Summary Nur 354 Exam 3 study guide/review

Nur 354 Exam 3 Review

1. Normal Prothrombin and INR Levels
Prothrombin Time (PT): 11-13.5 seconds
International Normalized Ratio (INR): 0.9-1.1 (for normal
individuals)
For patients on anticoagulants, INR typically ranges from
2.0-3.0.
Nursing Implication: Monitor INR regularly for patients on
warfarin to ensure therapeutic anticoagulation.

2. Normal LDL, HDL, Cholesterol, and Triglyceride Levels
LDL (Low-Density Lipoprotein): Less than 100 mg/dL
HDL (High-Density Lipoprotein): Greater than 40 mg/dL for men and 50
mg/dL for women
Total Cholesterol: Less than 200 mg/dL
Triglycerides: Less than 150 mg/dL
Nursing Implication: Educate patients on the importance of diet and
exercise in managing cholesterol levels, especially for those on statins.

3. Normal Potassium and Sodium Levels
Potassium (K): 3.5 - 5.0 mEq/L
Sodium (Na): 135 - 145 mEq/L
Nursing Implication: Monitor electrolyte levels, especially in patients
on diuretics (e.g., Lasix) and ACE inhibitors.

4. Adverse Effects of Atorvastatin
Common effects: muscle pain, weakness, liver enzyme abnormalities,
gastrointestinal issues.
Rare but serious: rhabdomyolysis (muscle breakdown), elevated liver
enzymes.
Nursing Implication: Monitor liver function tests (LFTs) and CK levels
in patients on atorvastatin.

5. Adverse Effects of Clopidogrel
Common effects: bleeding, bruising, gastrointestinal discomfort.
Serious effects: thrombocytopenic purpura (TTP).
Nursing Implication: Monitor for signs of bleeding and educate
patients to report unusual bruising or bleeding.

6. Reasons to Withhold Metoprolol
Withhold if:
oHeart rate is less than 50-60 bpm or BP is too low (systolic BP
less than 90 mmHg).

, oSevere bradycardia, heart block, or acute decompensated heart
failure.
oPatients with asthma or COPD (due to bronchoconstriction risk).
oNursing Implication: Assess heart rate and blood pressure
before administration.

7. Priority Labs for Someone Receiving Lasix (Furosemide)
Potassium: Risk of hypokalemia.
Sodium: Watch for hyponatremia.
Kidney function: Monitor BUN, creatinine.
Magnesium levels: May also drop with diuretics.
Nursing Implication: Regularly monitor electrolytes and kidney
function to prevent electrolyte imbalances and renal impairment.

8. Foods High in Vitamin K
Leafy greens (e.g., spinach, kale, broccoli), Brussels sprouts, cabbage,
and certain vegetable oils.
Nursing Implication: For patients on warfarin, ensure consistent
intake of Vitamin K.

9. Advantages of Using Rivaroxaban Versus Warfarin
Rivaroxaban: Fixed dosing, no need for routine INR monitoring, fewer
food interactions.
Warfarin: Requires frequent INR monitoring and has significant
dietary restrictions (Vitamin K).
Nursing Implication: Educate patients on the ease of use with
rivaroxaban, but continue to monitor for bleeding risks

10. Labs Used for Warfarin
INR (International Normalized Ratio): Therapeutic range is typically 2.0-
3.0.
Nursing Implication: Regularly monitor INR to ensure proper dosing
and prevent bleeding or clotting risks

11. Patient Education on Newly Diagnosed Hyperlipidemia and Use
of Statins
Diet and lifestyle changes: Emphasize low-fat diet, exercise, and
smoking cessation.
Medications: Adherence to statin therapy and monitoring for side
effects (e.g., muscle pain, liver dysfunction).
Nursing Implication: Educate on the importance of routine
cholesterol monitoring
12. What to Assess in a Patient Taking Digoxin
Heart rate: Hold if less than 60 bpm.

, Signs of toxicity: Nausea, vomiting, visual disturbances
(yellow/green halos).
Kidney function: Check BUN and creatinine.
Nursing Implication: Monitor vital signs closely and assess for
digoxin toxicity.

13. Teaching Points for Someone Taking Warfarin
Consistent diet: Maintain consistent Vitamin K intake.
Monitor INR: Ensure therapeutic levels (usually 2.0-3.0).
Signs of bleeding: Educate on recognizing bleeding and bruising.
Nursing Implication: Reinforce patient education on drug
interactions and adherence to therapy.

14. What Needs to Be Monitored When Someone Is Receiving
Milrinone
Heart rate and blood pressure: May cause hypotension and
arrhythmias.
Electrolytes: Especially potassium levels.
Renal function: Monitor creatinine and urine output.
Nursing Implication: Monitor vital signs and electrolytes closely
during therapy.

15. Proper Steps in Self-Administration of SQ Heparin
Clean injection site with alcohol.
Pinch skin and insert needle at a 90-degree angle.
Inject medication slowly, then dispose of needle properly.
Nursing Implication: Provide patient education on self-injection
technique and signs of bleeding.

16. Proper Steps in Obtaining an Apical Pulse
Place the stethoscope on the chest at the fifth intercostal space near
the midclavicular line.
Count the beats for one full minute.
Nursing Implication: Assess for abnormalities (e.g., irregular
rhythms, bradycardia, tachycardia).

17. Labs for Someone Taking Atorvastatin
Liver function tests (ALT, AST): To monitor for hepatotoxicity.
Creatine kinase (CK): To assess for muscle damage (rhabdomyolysis).
Nursing Implication: Regularly monitor liver enzymes and muscle
function


18. What Does the Drug Alirocumab Do?

, Alirocumab is a PCSK9 inhibitor that lowers LDL cholesterol by
increasing the liver's ability to remove LDL from the blood.
Nursing Implication: Educate patients on the need for regular
cholesterol monitoring.

19. Can IV Lasix Cause Hearing Loss if Administered Too Fast?
Yes, rapid infusion of IV Lasix (furosemide) can cause ototoxicity and
hearing loss.
Nursing Implication: Administer slowly and monitor for signs of
ototoxicity.

20. Is the Medication Ezetimibe Used for Heart Failure?
No, Ezetimibe is primarily used for lowering cholesterol, not heart
failure.
Nursing Implication: Clarify the purpose of medications with patients
to ensure adherence.

21. Manifestations of Digoxin Toxicity
Visual disturbances (yellow/green halos).
Nausea and vomiting.
Bradycardia.
Nursing Implication: Monitor for signs of toxicity, especially if patient
is hypokalemic or has renal dysfunction.

22. Afterload, Preload, Cardiac Output – Definitions
Afterload: The pressure the heart must overcome to eject blood.
Preload: The volume of blood returning to the heart.
Cardiac Output: The amount of blood the heart pumps per minute.
Nursing Implication: Understand these concepts when managing
heart failure and circulatory conditions.

23. Adverse Effects of Ezetimibe
Gastrointestinal discomfort (diarrhea, nausea).
Liver enzyme elevation - Monitor LFTs.
Muscle pain (rarely).
Nursing Implication: Monitor for gastrointestinal side effects and
liver function.

24. Antidote for Rivaroxaban
Andexanet alfa (Andexxa).
Nursing Implication: Be prepared to administer antidote in the event
of life-threatening bleeding