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Chapter 22: Cardiac Emergency and Shock Drugs

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Chapter 22: Cardiac Emergency and Shock Drugs

12 problems · 0 figures

Case Study 22.2.1 §22.2 source ↗

Table 22.13 in the book ↗
Vital Signs Physical Examination
Temperature: 98.1°F

• Head, eyes, ears, nose, throat (HEENT): Within defined limits

• Neurologic: Within defined limits

• Cardiovascular: No jugular venous distension; S1 and S2 heard on heart auscultation; no S3 noted; brisk capillary refill in nailbeds of hands and feet

• Respiratory: Clear to auscultation bilaterally

• GI: Bowel sounds heard in all four quadrants, no tenderness, no distension

• GU: Appropriate for age

• Integumentary: Skin appropriate for age
Blood pressure: 160/92 mm Hg
Heart rate: 86 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 96% on room air
Height: 5'11"
Weight: 240 lb

Read the following clinical scenario to answer the questions that follow.

James Ryan is a 72-year-old client whose wife brought him to the emergency department because of chest pain and difficulty breathing. He said he was shoveling snow from the sidewalk when he started having pain in his left arm and chest. He also had difficulty catching his breath. After a few minutes, James went inside and sat down, but the pain in his arm and chest continued. He started to feel lightheaded, and even though he was sitting down, he still found it hard to breathe. James wanted to lie down on the couch, but his wife insisted that he go to the emergency department.

History
Hypertension

Current Medications
Losartan 50 mg daily
Hydrochlorothiazide 25 mg daily

In the emergency department, James underwent an ECG and bloodwork, which revealed he was in the midst of an AMI.

The nurse receives orders to administer nitroglycerin sublingually. Which parameter will the nurse monitor to determine the effectiveness of nitroglycerin?
  1. a.
    Chest pain
  2. b.
    Heart rate
  3. c.
    Blood pressure
  4. d.
    Level of consciousness

Answer

A. Chest pain
Nitroglycerin dilates coronary arteries, which increases oxygen delivery to the heart tissue, thereby reducing chest pain.

Case Study 22.2.2 §22.2 source ↗

Table 22.13 in the book ↗
Vital Signs Physical Examination
Temperature: 98.1°F

• Head, eyes, ears, nose, throat (HEENT): Within defined limits

• Neurologic: Within defined limits

• Cardiovascular: No jugular venous distension; S1 and S2 heard on heart auscultation; no S3 noted; brisk capillary refill in nailbeds of hands and feet

• Respiratory: Clear to auscultation bilaterally

• GI: Bowel sounds heard in all four quadrants, no tenderness, no distension

• GU: Appropriate for age

• Integumentary: Skin appropriate for age
Blood pressure: 160/92 mm Hg
Heart rate: 86 beats/min
Respiratory rate: 20 breaths/min
Oxygen saturation: 96% on room air
Height: 5'11"
Weight: 240 lb

Read the following clinical scenario to answer the questions that follow.

James Ryan is a 72-year-old client whose wife brought him to the emergency department because of chest pain and difficulty breathing. He said he was shoveling snow from the sidewalk when he started having pain in his left arm and chest. He also had difficulty catching his breath. After a few minutes, James went inside and sat down, but the pain in his arm and chest continued. He started to feel lightheaded, and even though he was sitting down, he still found it hard to breathe. James wanted to lie down on the couch, but his wife insisted that he go to the emergency department.

History
Hypertension

Current Medications
Losartan 50 mg daily
Hydrochlorothiazide 25 mg daily

In the emergency department, James underwent an ECG and bloodwork, which revealed he was in the midst of an AMI.

The health care provider orders aspirin for James. Which action should the nurse take?
  1. a.
    Tell James not to chew the aspirin.
  2. b.
    Tell James that aspirin will relieve his pain.
  3. c.
    Ask James if he has a history of asthma.
  4. d.
    Teach James that aspirin causes vasodilation.

Answer

C. Ask James if he has a history of asthma.
A history of asthma is a contraindication to taking aspirin.

22-1 §22.RQ source ↗

The nurse is caring for a client receiving morphine 4 mg IV every 15 minutes for chest pain. Which assessment finding is of most concern to the nurse?
  1. a.
    Heart rate 68 beats/min
  2. b.
    Respiratory rate 8 breaths/min
  3. c.
    Blood pressure 118/68 mm Hg
  4. d.
    Oxygen saturation 95% on room air

Answer

B. Respiratory rate 8 breaths/min
Morphine is a potent opioid agonist and can cause respiratory depression and failure. It is very important to monitor the client frequently (reassess at least every 5–10 minutes) when using morphine to control chest pain.

22-2 §22.RQ source ↗

The nurse has administered sublingual nitroglycerin to a client with chest pain. Which assessment finding does the nurse anticipate for this client?
  1. a.
    An increase in respiratory rate
  2. b.
    An increase in heart rate
  3. c.
    A decrease in blood pressure
  4. d.
    A decrease in oxygen saturation

Answer

C. A decrease in blood pressure
Nitroglycerin is a vasodilator, and vasodilation causes the blood pressure to drop.

22-3 §22.RQ source ↗

At what rate should the nurse administer adenosine 6 mg IV to a client with supraventricular tachycardia?
  1. a.
    Over 1–2 seconds
  2. b.
    Over 1 minute
  3. c.
    Over 5–10 minutes
  4. d.
    Slowly over 1–2 hours

Answer

A. Over 1–2 seconds
Adenosine has a very short half-life and should be administered as a rapid IV bolus directly into a vein over 1–2 seconds, followed by a rapid saline flush.

22-4 §22.RQ source ↗

Which question should the nurse ask a client before administering nitroglycerin for chest pain?
  1. a.
    Do you have lupus erythematosus?
  2. b.
    Do you have a history of asthma?
  3. c.
    Do you take any medications for erectile dysfunction?
  4. d.
    Do you have Wolff–Parkinson–White syndrome?

Answer

C. Do you take any medications for erectile dysfunction?
The nurse should ask whether the client is taking any medications for erectile dysfunction because the use of nitroglycerin is contraindicated in clients who are taking a phosphodiesterase inhibitor such as tadalafil or sildenafil.

22-5 §22.RQ source ↗

The nurse in the emergency department is caring for a client who reports chest pain that is relieved at rest. Which diagnosis should the nurse anticipate?
  1. a.
    Stable angina
  2. b.
    Unstable angina
  3. c.
    Myocardial infarction
  4. d.
    Ventricular dysrhythmia

Answer

A. Stable angina
Stable angina occurs during exercise or exertion and improves with rest. Stable angina presents when the heart needs more oxygen but the supply of oxygen is restricted. Once the heart does not need increased oxygen, the angina subsides.

22-6 §22.RQ source ↗

The health care provider has ordered diltiazem IV bolus 0.25 mg/kg for a client with atrial fibrillation with rapid ventricular response. The client weighs 176 lb (80 kg). What is the correct dose of diltiazem for the nurse to administer?
  1. a.
    15 mg
  2. b.
    20 mg
  3. c.
    25 mg
  4. d.
    30 mg

Answer

B. 20 mg
The ordered dose of diltiazem is 0.25 mg/kg, and 176 l b ÷ 2.2 k g = 80 k g , so 0.25 m g / k g × 80 k g = 20 m g .

22-7 §22.RQ source ↗

Which therapeutic response would the nurse anticipate when administering epinephrine to a client in anaphylaxis?
  1. a.
    Bronchodilation
  2. b.
    Bradycardia
  3. c.
    Hypotension
  4. d.
    Hypokalemia

Answer

A. Bronchodilation
The therapeutic effects of epinephrine include bronchodilation, increased heart rate, and increased blood pressure.

22-8 §22.RQ source ↗

Which adverse effect should the nurse monitor for in the client receiving dopamine by peripheral IV infusion?
  1. a.
    Dizziness
  2. b.
    Skin sloughing at the IV site
  3. c.
    Electrolyte abnormalities
  4. d.
    Facial flushing

Answer

B. Skin sloughing at the IV site
Dopamine causes vasospasm and can lead to necrosis, sloughing, and potentially gangrene if extravasation into the tissue occurs at the IV site.

22-9 §22.RQ source ↗

The nurse in the cardiology clinic is caring for a client taking an antidysrhythmic medication for ventricular dysrhythmia who develops a positive antinuclear antibody test. Which antidysrhythmic medication does the nurse anticipate this client is taking?
  1. a.
    Amiodarone
  2. b.
    Diltiazem
  3. c.
    Lidocaine
  4. d.
    Procainamide

Answer

D. Procainamide
Prolonged use of procainamide may lead to a positive antinuclear antibody test; if this occurs, the risk–benefit ratio of procainamide use should be reassessed.

22-10 §22.RQ source ↗

What is the preferred route for administering epinephrine to a client with anaphylaxis who is in sinus tachycardia?
  1. a.
    Intramuscular
  2. b.
    Intravenous
  3. c.
    Sublingual
  4. d.
    Inhalation

Answer

A. Intramuscular
Epinephrine is administered intramuscularly for the client in anaphylaxis who does not have ventricular fibrillation, pulseless ventricular tachycardia, asystole, or pulseless electrical activity.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.