of foods like broccoli and cabbage

Which medication would the nurse expect to administer to a surgical client that has
suddenly begun to excessively hemorrhage while in the operating room?

A client has been taking anti-platelet medication for several weeks, and presents with a
noticeable bruise on the arm. What information should the nurse assess first to
determine if this skin manifestation is related to drug therapy?

Whether the client has bruising and discoloration on other areas of the body.

A client is receiving heparin therapy and the nurse is monitoring the activated partial
thromboplastin time (APTT). Which result would the nurse consider a therapeutic level?
APTT level of 1.5–2.5 times the control value
A client is being discharged on warfarin following heart valve replacement surgery.
What information would the nurse give to the client to provide safe and effective care
during the course of therapy?
Be alert to the possibility of bleeding tendencies caused by this drug therapy, and
use electric razors and soft toothbrushes.

The nurse is caring for a client with chronic stable angina receiving amlodipine. In
developing a medication teaching plan, the nurse should include which finding as an
adverse reaction to this medication?
Hypotension
Amlodipine is a calcium channel blocker. Adverse or toxic reactions from
over dosage could produce excessive peripheral vasodilation, and marked hypotension
with reflex tachycardia. Frequent side effects include peripheral edema, headache, and
flushing. Some sustained-release forms of calcium channel blockers (such as Calan SR
) could lead to constipation, a milder side effect than the others.
The nurse would assess a client who is receiving anistreplase for which manifestation?

Cardiac dysrhythmias
Dry mouth is not a manifestation of thrombolytic therapy. Decreased urine
output is not expected with thrombolytic therapy. Decreased clotting times are not seen
with thrombolytic therapy. The use of thrombolytic agents can cause cardiac irritation
and lead to development of dysrhythmias that can be life-threatening. The nurse must
be aware of the serious likelihood that treatment can cause further cardiac compromise.

A client who is receiving warfarin therapy comes to the office for a follow-up visit. The
client states that he has taken propoxyphene with aspirin (Darvon Compound 65) for
aches and pains related to an old back injury. What should the nurse respond to this
information?
Advise the client that Darvon contains aspirin, which can interfere with
warfarin therapy. Consult the physician for an alternate form of pain-relief therapy.

Adenosine is to be administered to a client in the emergency department. Before the

preparation of the medication, the nurse's priority should be to ensure that which
equipment is operational?
A cardiac monitor
A pulse oximetry machine might be helpful in assessing oxygenation, but
is not a priority item. An IV pump might be needed, but is not a priority because this
medication is administered rapidly by IV push. Adenosine is an antidysrhythmic used in
the treatment of paroxysmal supraventricular tachycardia (SVT). Cardiac performance
must be assessed before and throughout treatment by cardiac monitoring. An
endotracheal tube may be used if an emergency arises necessitating mechanical
ventilation, but the tube itself is a rather isolated item.

A client taking cholestyramine to lower lipid levels should be monitored for possible
deficiency of which vitamin(s)?
Vitamin A and D

Diltiazem is prescribed for a client with chronic, stable angina. Which statement made
by the client indicates to the clinic nurse that the client needs additional medication
information?

“I will take the medication after meals.”

The client should notify the prescriber if shortness of breath, irregular
heartbeat, pronounced dizziness, nausea, or constipation develops. Postural
hypotension can occur, so the client must be instructed to rise slowly to avoid dizziness
and falling. Diltiazem is usually administered before meals and at bedtime to increase
the absorption of medication. The medication can cause a decrease in mental alertness
until the body adjusts and the proper dosage is established.
The client states, "I always put my nitroglycerin (NTG) patch in the same place, so I do
not forget to take it off." What is the nurse's best response?
"You should rotate the NTG patch to a different hairless area each day."

A client has been admitted to the hospital with chest pain. The client's symptom has not
been relieved after one dose of nitroglycerine (NTG) sublingually. Upon monitoring the
vital signs (VS), the nurse notices that they are stable. What is an appropriate action for
nurse to take next?
Give another dose of nitroglycerine.

A client is receiving intravenous (IV) thrombolytic therapy, and reports pain and redness
at the insertion site. Which nursing actions are most appropriate?
Restart infusion in the opposite extremity. Further dilute medication per protocol
to prevent thrombophlebitis.

A client taking long-term warfarin therapy following cardiac valve replacement surgery
comes in to the office for a follow-up visit. Upon reviewing intake, which dietary pattern
would be of most concern to the nurse?
The client has a salad for lunch every day during the week.
A 45-year-old female comes to the clinic with reporting leg cramps. She has
hypertension, and has been taking indipamide 2.5 mg daily. Her blood pressure is
126/70 upon arrival. After completion of assessment, the nurse plans to take which
action?

A client receiving intravenous heparin has an activated partial thromboplastin time

(APTT) level of 140 seconds (control time is 36 seconds). What action should the nurse
take at this time?
Stop the heparin for 1 hour, restart it in 1 hour at a decreased rate, and obtain a
repeat APTT in 2–3 hours after restart
The effectiveness of heparin is monitored by trending APTT results to
achieve a therapeutic level. An APTT of 140 is above the therapeutic level of
anticoagulation and therefore the infusion should be stopped and resumed at a
decreased dose in one hour’s time with a repeat APTT done in 2–3 hours. The dose
should not be increased, as this would cause serious consequence to the client.
Stopping the medication for a total of 6 hours would undermine the anticoagulation
control that the healthcare provider is trying to achieve. Ordering another APTT and
continuing to run the infusion could also cause serious consequences to the client.
A postoperative client asks why subcutaneous enoxaparin has been prescribed.
What should the nurse respond to this client?
“Enoxaparin helps prevent blood clots in people who have reduced mobility after
surgery.”

A hospitalized client experiences chest pain that has not been relieved after one dose of
sublingual nitroglycerine (NTG). The client's blood pressure is currently 126/84. Which
action should the nurse take next?
Give another dose of NTG
A client is being discharged after treatment for an acute myocardial infarction (MI) with
recurrent angina. The nurse is teaching the client regarding the following medications:
diltiazem 90 mg PO twice daily; isosorbide dinitate 10 mg PO three times daily; and
nitroglycerine 0.4 mg sublingually as needed. Which statement made by the client
would indicate that further discharge teaching is needed?
"I should notify my health care provider if I experience headaches with any of
these medications."

The nurse reviewing a client's laboratory test results would conclude that which of the
following would affect the client's ability to maintain hemostasis?
Thrombocytopenia

Which medication does the nurse anticipate will be used for a pregnant client who
requires anticoagulation therapy?
Heparin

Which classification of medication is lovastatin? 

Lip-lowering
Lovastatin belongs to a group of drugs classified as statins. They work by inhibiting
cholesterol synthesis in the liver. Bile-acid resins and fibric acid derivatives also work to
decrease cholesterol levels, but they work at different sites (options 1 and 3). Bile-acid
resins work in the gastrointestinal tract, and bind bile salts in the intestine. Fibric acid
derivatives work on lipoproteins and triglycerides to reduce cholesterol. Lovastatin is not
a hormone (option 2).

The client asks the nurse, "Can you give me the heparin dose in a pill or liquid form
instead of these injections?" What would be the most appropriate response by the
nurse?
"Gastric juices will destroy heparin if taken orally."
Not in oral form

The nurse is teaching the client newly diagnosed with angina about the use of
nitroglycerine (NTG) tablets at home. What client teaching is needed related to this
medication?
"Stop your activity and sit down near a telephone if possible, and place 1 NTG
under your tongue. Take no more than 3 tablets total, 1 every five minutes. If the pain is
not relieved after 3 tablets, call for help."
NTG becomes unstable when exposed to heat, light, and moisture. Teach the
client that the activity in which he is engaged might be causing the chest pain. Instruct
the client in the exact method of taking NTG to avoid dizziness. The client can take up
to 3 tablets, one at a time every 5 minutes, and shouldn't drive for safety reasons. The
frequency of the medication must be accurate and specific to prevent overdose, as
could happen with these instructions.
A client receiving heparin per protocol has an activated partial thromboplastin time
(APTT) level of 140 seconds (control time is 36 seconds). What is the priority action that
the nurse should institute?
Stop the infusion for 1 hour, then restart the medication in one hour at a
decreased rate per protocol. Obtain a repeat APTT 2–3 hours after restart of infusion.

What instruction would the nurse provide to the client who will be starting nicotinic acid
(Niacin) for elevated serum cholesterol levels?
Expect facial flushing, as this is a common expected effect of this medication.

The nurse is caring for a client with chronic angina pectoris. The client is receiving
sotalol 80 mg PO daily. Which client manifestation would the nurse conclude is a side
effect of this medication?
Bradycardia
Sotalol is a beta-adrenergic blocking agent. Side effects include bradycardia,
difficulty breathing, wheezing, bronchospasm, GI disturbances, anxiety, nervousness,
weakness, mood changes, depression, and loss of libido. The other symptoms listed do
not occur.

While talking with a client, the nurse finds that the client is unaware of the side effects of
warfarin. Which nursing diagnosis best describes the client’s current status?
Risk for injury

A client is taking warfarin for atrial fibrillation. The nurse would include in a teaching plan
that the client will need to remain on drug therapy for what period of time?
Indefinite or long term

A client was prescribed lovastatin to treat hyperlipidemia, since diet therapy and weight
reduction did not successfully lower cholesterol levels. The client does not understand
why medication is necessary, because he has been careful with diet for three months.
How would the nurse explain the relationship of drug therapy to dietary management?
Combination therapy (drugs and diet) often helps clients meet their treatment
goals to reduce cholesterol levels.

The nurse has just received an order to start intravenous heparin therapy for a client
admitted with deep vein thrombosis (DVT). What nursing intervention would the nurse
employ to implement this order safely?
Use an infusion pump to administer the heparin.
Protamine sulfate is a heparin antagonist, not vitamin K, and should be
used when reversal is indicated. The client does not have to be NPO during this type of
therapy. Heparin administration requires the use of an infusion pump in order to
maintain an accurate level of medication. If using weight-based therapy, it is important
to weigh the client at the same time with the same scale each day to verify accuracy.
Which priority intervention should the nurse implement for a client being treated with
heparin therapy that has a dangerously elevated APTT level?
Determine the amount of heparin that was given and the time frame that has
elapsed since its administration.
Explanation:
The dose of protamine sulfate will be calculated based on individual need. While it is
true that the maximum dose of protamine is 50 mg over a 10-minute period, that might
not be the dosage required, since the pertinent information relative to heparin is not
stated. APTT levels would be monitored, but are not the priority action at this time.
Because heparin is metabolized quickly in the body, it is important to know both the
amount of drug that was given and the elapsed time frame. Vitamin K should not be
given with protamine sulfate, as it is the antagonist to warfarin.

A client with angina pectoris received nitroglycerin tablets sublingually for chest pain.
The client reports a severe headache shortly after the medication is administered. What
interpretation should the nurse make based on the client’s statement?
This common response will diminish as tolerance to the medication develops.

The nurse is caring for a client who recently was admitted to the intermediate care unit
with a myocardial infarction (MI). The nurse is most concerned about achieving which
client outcome?
Pain free

A client with angina pectoris is given nitroglycerin (NTG) 1/150 sublingual for complaint
of chest pain. Prior to the NTG, his blood pressure was 110/78. After 5 minutes, he says
the chest pain is better but not gone. What action should the nurse take next?
Check the blood pressure (BP).
The client does need another NTG if the chest pain is still present;
however, a BP should be assessed first. If the systolic is greater than 100, another NTG
can be given. If the systolic is less than 100, the physician should be consulted. A blood
pressure measurement is more important than checking the client's pulse at this
time. Morphine sulfate is often given for pain unrelieved by NTG. 

The nurse teaching a client how to manage risk factors in coronary artery disease would
include which modifiable risk factor?
Total Cholesterol level of 290 mg/dL

The nurse teaching a client how to manage risk factors in coronary artery disease would
include which modifiable risk factor?
Total Cholesterol level of 290 mg/dL

In coordinating care for a client with venous stasis ulcers, the nurse explains to the
unlicensed assistive personnel (UAP) that which intervention is most important for ulcer
healing?
Elevation of the extremities to increase venous return.
 The nurse would plan to do which intervention as the most effective measure to
reduce the risk of developing deep vein thrombosis (DVT)?
Ambulation as soon as possible

The client presenting with angina pain in the emergency department states, "I thought I
was having a heart attack." Which response by the nurse would provide the client with
the most accurate information about the difference between the pain of angina and that
of myocardial infarction?
"The pain of angina is usually relieved by resting or lying down."
Angina pectoris is pain related to insufficient oxygen supply to meet the
workload demands of the heart. If the workload demand is decreased (as in rest), the
pain goes away. Option 1 may be correct but is not usually the case; option 2 is
incorrect. In option 3, a CPK-MB level indicates the amount of muscle damage.

The client in the emergency department was diagnosed with acute myocardial
infarction (MI). He asks the nurse to explain what this is. The nurse should tell him that
an MI usually results from which of the following?
Obstruction of a coronary artery with death of tissue distal to the blockage.

The mother asks the purpose of aspirin therapy in a child with rheumatic fever. The
nurse explains that the purpose is to do which of the following?
Provide comfort and reduce inflammation

Reduce fever


A client is due to receive a calcium channel blocker and a beta blocker for angina. Vital
signs are BP 100/68, pulse 52 bpm, respirations 20. Which of the following is an
appropriate action by the nurse?

Call the physician first.

A client who underwent a percutaneous transluminal coronary angioplasty (PTCA) four

hours ago has no change in vital signs or catheter site since returning from the
procedure. The nurse obtains a routine 12-lead ECG, and notes that the client has ST
depressions, although the client denies chest pain. What is the next action that the
nurse should take?
Notify the physician.

In planning care for a client receiving warfarin sodium (Coumadin), the nurse instructs
the client to take which action as part of therapeutic drug management?

Avoid aspirin and aspirin-containing products.

The pathophysiology of varicose veins is explained by which phenomenon?
Chronic increased intravenous pressure
Which client assigned to the nurse is most at risk for developing a deep vein thrombosis
(DVT)?
A 40-year old woman who smokes and uses oral contraceptives.
A client reports pain and cramping after short periods of walking, symptoms that stop
when he rests. The nurse concludes he is describing which symptom of peripheral
arterial disease?
Intermittent claudication

The client is being discharged from the hospital and needs discharge teaching. An
important measure the nurse should teach the client to prevent reinfarction following a
myocardial infarction (MI) would include:
Low-fat, low-sodium diet

The client presents to the emergency department with substernal chest pain and is
diagnosed with a subendocardial infarction. The client asks the nurse what that means.
Which description should the nurse use about the damage?
Involving the inner layer of the heart.

The first priority in assessing a client with thrombophlebitis is:

Inspection of the lower extremities for swelling.

Which medication is likely to be administered on a daily basis to a client newly admitted

to the clinical nursing unit who has a history of peripheral arterial disease?

Aspirin
Because of the risk for inflammation or a blood clot, low doses of aspirin
are recommended for all clients with peripheral vascular disease. Aspirin has
antiplatelet activity; without platelet aggregation, a clot cannot form. 

A male client is seen in the clinic because of pain when he tries to walk for exercise
three times a week. His feet are noted to be dusky and purplish while dangling from the
stretcher. The pedal pulse is palpable but diminished, and he states his feet "tingle on
occasion." The nurse has him lie supine on the stretcher with the foot of the stretcher
elevated for about 30 minutes, after which his feet show pallor. Which disorder would
the nurse expect to find in the client's medical record?
Peripheral vascular disease (PVD)
Pain and itching are usually felt with varicose veins. Thrombophlebitis is
associated with redness, warmth, and swelling of an extremity. Raynaud's is more
involved with the digits of both the hands and feet. These are signs and symptoms of
PVD; the diagnosis is supported by the pallor noted when the feet are elevated for 30
minutes. The pulse is diminished because it is arterial occlusion and not venous.
The client presents with a total cholesterol level of 325 mg/dL. In teaching the client
about risk factors for coronary artery disease (CAD), how would the nurse best describe
cholesterol?
A substance that sticks to the inside of blood vessels, decreasing blood
flow

A client with venous stasis ulcers is being treated with an Unna boot. Which additional
intervention should be in this client's plan of care? Select all that apply.
Elevate the legs and Assess peripheral pulses

Which laboratory value is most important for the nurse to assess when monitoring
therapeutic levels of heparin?
Partial thromboplastin time (PTT)

The nurse is caring for a client with angina pectoris who was ruled out for having a
myocardial infarction. The nurse reviews the client's laboratory results, and plans to
include dietary teaching after noting that the client's lipid profile shows which values?

Cholesterol: 220; HDL: 40; triglycerides: 190

The nurse explains to a high risk client that which is the most common cause of a
thrombus?
Venous stasis, hypercoagulability, and venous wall injury

A client is prescribed sublingual nitroglycerine for the treatment of angina pectoris. What
response from the client indicates that the client understands this medication?
"I have a small, labeled case for a few nitroglycerine tablets that I carry with me
when I go out."

A client with venous stasis ulcers is being treated with an Unna boot. Which other
intervention should the nurse include:
Elevating legs and assessment of peripheral pulses.

Evidence that the outcome of increased arterial blood supply to the extremity has been
met in a client with peripheral arterial disease includes which of the following?
Reduced muscle pain
The nurse explains to a client that which is a goal of anticoagulant therapy for clients
with deep vein thrombosis?
Prevent embolization.
The client with intermittent claudication is at risk for activity intolerance and possible
tissue breakdown. If tissue breakdown occurs, the plan of care would consist of:
Bed rest
Which is the first priority of care in the management of a client with thrombophlebitis?
Using anticoagulant therapy with heparin (Liquaemin).
Anticoagulant therapy is started early to prevent the extension of the
thrombus or the possible embolization of the thrombus. All options are correct but
anticoagulant therapy is the highest priority. Elevation of the client's legs is a comfort
measure, and the elastic bandages will provide support to the extremity. The client's
heel must be included in the wrap. These bandages are to be applied snuggly and
rewrapped every 4 to 8 hours. They must be inspected frequently as they may become
dislodged. The use of warm packs and a sedative is not beneficial for the client. The
monitoring of the PTT will be done every 6 hours.

Which statement made by a client receiving dietary instruction for atherosclerosis would
indicate a need for further discussion?
"Margarine has less fat than butter, so I will no longer use butter."
The nursing management for a client with thrombophlebitis would include:
The use of anticoagulant therapy to inhibit the clotting factors.
Which suggestions should the nurse include when conducting health teaching for clients
with arterial insufficiency?

Select all that apply.

 The client should avoid long periods of standing or sitting to promote
adequate blood flow.
 The legs and feet should be below heart level to increase peripheral circulation. 
 Decreasing ambulation inhibits development of collateral circulation and will not
help in disease management.
 Moist heat is helpful for venous problems but direct heat to the extremity affected
by arterial insufficiency could place the skin at risk for burns because of
preexisting local hypoxia and friable tissue.
 The client with arterial insufficiency should engage in a walking program as
prescribed by the healthcare provider to build collateral circulation and slow
progression of the disease.
 Avoid long periods of sitting and standing.
 Increase distances walked to build collateral circulation.


What is the priority intervention the nurse should include when caring for a client with
deep vein thrombosis?
Monitor the anticoagulant therapy
Interventions when caring for a client with thrombi include
monitoring for pain, elevating the affected leg, assessing for lung sounds to monitor for
embolism. The priority intervention is monitoring the anticoagulant therapy.
Anticoagulant medications have a narrow therapeutic index and a therapeutic level must
be maintained.

Evidence that the outcome of "restore tissue integrity" has been met in a client with a
venous stasis ulcer includes which finding?
No signs of inflammation or infection
A goal of venous ulcer care is for the client to experience no signs
of inflammation or infection. This is the goal that is directly related to tissue integrity.
The other options are good outcomes but do not relate directly to the question as
stated.