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Pharmacology · chapter 22 · Cardiac Emergency and Shock Drugs

Cardiac Emergency Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Aspirin contraindications

    Contraindications to aspirin are allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), asthma, hemophilia, and other blood clotting disorders.

  2. When oxygen is used

    Supplemental oxygen may be used if the client’s oxygen saturation is less than 94% on room air.

  3. Nitroglycerin contraindications

    Contraindications include allergies to nitrates, concomitant use of phosphodiesterase (PDE) inhibitors such as tadalafil and sildenafil, history of right ventricular infarction, and hypertrophic cardiomyopathy.

  4. Sit or lie the client down

    Nitrates can cause hypotension. In an emergency situation, make sure the client is sitting or lying down before administering nitroglycerin.

  5. Symptomatic hypotension on IV nitroglycerin

    If symptomatic hypotension occurs, do not give the nitroglycerin and inform the health care provider.

  6. Morphine is now second to nitroglycerin

    For many years, morphine was a first-line drug in the emergency management of AMI and unstable angina, but now it is used if nitroglycerin cannot control the chest pain (Hermiz Sedhai, 2023).

  7. Frequent reassessment with morphine

    Morphine can cause respiratory depression, respiratory arrest, cardiac arrest, and shock. Nurses must monitor the client frequently (reassess at least every 5–10 minutes) when using morphine to control pain.

  8. Respiratory rate below 10

    If the client’s respiratory rate is less than 10 breaths/min, inform the health care provider.

  9. How to push adenosine

    Adenosine has a very short half-life and should be administered as a rapid IV bolus directly into a vein, followed by a rapid saline flush.

  10. Amiodarone lung toxicity

    Amiodarone can cause pulmonary toxicity and swelling in the lungs.

  11. Nausea as an early liver sign

    Inform the health care provider of nausea, which may be an early indication of liver damage.

  12. Atropine for symptomatic bradycardia

    Atropine is a first-line drug used for treating symptomatic bradycardia. It is an anticholinergic drug, which means it blocks receptors in the parasympathetic nervous system.

  13. Dopamine extravasation

    Extravasation of dopamine into the tissue around an IV site may cause necrosis, sloughing, and potentially gangrene.

  14. Correct hypovolemia before dobutamine

    Dobutamine may cause marked increase in blood pressure or heart rate. Hypovolemia must be corrected prior to initiating dobutamine.

Terms to know

nonselective adrenergic agonist
Epinephrine is a nonselective adrenergic agonist, which means it stimulates all receptors in the SNS.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client with suspected AMI is prescribed sublingual nitroglycerin. The client took sildenafil yesterday. What should the nurse do?

    1. Give the nitroglycerin with the client lying down.
    2. Give half the ordered dose.
    3. Hold the nitroglycerin and notify the health care provider.
    4. Give the nitroglycerin and recheck blood pressure in an hour.

    Answer: Hold the nitroglycerin and notify the health care provider.

    Concomitant use of PDE inhibitors such as sildenafil and tadalafil is a contraindication to nitroglycerin. Positioning or dose changes do not remove a contraindication.

  2. A client with suspected unstable angina is given aspirin in the emergency department. Which instruction is correct?

    1. Let the tablet dissolve under the tongue.
    2. Swallow the tablet whole with water.
    3. Chew the tablet and then swallow it.
    4. Take the tablet after eating a meal.

    Answer: Chew the tablet and then swallow it.

    In suspected AMI or unstable angina, the nurse directs the client to chew the aspirin and then swallow it. The other routes are not what the section describes for emergency aspirin.

  3. The nurse gave IV morphine for chest pain unrelieved by nitroglycerin. Ten minutes later the client's respiratory rate is 8 breaths/min. What is the nurse's priority?

    1. Give another dose of morphine for comfort.
    2. Encourage the client to sleep.
    3. Document the finding and reassess in an hour.
    4. Inform the health care provider and have naloxone ready.

    Answer: Inform the health care provider and have naloxone ready.

    Morphine can cause respiratory depression; a rate under 10 breaths/min is reported to the provider, and the reversal agent naloxone must be available. Waiting, redosing, or encouraging sleep worsens the risk.

  4. A nurse is preparing to give adenosine to a client in supraventricular tachycardia. Which actions are correct? Select all that apply.

    1. Follow with a rapid saline flush.
    2. Push adenosine rapidly over 1–2 seconds directly into a vein.
    3. Be prepared to give a second dose.
    4. Tell the alert client they may briefly feel chest pain.
    5. Infuse adenosine slowly over 10 minutes.

    Answer: Follow with a rapid saline flush., Push adenosine rapidly over 1–2 seconds directly into a vein., Be prepared to give a second dose., Tell the alert client they may briefly feel chest pain.

    Adenosine has a very short half-life, so it is pushed rapidly and followed by a saline flush; the client may feel brief chest pain, and a second dose may be needed. A slow infusion would let the drug wear off before it acts.

  5. A client is receiving a dopamine infusion for shock. Which nursing actions are appropriate? Select all that apply.

    1. Monitor the IV site for signs of extravasation.
    2. Give the infusion on a general floor without monitoring.
    3. Ignore complaints of pain at the IV site.
    4. Monitor blood pressure frequently.
    5. Keep the client on continuous cardiac monitoring.

    Answer: Monitor the IV site for signs of extravasation., Monitor blood pressure frequently., Keep the client on continuous cardiac monitoring.

    Dopamine extravasation can cause necrosis and gangrene, so the site is watched, and blood pressure and cardiac rhythm are monitored. Dopamine is potent and should be given only in an intensive care area, and pain at the IV site must be reported.

  6. A client receiving IV amiodarone for ventricular tachycardia reports new nausea. How should the nurse interpret this?

    1. Nausea means the dose is too low.
    2. Nausea shows the drug is converting the rhythm.
    3. Nausea may be an early sign of liver damage and should be reported.
    4. Nausea is harmless and needs no follow-up.

    Answer: Nausea may be an early sign of liver damage and should be reported.

    Clients receiving amiodarone are taught to report nausea because it may be an early indication of liver damage; hepatic injury is a listed adverse effect. The other interpretations are not supported by the section.

Where every quote comes from

Section 22.2 Cardiac Emergency Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.