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MODULE 10: NSG124 CARDIOVASCULAR
AGENTS II: EXAM, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
ACTIVITY 1 NSG124.10.01.01 DYSRHYTHMIA PATHOPHYSIOLOGY & MANAGEMENT ACTIVITY 2 NSG124.10.01.02 ANTIDYSRHYTHMIC DRUGS ACTIVITY 3 NSG124.10.01.03 NURISNG CARE FOR ANTIDYSRHYTHMIC AGENTS ACTIVITY 4 NSG124.10.02.01 ATHEROSCLEROTIC PATHOPHYSIOLOGY ACTIVITY 5 NSG124.10.02.02 ATHEROSCLEROTIC DRUGS ACTIVITY 6 NSG124.10.02.03 NURSING CARE FOR ATHEROSCLROTIC AGENTS ACTIVITY 7 NSG124.10.03.01 ANGINA PECTORIS PATHOPHYSIOLOGY ACTIVITY 8 NSG124.10.03.02 ANGINA DRUGS
ACTIVITY 9 NSG124.10.03.03 NURSING CARE FOR ANTIANGINAL AGENTS ACTIVITY 10 NSG121.10.04.01 HEMOSTASIS AND THROMBOSIS ACTIVITY 11 NSG124.10.04.02 ANTICOAGULANT DRUGS ACTIVITY 12 NSG124.10.04.03 ANTICOAGULANT NURSING CONSIDERATIONS ACTIVITY 13 NSG124.10.04.04 ANTIPLATELET DRUGS ACTIVITY 14 NSG124.10.04.05 ANTIPLATELET NURSING CONSIDERATIONS ACTIVITY 15 NSG124.10.04.06 THROMBOLYTIC DRUGS ACTIVITY 16 NSG124.10.04.07 THROMBOLYTIC NURSING CONSIDERATIONS ACTIVITY 17 NSG124.10.05.01 MYOCARDIAL PATHOPHYSIOLOGY & MANAGEMENT ACTIVITY 18 NSG124.10.05.02 MYOCARDIAL INFARCTION AGENTS ACTIVITY 19 NSG124.10.06.01 IRON DEFICIENCY ANEMIA & TREATMENT
ACTIVITY 1
NSG124.10.01.01 DYSRHYTHMIA PATHOPHYSIOLOGY & MANAGEMENT
ELECTROCARDIOGRAM (ECG)
Graphic representation of cardiac electrical activity P WAVE Caused by depolarization in the atria and corresponds to atrial contraction BRADYDYSARHYTHMIAS dysrhythmias in which heart rate is slowed CLASS IV: CALCIUM CHANNEL BLOCKERS Reduce calcium entry and depress phase 4 depolarization, which reduces automaticity, slows conduction velocity, and reduce contractility DYSRHYTHMIA An abnormality in the rhythm of the heartbeat T WAVE Repolarization of the ventricles, so this wave is not associated with overt physical activity of the heart QRS COMPLEX Cause by depolarization of the ventricles and corresponds to ventricular contraction
T/F: All antidysrhythmic drugs can worsen existing dysrhythmias and generate new ones. True. ACTIVITY 2 NSG124.10.01.02 ANTIDYSRHYTHMIC DRUGS SODIUM CHANNEL BLOCKER - LIDOCAINE Used only for ventricular dysrhythmias DIGOXIN Supraventricular dysrhythmias by decreasing conduction through the AV Node and by decreasing automaticity in the D=IN POTASSIUM CHANNEL BLOCKER - AMIODARONE Approved only for life-threatening ventricular dysrhythmias and adverse effects related to ophthalmic and pulmonary toxicities SODIUM CHANNEL BLOCKER - QUINIDINE Broad-spectrum agent active against supraventricular and ventricular dysrhythmias BETA BLOCKER - PROPANOLOL Treating dysrhythmias caused by excessive sympathetic stimulation of the heart CALCIUM CHANNEL BLOCKER - VERAPAMIL Slow ventricular rate in patients with atrial fibrillation or atrial flutter and terminate SVT caused by an AV nodal reentrant circuit
ventricular rate. The preferred method is to slow ventricular rate. Warfarin (Coumadin) is also prescribed. What are the risks involved in treating my dysrhythmia? Answer: Antidysrhythmic therapy carries considerable risk. Because of their prodysrhythmic actions, antidysrhythmic drugs can exacerbate existing dysrhythmias and generate new ones. Examples abound: Toxic doses of digoxin can generate a wide variety of dysrhythmias; drugs that prolong the QT interval can cause torsades de pointes; many drugs can cause ventricular ectopic beats; several drugs (quinidine, flecainide, and propafenone) can cause atrial flutter; and one drug, flecainide, can produce incessant ventricular tachycardia. It is important to appreciate that virtually all of the drugs used to treat dysrhythmias can also cause dysrhythmias. These drugs can create new dysrhythmias and worsen existing ones. Rationale: Because of these prodysrhythmic actions, antidysrhythmic drugs should be employed only when the benefits of treatment clearly outweigh the risks. LIDOCAINE Acute management of ventricular dysrhythmias Continuous ECG monitoring is required. Plasma drug levels should be kept between 1.5 and 5 mcg/mL. Excessive doses can cause convulsions and respiratory arrest. Equipment for resuscitation should be available. QUINIDINE
The usual goal is long-term suppression of atrial and ventricular dysrhythmias. Monitor for beneficial changes in the ECG. Advise patients to take with meals. Warn them not to crush or chew sustained-release formulations. Diarrhea and other GI disturbances occur in one-third of patients and frequently force drug withdrawal. Monitor the ECG signs of cardiotoxicity, especially widening of the QRS complex (by 50% or more) and excessive prolongation of the OT interval. Monitor pulses for significant changes in rate or regularity. If signs of cardiotoxicity develop, withhold and notify the prescriber. inform patients about symptoms of cinchonism (tinnitus, headache, nausea, vertigo, disturbed vision ), and instruct them to notify prescriber if these develop. Plasma drug levels should be kept between 2 and 5 mcg/mL. Inform patients that they can reduce GI effects by taking with meals. AMIODARONE Advise patients to avoid sunlamps and to wear sunscreen and protective clothing when outdoors. With prolonged sun exposure, skin may develop a bluish-gray discoloration, which typically resolves a few months after amiodarone is stopped. Inform patients about signs and symptoms of liver injury (e.g.,
Elevated cholesterol in pediatric patients HMG-CoA REDUCTASE Drugs that inhibit this enzyme - the statins - are our most effective and widely used cholesterol-lowering agents FRAMINGHAM RISK FACTOR PREDICTION SCORE Takes into account: age, total cholesterol, HDL cholesterol, smoking status, and systolic blood pressure LOW-DENSITY LIPOPROTEINS (LDL) Inhibit macrophage mobility, thereby keeping macrophages at the site of atherogenesis ACTIVITY 5 NSG124.10.02.02 ATHEROSCLEROTIC DRUGS What are the therapeutic actions of HMG-CoA reductase inhibitors? Select all that apply. Reduction of LDL cholesterol Increase progression of coronary artery calcification Increase inflammation at the plaque site Elevation of HDL cholesterol Reduction of LDL cholesterol Elevation of HDL cholesterol Improve abnormal endothelial function Promote atherosclerotic plaque stability Reduce the risk of thrombosis EZETIMIBE [ZETIA]
Unique drug for reducing plasma cholesterol. Benefits derive from blocking cholesterol absorption Indicated as an adjunct to diet modification for reducing total cholesterol, LDL cholesterol, and apolipoprotein B in patients with primary hypercholesterolemia In patients with hepatic impairment, bioavailability is significantly increased and patients with moderate or severe hepatic insufficiency should not be given this drug BILE-ACID SEQUESTRANTS - COLESEVELAM Indicated as adjunctive therapy to diet and exercise for reducing LDL cholesterol in patients with primary hypercholesterolemia Mechanism by which statins decrease LDL cholesterol levels is complex and depends ultimately on increasing the number of LDL receptors on hepatocytes (liver cells). Adverse effects are limited to the GI tract and primarily constipation. T/F: HMG-CoA reductase inhibitors - lovastatin are contraindicated with orange juice due to CYP3A4 inhibition. False. HMG-CoA reductase inhibitors - lovastatin, are contraindicated with grapefruit juice due to CYP3A4 inhibition. ACTIVITY 6 NSG124.10.02.03 NURSING CARE FOR ATHEROSCLROTIC AGENTS
Indications: Adjunct to diet and exercise to lower serum cholesterol levels; in combination with atorvastatin or simvastatin for the treatment of homozygous familial hypercholesterolemia. Actions: Works in the brush border of the small intestine to inhibit the absorption of cholesterol. Pharmacokinetics:Route: OralOnset: ModeratePeak: 4-12 hT1/2�1/2: 22 hours; metabolized in the liver and small intestine and excreted in feces and urine Adverse effects: Headache, dizziness, abdominal pain, diarrhea, URI, back pain, myalgia, arthralgia What are the key teaching points for patients receiving HMG-CoA inhibitor drug to lower lipid levels? Suggested Answers to Case Study An HMG-CoA inhibitor, or “statin,” is an antihyperlipidemic agent, which means it works to decrease the levels of certain lipids, or fats, in your blood. An increase in serum lipid levels has been associated with the development of many blood vessel disorders, including coronary artery disease, which can lead to a heart attack. This drug must be used in conjunction with a low-calorie, low-saturated-fat diet and an exercise program. Some of the following adverse effects may occur: Headache, blurred vision, nervousness, insomnia: Avoid driving or performing hazardous or delicate tasks that require concentration; these effects may pass with time.
Nausea, vomiting, flatulence, constipation: Small, frequent meals may help. If constipation becomes a problem, consult with your health care provider for appropriate interventions. Report any of the following to your health care provider: severe GI upset; vision changes; unusual bleeding, dark urine, or light-colored stools; sudden muscle pain accompanied by fever. You will need to have regular medical examinations to monitor the effectiveness of this drug on your lipid levels and to detect any adverse effects. These examinations will include blood tests and eye examinations. Avoid grapefruit juice while you are taking this drug. Tell any doctor, nurse, or other health care provider that you are taking this drug. Keep this drug, and all medications, out of the reach of children. To help decrease your risk of heart disease, follow these guidelines: adhere to a diet that is low in calories and saturated fat, exercise regularly, stop smoking, and reduce stress. What are the considerations for an adult for the use of drugs that lower lipid levels? Lifestyle changes, including dietary restrictions, exercise, smoking cessation, and stress reduction, should be tried before any antihyperlipidemic drug is used. HMG-CoA reductase inhibitors are the first drug of choice in the treatment of hypercholesterolemia in patients who are at risk for, or who have already developed coronary artery disease. The drugs are well tolerated and less expensive than some of the other
ACTIVITY 7
NSG124.10.03.01 ANGINA PECTORIS PATHOPHYSIOLOGY
______________ pectoris is defined as sudden pain beneath the sternum, often radiating to the left shoulder, left arm, and jaw. Angina T/F: Anginal pain is precipitated when the oxygen supply to the heart is insufficient to meet oxygen demand. True. T/F: Oxygen demand can be reduced with drugs that decrease heart rate, contractility, afterload, and preload, which decreases anginal pain. True. T/F: Unstable angina is triggered most often by an increase in physical activity; however, emotional excitement, large meals, and cold exposure may also precipitate an attack. False. Stable angina is triggered most often by an increase in physical activity, however emotional excitement, large meals, and cold exposure may also precipitate an attack. ACTIVITY 8 NSG124.10.03.02 ANGINA DRUGS The nurse is preparing to administer the antianginal drug nitroglycerin to a patient. The nurse knows which of the following are correct? Select
all that apply. Causes orthostatic hypotension - administer sitting or lying Decreases the pain of exertional angina primarily by decreasing cardiac oxygen demand Effects of sublingual nitroglycerin begin rapidly—in 10 to 15 minutes Patches are applied once daily to a hairless area of skin. The site should be rotated to avoid local irritation. Nitroglycerin patches are used continuously Causes orthostatic hypotension - administer sitting or lying Decreases the pain of exertional angina primarily by decreasing cardiac oxygen demand Patches are applied once daily to a hairless area of skin. The site should be rotated to avoid local irritation. May produce severe headache Acts directly on vascular smooth muscle to promote vasodilation __________________ blockers reduce anginal pain primarily by decreasing cardiac oxygen demand, principally through blockade of beta receptors in the heart, which decreases heart rate and contractility. Beta Ranolazine works by reducing accumulation of sodium and __________ in myocardial cells, which may help the myocardium use energy more efficiently. calcium ACTIVITY 9 NSG124.10.03.03 NURSING CARE FOR ANTIANGINAL AGENTS CASE STUDY
emergency care, the patient can take 1 more tablet and then a third tablet 5 minutes later. Rationale: Effects of sublingual nitroglycerin begin rapidly—in 1 to 3 minutes—and persist up to 1 hour. Because sublingual administration works fast, this route is ideal for (1) terminating an ongoing attack and (2) short-term prophylaxis when exertion is anticipated. What are the adverse effects of nitroglycerin? Answer: Principal adverse effects—headache, hypotension, and tachycardia—occur secondary to vasodilation. Rationale: Vasodilation causes adverse effects. The nurse is preparing to administer nitroglycerin to a patient. The nurse knows which of the following are correct? Select all that apply. Instruct patients to store tablets in a convenient location and container that will be close by such as automobile glove compartment or plastic bag. Instruct patients to initially place the tablet or empty the powder under the tongue and then swallow with a full glass of water. Causes significant orthostatic hypotension. Patients should be instructed to change positions slowly and administer drug with patient in sitting or lying position. Instruct patients to call 911 or go to an emergency department if pain is not relieved in 5 minutes following first dose during an acute attack. While awaiting emergency care, they can take 1 more dose, and then a third 5 minutes later. Use with caution in hypotensive patients and in patients taking drugs that can lower blood pressure, including
Causes significant orthostatic hypotension. Patients should be instructed to change positions slowly and administer drug with patient in sitting or lying position. Instruct patients to call 911 or go to an emergency department if pain is not relieved in 5 minutes following first dose during an acute attack. While awaiting emergency care, they can take 1 more dose, and then a third 5 minutes later. Use with caution in hypotensive patients and in patients taking drugs that can lower blood pressure, including alcohol and antihypertensive medications. Contraindicated with sildenafil [Viagra] and other PDE5 inhibitors. Sustained-release oral capsules should be swallowed intact, without chewing or crushing. Therapeutic goal is reduction of the frequency and intensity of anginal attacks. ACTIVITY 10 NSG121.10.04.01 HEMOSTASIS AND THROMBOSIS T/F: The drug Heparin may be administered intravenously to patients at risk for thrombus formation. It does not dissolve clots but will PREVENT further growth of the thrombus. True. STAGE TWO: COAGULATION Factor VIIIa, which is produced under the influence of thrombin, greatly increases the activity of factor IXa, even though it has no direct catalytic activity of its own
