Exam 2 - Neuropharm pt2, cardiovascular (practice questions + quizzes)

A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? A. "Adaptation results in an increased sensitivity to side effects over time." B. "Adaptation can lead to tolerance of the drug with prolonged use. C. Adaptation helps explain how physical dependence occurs D. Adaptation often must occur before therapeutic effects develop

A. "Adaptation results in an increased sensitivity to side effects over time."

A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: A. Changes in the brain as a result of prolonged drug exposure B. Direct action of the brain on specific synaptic functions in the brain C. Slowed drug absorption across the blood-brain barrier D. Tolerance to exposure to the drug over time

A. Changes in the brain as a result of prolonged drug exposure

Which drug is the most effective for lowering LDL cholesterol? a) Atorvastatin [Lipitor] b) Cholestyramine [Questran] c) Gemfibrozil [Lopid] d) Ezetimibe [Zetia]

Answer: A Rationale: The statin drugs (such as atorvastatin) are most effective for reducing cholesterol

A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: A) changes in the brain as a result of prolonged drug exposure B) direct actions of the brain on specific synaptic functions in the brain C) slow drug absorption across the blood brain barrier D) tolerance to exposure to the drug over time

Answer: A) changes in the brain as a result of prolonged drug exposure

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a) Reduction of LDLs b) Elevation of HDLs c) Stabilization of the plaque in coronary arteries d) Reduction of risk of cardiovascular events e) Improvement of liver function

Answer: A, B, C, D Rationale: The benefits of statin drugs include all but answer choice (e). Statins can actually be hepatotoxic in some people.

1) The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? a) "I can take this medication in the morning to reduce nighttime urination." b) "I will rise slowly when changing from a sitting to a standing position." c) My heart rate may slow down with this drug. I will call if my pulse is below 60." d) "I need to increase my intake of fluids and foods that are high in fiber."

Answer: B Rationale: Vasodilators can cause orthostatic hypotension so (b) best describes effective understanding of this side effect.

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? a) + 2 edema of the lower extremities b) Potassium level of 3.5 mEq/L c) Crackles in the lungs are no longer heard d) Jugular vein distention a) "I need to increase my intake of fluids and foods that are high in fiber." a) To protect against reflex tachycardia

Answer: C Rationale: ACE inhibitors for the treatment of heart failure, among other things, works to reduce fluid volume retention and prevent or ameliorate hypervolemic complications such as pulmonary edema (which would cause crackles in the lung). +2 edema is a sign of fluid volume retention as is jugular vein distension so both (a) and (d) would suggest the ACE inhibitor is not effective. And a potassium level of 3.5 is normal and unrelated to the therapeutic goals of ACEi drugs.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? a) Very-low-density lipoprotein (VLDL) b) polipoprotein B-100 c) Low-density lipoprotein (LDL) d) High-density lipoprotein (HDL)

Answer: C Rationale: LDLs carry cholesterol through the bloodstream. High LDL concentration is the leading risk factor for coronary heart disease.

1) The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? a) To reduce the risk of headache b) To improve hypotensive effects c) To prevent heart failure d) To protect against reflex tachycardia

Answer: D Rationale: Hydralazine is a vasodilator and will cause a decline in BP. Drops in blood pressure can cause reflex tachycardia. Beta blockers such as propranolol taken along with a vasodilator will block reflex tachycardia.

Which laboratory result may be a consequence of therapy with a thiazide diuretic? a) Serum glucose level of 58 mg/dL b) Serum potassium level of 5.3 mEq/L c) Serum sodium level of 135 mEq/L d) Serum uric acid level of 10.4 mg/dL

Answer: D Rationale: Thiazide diuretics will not cause hypoglycemia as seen in (a), (b) & (c) represent normal potassium and sodium levels so they don't qualify as "consequences" of drug therapy. The uric acid levels in (d) are higher than normal which is a possible adverse effect of many diuretic drugs including thiazides.

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? a) Quinapril [Accupril] b) Aliskiren [Tekturna] c) Eplerenone [Inspra] d) andesartan [Atacand]

Answer: D Rationale: andesartan is the only drug on the list that is an Angiotensin II receptor blocker

A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient: A. Has developed a psychological dependence on the drug B. May need increased amounts of the drug over time C. Will cause an abstinence syndrome if the drug is discontinued abruptly D. Will have increased sensitivity to drug side effects

B. May need increased amounts of the drug over time

A group of nursing students ask a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier: A. Causes infants to be less sensitive to CNS drugs thus require larger doses B. Allow only ionized or protein-bound drugs to cross into the central nervous system C. Prevents some potentially toxic substances from crossing into the central nervous system D. Prevents lipid-soluble drugs from entering the central nervous system

C. Prevents some potentially toxic substances from crossing into the central nervous system

A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure? A. Absence B. Myclonic C. Atonic D. Tonic-clonic

D. Tonic Clonic

The nurse teaches a patient about benazepril [Lotensin]. Which statement by the patient requires an intervention by the nurse? A."I use NoSalt (a salt substitute) instead of salt to season foods." B."I eat sweet potatoes once or twice a week." C."I drink 4 ounces of prune juice each morning." "I like asparagus because it's high in vitamin K."

•Answer: A •Rationale: An adverse effect of angiotensin-converting enzyme (ACE) inhibitors (for example, benazepril) is hyperkalemia. Significant potassium accumulation is usually limited to patients taking potassium supplements, salt substitutes (which contain potassium), or a potassium-sparing diuretic. Patients should be instructed to avoid potassium supplements and potassium-containing salt substitutes unless they are prescribed. Sweet potatoes and prune juice are foods high in potassium; asparagus is high in vitamin K. Foods high in vitamin K are restricted for patients who are prescribed warfarin [Coumadin].

The nurse cares for a patient receiving digoxin [Lanoxin]. What indicates to the nurse that treatment with this medication is effective? A.Improved cardiac output B.Reduced exercise tolerance C.Increased body weight D.Decreased cardiac contractility

•Answer: A •Rationale: Digoxin increases the cardiac output of patients with heart failure; it improves cardiac output, decreases the heart rate, decreases heart size, decreases constriction of arterioles and veins, reverses water retention, decreases blood volume, decreases peripheral and pulmonary edema, decreases weight (by water loss), and improves exercise tolerance.

The nurse cares for a patient with a digoxin level of 1.9 ng/mL. Which action would be most appropriate for the nurse to take initially? A.Start continuous heart monitoring. B.Check the patient's serum creatinine. C.Administer digoxin as prescribed. D.Give Fab antibody fragments [Digibind].

•Answer: A •Rationale: The optimal therapeutic range for digoxin is 0.5 to 0.8 ng/mL; levels higher than 2 ng/mL usually are associated with toxic symptoms. A priority action is to assess for dysrhythmias; the nurse should immediately initiate continuous heart monitoring. Serum creatinine indicates renal function, and digoxin is eliminated primarily by renal excretion. Renal impairment can lead to toxic accumulation, and the dosage must be reduced if kidney function declines. Digoxin should not be given to a patient suspected of having digoxin toxicity. If a severe digoxin overdose is responsible for dysrhythmias, digoxin levels can be lowered using Fab antibody fragments.

A nurse instructs a patient about signs and symptoms of digoxin toxicity. The nurse determines that teaching is successful if the patient makes which statement? A."If my heart is racing, the dose may be too high." B."I should report any muscle weakness or nausea." C."My doctor should be notified if diarrhea occurs." "The dose will be reduced if I develop memory loss."

•Answer: B •Rationale: Digoxin toxicity manifests with dysrhythmias, bradycardia, muscles weakness, anorexia, nausea, vomiting, fatigue, and visual disturbances.

A patient is prescribed hydralazine. What is most important for the nurse to teach the patient? A.Precautions for postural hypotension B.Prevention of reflex tachycardia C.High initial dose for slow acetylators D.Recognition of hypertrichosis

•Answer: B •Rationale: Hydralazine is usually combined with a beta blocker to protect against reflex tachycardia. Hydralazine is an arterial vasodilator; postural hypotension is minimal. Hydralazine is inactivated by acetylation, and the ability to acetylate drugs is genetically determined. To avoid hydralazine accumulation, the dosage should be reduced in slow acetylators. Minoxidil commonly causes hypertrichosis, or increased hair growth.

A patient who is hospitalized for an infection takes eplerenone [Inspra] for heart failure. Which medication, if ordered by the physician, should the nurse question? A.Ciprofloxacin [Cipro] B.Itraconazole [Sporanox] C.Tetracycline [Sumycin] D.Ampicillin [Principen]

•Answer: B •Rationale: Inhibitors of CYP3A4 can increase levels of eplerenone, thereby posing a risk of toxicity. Weak inhibitors (for example, erythromycin, saquinavir, verapamil, fluconazole) can double eplerenone levels. Strong inhibitors (for example, ketoconazole, itraconazole) can increase levels fivefold. If eplerenone is combined with a weak inhibitor, the eplerenone dosage should be reduced. Eplerenone should not be combined with a strong inhibitor.

A patient with severe hypertension is prescribed minoxidil. Which medications will the nurse expect to be administered to reduce adverse responses to minoxidil? A.Adenosine [Adenocard] and ticlopidine [Ticlid] B.Furosemide [Lasix] and propranolol [Inderal] C.Digoxin [Lanoxin] and captopril [Capoten] D.Donepezil [Aricept] and clonidine [Catapres]

•Answer: B •Rationale: Minoxidil may cause adverse responses (for example, reflex tachycardia, expansion of blood volume, pericardial effusion). Minoxidil should be used with a beta blocker (for example, propranolol) plus intensive diuretic therapy (for example, furosemide).

A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications? A.Serum sodium B.Blood urea nitrogen C.Serum potassium D.Plasma B-natriuretic peptide

•Answer: C •Rationale: Furosemide is a loop diuretic that promotes loss of potassium and thereby increases the risk of digoxin-induced dysrhythmias. When digoxin and furosemide are used concurrently, serum potassium levels must be monitored and maintained within a normal range (3.5 to 5 mEq/L).

A patient is prescribed digoxin [Lanoxin] and furosemide [Lasix]. It is most important for the nurse to assess which value before administering these medications? A.Serum sodium B.Blood urea nitrogen C.Serum potassium Plasma B-natriuretic peptide

•Answer: C •Rationale: Furosemide is a loop diuretic that promotes loss of potassium and thereby increases the risk of digoxin-induced dysrhythmias. When digoxin and furosemide are used concurrently, serum potassium levels must be monitored and maintained within a normal range (3.5 to 5 mEq/L).

A patient who is taking spironolactone [Aldactone] is prescribed losartan [Cozaar]. The nurse should take which action? A.Assess for symptoms of hyperkalemia. B.Observe for a hypertensive crisis. C.Administer the medications as scheduled. D.Evaluate for first-dose hypotension.

•Answer: C •Rationale: These medications may be administered together without serious drug interactions. Spironolactone is a potassium-sparing diuretic, and losartan is an angiotensin II receptor blocker (ARB). The hypotensive effects of ARBs are additive with those of other antihypertensive drugs. When an ARB is added to an antihypertensive regimen, dosages of the other drugs may require reduction. The patient would be observed for hypotension (not first-dose hypotension).

Which patient would most likely be prescribed sodium nitroprusside [Nitropress]? A.A patient with a recent diagnosis of essential hypertension B.A patient with heart failure who receives weekly home visits C.A patient who is hypotensive after a myocardial infarction D.A patient with a hypertensive crisis in the intensive care unit

•Answer: D •Rationale: Sodium nitroprusside is used to treat hypertensive emergencies. The medication is administered intravenously, with continuous monitoring of blood pressure.

Which patient is the most appropriate candidate for both lifestyle changes and drug therapy with an antihypertensive medication? A.A 47-year-old patient with blood pressure of 110/78 mm Hg and with type 2 diabetes mellitus B.A 76-year-old patient with blood pressure of 128/88 mm Hg and a history of dyslipidemia C.A 52-year-old patient with blood pressure of 136/89 mm Hg who smokes 1 pack of cigarettes per day D.A 32-year-old patient with blood pressure of 142/94 mm Hg who is sedentary

•Answer: D •Rationale: Stages 1 and 2 hypertension should be treated with both lifestyle changes and drug therapy to control blood pressure.