Pharm: Unit 2 Questions

You're teaching a patient about how angiotensin II receptor blockers (ARBs) work. Which statement below BEST describes how these medications work on the body? A. "They prevent Angiotensin II Type I Receptors from binding with Angiotensin II." B. "These medications prevent the activation of Angiotensin II Type II Receptors from binding with Angiotensin II." C. "They inhibit angiotensin-converting-enzyme (ACE) from converting an Angiotensin I to Angiotensin II." D. "These medications prevent Angiotensin II Type I Receptors from binding with angiotensin-converting-enzyme (ACE)."

The answer is A. ARBs prevent Angiotensin II Type I Receptors from binding with Angiotensin II. Remember ACE Inhibitors inhibit angiotensin-converting-enzyme (ACE) from converting Angiotensin I to Angiotensin II.

A patient is admitted with a dysrhythmia. The physician prescribes Propranolol. Which statement by the patient requires the nurse to hold the ordered dose and notify the physician for further orders? A. "I use an inhaler at home for asthma." B. "My heart feels like it is racing, and I feel very weak." C. "I had caffeine this morning with breakfast." D. "I smoke 2 packs of cigarettes per day."

The answer is A. Propranolol is a nonselective beta blocker. Therefore, it affects beta 1 and beta 2 receptors. Beta 2 receptors are found in the lungs (specifically the bronchioles). This medication could cause bronchoconstriction in patients with asthma or COPD and should be avoided. Selective beta blockers (Atenolol, Esmolol, Metorprolol) block only beta 1 (which are found in the heart and kidneys). Therefore, they are less likely to cause bronchoconstriction.

Which patient below would MOST benefit from an ACE Inhibitor? A. A 50-year-old female with systolic dysfunction heart failure. B. A 48-year-old male with severe renal failure. C. A 35-year-old female with chronic hepatitis. D. A 54-year-old male with hypovolemic shock.

The answer is A. ACE Inhibitors are used to treat patient with hypertension, systolic dysfunction heart failure (the left ventricle is too weak to pump blood forward out of the heart...ACE inhibitors will decrease afterload which will make it easier for the heart to pump blood), and after a myocardial infarction. Patients with renal failure or liver disease are not candidates for ACE inhibitors because of the effects of the drug on the kidneys and how it is cleared in the liver. In option D, the patient will be hypotensive and need fluids or vasopressors....NOT a medication that will lower the blood pressure.

A patient is taking Digoxin. What medication on the patient's medication list increases the patient's risk of experiencing Digoxin toxicity? A. Furosemide B. Metformin C. Nitroglycerin D. Coumadin

The answer is A. Furosemide is a loop-diuretic and this medication wastes potassium. Remember hypokalemia (low potassium level) increases the risk of a patient developing Digoxin toxicity. Hypercalcemia (>10.2 mg/dL) and hypomagnesemia ( < 1.5 mg/dL)also increases Digoxin toxicity.

What is the antidote for Heparin? A. Protamine sulfate B. Vitamin K C. Flumazenil D. Narcan

The answer is A. Protamine sulfate is the antidote for Heparin.

You're educating a group of new nurse graduates about loop diuretics. One topic you discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse side effect in a patient prescribed a loop diuretic. Which response by one of the new nurses is correct? A. "Always administer intravenous loop diuretics slowly." B. "Monitor for signs and symptoms of low potassium levels because this increases the risk of inner ear damage while taking loop diuretics." C. "Administer the medication with meals." D. "Avoid administering loop diuretics with a tetracycline."

The answer is A. Rapid IV administration of a loop diuretic can increase the risk of ototoxicity in a patient taking loop diuretics. Always give these medications slowly when ordered the IV route.

A patient develops Heparin-Induced Thrombocytopenia (HIT). As the nurse, you would expect the Heparin to be discontinued and the patient to be started on what other type of anticoagulant? A. Direct thrombin inhibitor B. Protamine sulfate C. Switched to subcutaneous Heparin injections D. Vitamin-K agonist

The answer is A. The Heparin is discontinued and direct thrombin inhibitors can be started like: Argatroban, Bivalirudin etc.

A patient is prescribed Metoprolol. Which statement by the patient requires the nurse to re-educate the patient on how to take the medication properly? A. "After I stop taking this medication I will let my physician know." B. "I take this medication with my breakfast every morning." C. "I will change positions slowly while I'm taking this medication." D. "While I'm taking this medication I will monitor my heart rate."

The answer is A. The patient should NOT just stop taking the medication. It must be tapered off over a period of time (usually about 2 weeks). This will prevent the development of rebound hypertension, myocardial ischemia, and angina.

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation....(ex: up to 4.5)

Your patient is prescribed to take Lisinopril and Triamterene. As the nurse you know that these medications increase a patient's risk for developing? A. Hyperkalemia B. Hypertension C. Hypernatremia D. Renal failure

The answer is A. Lisinopril is an ACE inhibitor (ACEI) and this medication can increase potassium levels due to how it affects the RAAS. Triamterene is a potassium-sparing diuretic, which can increase potassium levels. Therefore, the nurse should monitor for HYPERkalemia.

Heparin is an anticoagulant. What family of anticoagulant medications does this drug belong to? A. Direct thrombin inhibitors B. Indirect thrombin inhibitors C. Vitamin K antagonists D. Factor Xa inhibitors

The answer is B Heparin is an anticoagulant that belongs to the Indirect Thrombin Inhibitors family.

A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is? A. Tell the patient to immediately stop taking the medication and seek medical treatment. B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication. C. Recommend the patient start taking the medication at night to decrease the coughing. D. Reassure the patient that the cough will disappear within 6 months of taking the medication.

The answer is B. A persistent, dry cough can occur in some patients taking ACE Inhibitors and is usually harmless. It is due to how ACE Inhibitors affect bradykinin (an inflammatory substance in the body). A patient should NEVER abruptly stop taking an ACE inhibitor because it can cause rebound hypertension. If the patient cannot tolerate the cough, they should speak with the MD about switching to another type of medication.

A patient is scheduled to take a dose of Warfarin (Coumadin) at 1800. The patient's INR level is 6. As the nurse you will? A. Administer the dose as scheduled B. Hold the dose and notify the physician C. Double the dose D. Hold today's dose but administer tomorrow's dose as scheduled.

The answer is B. A therapeutic INR level should be 2-3 (it may be up to 4.5 if the patient is at a HIGH risk for blood clot formation). A level of 6 is HIGH and places the patient at risk for bleeding. The nurse should hold the dose and notify the physician.

A patient is taking an ACE Inhibitor and Spironolactone. It is priority the nurse teaches the patient? A. To avoid consuming alcoholic beverages B. To limit foods high in potassium C. To limit salt intake D. To take the medications with food

The answer is B. ACE Inhibitors and spironolactone (it's a potassium-sparing diuretic) will both cause the kidneys to retain potassium. Therefore, it is very important the nurse teaches the patient to limit foods high in potassium.

Your patient is prescribed an Angiotensin II Receptor Blocker (ARB) for the treatment of blood pressure management. Which statement below BEST describes how this medication will manage blood pressure in a patient? A. "This medication will increase systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water." B. "This medication will decrease systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water." C. "ARBs will cause vasoconstriction and increase renal blood flow and volume." D. "ARBs will cause vasodilation and the kidneys to retain sodium and water."

The answer is B. ARBs will decrease systemic vascular resistance (SVR) and decrease blood pressure, while decreasing blood volume through the excretion of sodium and water."

A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor? A. Metoprolol B. Benazepril C. Losartan D. Amlodipine

The answer is B. Benazepril is an ACE Inhibitor. Remember ACE Inhibitors end in PRIL.

Which patient below is at MOST risk for developing Digoxin toxicity? A. A 30-year-old male patient with heart failure and hyperglycemia B. A 82-year-old male patient with atrial fibrillation and magnesium level of 1 mg/dL. C. A 45-year-old female with potassium level of 4.2 mEq/L. D. A 50-year-old female with a calcium level of 9 mg/dL.

The answer is B. Elderly patients are at a very high risk of Digoxin toxicity due to a decrease of function in the liver and renal system. Also, this patient in option B is experiencing hypomagnesemia (<1.5 mg/dL) which increases the risk of Digoxin toxicity even more.

Your patient is prescribed hydrochlorothiazide. The patient's potassium level is 2 mEq/L. What medication below should the nurse hold and notify the physician for further orders? A. Dilantin B. Digoxin C. Warfarin D. Lithium

The answer is B. Hypokalemia (low potassium level in the blood) can increase Digoxin toxicity. Hydrochlorothiazide causes the body to lose potassium. A normal blood potassium level is 3.5-5 mEq/L. Therefore, the nurse should hold the Digoxin and notify the physician for further orders.

A patient with heart failure is prescribed Digoxin and a loop diuretic. The nurse knows that what finding below would increase a patient's risk of developing Digoxin toxicity? A. Magnesium level 1.8 mg/dL B. Potassium 2 mEq/L C. BUN 15 D. Albumin 5 g/dL

The answer is B. Hypokalemia (low potassium level in the blood) increases the risk of Digoxin toxicity (normal potassium 3.5-5 mEq/L). Therefore, the nurse should always check a patient's potassium result before administering Digoxin, especially if they are taking a loop diuretic (remember loop diuretics waste potassium and can decrease the blood level).

A patient is taking Warfarin (Coumadin). What order received from the physician requires that you ask for an order clarification? A. Check PT/INR daily B. Administer Prednisone IM daily C. Ambulate three times per day D. Draw CBC in the morning

The answer is B. IM (intramuscular) injections should be AVOIDED in patients taking Warfarin (Coumadin) due to the bleeding risk. Other routes should be ordered.

A patient, who is taking Warfarin (Coumadin), asks what he should do if he misses a dose. Your response would be: A. Double the dose the next day and notify the physician. B. Take the dose when remembered, if on the same day. However, if not remembered on the same day but the next day, skip the missed dose and take the next dose at the regular scheduled time. C. Hold all doses and call the doctor. D. Split the dose the next day.

The answer is B. If a dose is missed the patient should take the dose when remembered IF on the SAME day. However, if not remembered on the SAME day but the next day, the patient should skip the missed dose and take the next scheduled dose at its regular scheduled time.

Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose and notify the physician for further orders? A. Calcium level 9 mg/L B. Potassium level 1.5 mEq/L C. Blood pressure 102/78 D. Sodium level 144

The answer is B. Loop diuretics are known to decrease potassium levels due to the way they affect how the nephron wastes potassium (this happens in the distal convoluted tubule due to the high concentrated amount of sodium in the filtrate...this tubule will exchange potassium and hydrogen ions for sodium ions under the influence of aldosterone, which will lead potassium to enter the filtrate and exit the body as urine.)

Which category of beta blockers block beta 1 and beta 2 receptors? A. Selective beta blockers B. Nonselective beta blockers

The answer is B. Nonselective beta blockers BLOCK beta 1 and beta 2...therefore they're not selective. Selective beta blockers block ONLY beta 1 receptors and are sometimes referred to as cardioselective.

You're providing care to a patient who has been receiving long-term doses of Heparin. What finding in this patient demonstrates the patient may be experiencing a complication that can occur due to long-term use of this drug? A. Uncontrolled hypertension B. Bone fractures C. Hyperkalemia D. Raynaud's Syndrome

The answer is B. Osteoporosis can occur due to long-term, high doses of Heparin. Bone fractures would indicate this patient is experiencing this complication. Heparin can stimulate osteoclasts and inhibits osteoblast, which affects the strength of the bones.

A patient is currently taking a potassium-sparing diuretic. The patient is experiencing EKG changes with tall-peaked T-waves, nausea, diarrhea, and paresthesia. The patient's morning lab results are back and the nurse makes it priority to check what lab result? A. Calcium B. Potassium C. Magnesium D. Sodium

The answer is B. Potassium-sparing diuretics can increase a patient's potassium level and based on the patient's signs and symptoms in the scenario above this correlates with hyperkalemia. The nurse should check the morning lab result for potassium.

A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient's scheduled medication list is an ARB? A. Metoprolol B. Losartan C. Lisinopril D. Nicardipine

The answer is B. Remember ARBs end with "SARTAN". Losartan is an ARB.

A patient is scheduled to take a dose of Lithium at 1000. The patient is also prescribed a thiazide diuretic. What lab result below requires the nurse to hold the dose of Lithium and notify the physician for further orders? A. Potassium 3.2 mEq/L B. Sodium 115 mEq/L C. Calcium 10.5 mg/L D. Magnesium 2 mg/dL

The answer is B. The nurse must monitor for Lithium toxicity in patients who are taking Lithium and a thiazide diuretic. These types of diuretics lower the amount of sodium in the blood because it prevents the reabsorption of it within the nephron...so more is excreted into the urine. Therefore, low sodium levels in the blood INCREASE the risk of Lithium toxicity. A normal blood sodium level is 135-145 mEq/L.

A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? A. Vital signs B. Weight C. PT/INR level D. EKG

The answer is B. The nurse would want to make sure the documented weight of the patient is current and accurate. This medication is weight-based. Therefore, for proper dosing to be administered, a correct weight should be used.

You're providing discharge instructions to a patient who will be taking a calcium channel blocker at home. Which statement by the patient demonstrates they did NOT understand the teaching instructions and needs re-education? A. "I will follow a low-fat and high-fiber diet." B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice." C. "This medication can enlarge my gums so I will maintain good oral hygiene." D. "I will monitor my blood pressure regularly because this medication can cause low blood pressure."

The answer is B. The patient should AVOID grapefruit juice while taking CCBs because this could lead to an increase in drug levels. The patient should follow a high-fiber diet due to constipation (especially with Verapamil). In addition, CCBs can enlarge the gums (gingival hyperplasia) and lower blood pressure.

As the nurse you know to tell the patient that the best way to PREVENT rebound hypertension while taking an Angiotensin II Receptor Blocker (ARB) is to? A. assess the blood pressure daily with a self-monitoring device B. never abruptly stop taking the medication C. avoid taking the medication with milk or grapefruit juice D. avoid taking over-the-counter medications

The answer is B. The patient should NEVER just quit taking the medication because rebound hypertension can occur.

Your patient is being discharged home and will be required to self-administer injectable Heparin. You are observing the patient administer their scheduled dose of Heparin to confirm that the patient knows how to do it correctly. What action by the patient requires you to re-educate them about how to administer Heparin? A. The patient injects the needle into the fatty tissue of the abdomen. B. The patient injects the needle 1 inch away from the umbilicus. C. The patient rotated the injection site from the previous dose of Heparin. D. The patient does not massage the injection site after administering the medication.

The answer is B. The patient should inject the needle 2 inches (NOT 1 inch) away from the umbilicus. All the other options are correct.

The physician prescribes the patient a thiazide diuretic. The patient is experiencing increased urination. As the nurse you know that this medication causes this type of affect by how it affects the nephron. It does this by? A. inhibiting the sodium-potassium-chloride cotransporter in the distal convoluted tubule B. inhibiting the sodium-chloride cotransporter in the distal convoluted tubule C. inhibiting the water reabsorption in the distal convoluted tubule D. inhibiting the sodium-potassium transporter in the distal convoluted tubule

The answer is B. Thiazide diuretics inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. When this occurs it prevents sodium from being reabsorbed back into the blood. Since the sodium stays in the tubule, it will keep water with it. This will decrease the amount of water reabsorbed into the blood/body...thus increasing urination and extra fluid removal from the blood (causing a diuretic effect).

What is considered a normal INR level in a person who is NOT taking Warfarin (Coumadin)? A. 10-12 seconds B. 0.75-1.25 C. 2-3 D. 5-7

The answer is B. This is considered a normal INR level in someone who is NOT taking Warfarin (Coumadin).

Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are? A. Low in calcium B. High in fiber C. Low in potassium D. High in sodium

The answer is B. Verapamil can cause constipation. The patient should choose to eat foods that are high in fiber to help prevent this side effect.

Which potassium-sparing diuretic can cause antiandrogenic effects in a patient, such as menstrual irregularities, gynecomastia, and decreased sex drive? A. Triamterene B. Spironolactone C. Amiloride D. Eplerenone

The answer is B. Spironolactone can have antiandrogen effects on some patients (gynecomastia, increase hair growth in women, menstrual irregulars, sexual dysfunction). This is because Spironolactone affects the androgen and progesterone receptors.

You're providing discharge teaching to a patient who will be taking a thiazide diuretic for the treatment of hypertension. You note that the patient has type I diabetes. What statement by the patient represents they misunderstood your teaching points about this medication and requires you reinforce some of the education pieces? A. "I must monitor my blood glucose closely while taking this medication." B." This medication can cause sudden and severe drops in my blood glucose." C. "I will try my best to eat a diet that includes foods rich in potassium." D. "I will report to my physician if I experience excessive thirst, little or no urination, and extreme fatigue."

The answer is B. Thiazide diuretics can INCREASE the blood glucose (lead to hyperglycemia)... not hypoglycemia. Therefore, the nurse should educate the patient to monitor the blood glucose level closely.

A patient is taking an Angiotensin II Receptor Blocker (ARB). What finding below is an adverse side effect of this medication and should be reported to the physician? A. BUN 10 B. Creatinine 1 mg/dL C. Potassium 6.8 mEq/L D. ALT 20 U/L

The answer is C. ARBs can lead to hyperkalemia due to how they decrease the release of aldosterone and cause the kidneys to excrete sodium and water, but conserve potassium. A normal potassium level is 3.5-5 mEq/L.

Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits? A. the sodium-chloride transporter B. the effects of aldosterone on the distal convoluted tubule C. the sodium-potassium-chloride cotransporter D. the transport of bicarbonate by the proximal convoluted tubule

The answer is C. Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2) cotransporter in the thick ascending limb of the loop of Henle. This inhibits the amount of sodium that is reabsorbed by the kidneys, which will cause the nephron to decrease the amount of water it reabsorbs...hence leading to more water leaving the kidneys via the urine (leading to its diuretics affects). Option A is how thiazide diuretics work, option B is how potassium-sparing diuretics work, and option D is how carbonic anhydrase inhibitors work.

The physician prescribes the patient a potassium-sparing diuretic. Which statement below best describes how this medication works to cause diuresis? A. These medications work to inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule. B. These medications work to inhibit the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle. C. These medications work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct. D. These medications work to inhibit the sodium channels within the proximal convoluted tubule by decreasing sodium reabsorption.

The answer is C. Potassium-sparing diuretics work to inhibit the sodium and potassium exchange within the sodium channels in the distal tubule and collecting duct.

What is the therapeutic range of the drug Digoxin? A. 2-3.5 ng/mL B. 0.1-2 ng/mL C. 0.5-2 ng/mL D. 3.5-5 ng/mL

The answer is C. A normal Digoxin level should be 0.5 - 2 ng/mL. Any levels greater than 2 ng/mL is considered toxic.

A patient who developed a dry, persistent cough while taking an ACE Inhibitor is switched to an angiotensin II receptor blocker (ARB). The patient reports the cough is now gone, but asks you to explain how this medication helped alleviate the cough. What is the correct response? A. "ARBs prevent ACE (angiotensin-converting-enzyme) from breaking down bradykinin so a dry, persistent cough is less likely." B. "ARBs increase ACE (angiotensin-converting-enzyme) which helps decrease bradykinin levels and helps alleviate the cough." C. "ARBs do not inhibit ACE (angiotensin-converting-enzyme), which is a substance that inactivates bradykinin by breaking it down; therefore, a cough is not likely with this medication." D. "ARBs prevent Angiotensin II Type I receptor sites from activating bradykinin in the lungs."

The answer is C. ACE Inhibitors can cause a dry, persistent cough in some patients because it inhibits ACE from inactivating bradykinin by breaking it down....therefore, levels of bradykinin increase and lead to coughing. ARBs do NOT inhibit ACE (angiotensin-converting-enzyme), which is a substance that inactivates bradykinin by breaking it down; therefore, a cough is not likely with this medication.

A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be? A. 0.5-2.5 times the normal value range B. 2-3 times the normal value range C. 1.5-2.5 times the normal value range D. 1-3.5 times the normal value range

The answer is C. An aPTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.

Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________. A. vasodilation; anti-diuretic hormone (ADH) B. vasodilation; aldosterone C. vasoconstriction; aldosterone D. vasoconstriction; anti-diuretic hormone (ADH)

The answer is C. Angiotensin II causes vasoconstriction of the vessels and triggers the release of aldosterone.

A patient is prescribed a beta blocker for a cardiac condition. You know this medication blocks the beta receptors in the body so ____________ and __________ cannot bind to the receptor site and elicit a _______ ________ _________ response. A. angiotensin II and angiotensin I; sympathetic nervous system B. dopamine and norepinephrine; parasympathetic nervous system C. norepinephrine and epinephrine; sympathetic nervous system D. dopamine and acetylcholine; parasympathetic nervous system

The answer is C. Beta blockers block the beta receptors in the body so norepinephrine and epinephrine cannot bind to the receptor site and elicit a sympathetic nervous system response.

At 1000 your patient is scheduled to take a dose of Atenolol. What finding below would require you to hold the scheduled dose and notify the physician? A. The patient's heart rate is 120 beats per minute. B. The patient's blood pressure is 102/76. C. The patient has swelling in lower extremities, dyspnea, and crackles in lung fields.

The answer is C. In option C, the patient is showing signs and symptoms of uncompensated heart failure (beta blockers are not used when uncompensated heart failure presents, but they can be sometimes be used when the patient is in compensated/stable heart failure). The reason is because beta blockers slow down the heart rate and decrease the strength of contractions (negative inotropic effect), which can lead to heart failure in SOME patients, and this is why the nurse must monitor for this.

Your patient is taking an ACE Inhibitor to manage blood pressure. Which finding below requires immediate nursing action? A. Urinary output is 190 mL within the past 4 hours. B. Patient has a persistent, dry cough. C. EKG shows tall, peaked t-waves. D. Patient has a negative Chvostek's sign.

The answer is C. This EKG finding demonstrates hyperkalemia. Remember ACE Inhibitors can cause a high potassium level because the kidneys will keep potassium, but excrete water and sodium (so it has a diuretic effect too).

What is the approximate NORMAL level range for an activated partial thromboplastin time (aPTT)? A. 20-25 seconds B. 2-3 seconds C. 30-40 seconds D. 60-80 seconds

The answer is C. This is considered a (approximate...varies in labs) normal aPTT level in someone who is NOT on Heparin.

Warfarin (Coumadin) is an anticoagulant. What family of anticoagulant medications does this drug belong to? A. Direct thrombin inhibitors B. Indirect thrombin inhibitors C. Vitamin K antagonists D. Factor Xa inhibitors

The answer is C. Warfarin (Coumadin) is an anticoagulant that belongs to the Vitamin K antagonists.

A patient with diabetes and hypertension is being discharged home. The patient will be taking Sotalol and insulin per sliding scale. Which statement by the patient demonstrates they did NOT understand your discharge instructions about the side effects of Sotalol? A. "This medication can affect my blood glucose levels." B. "I will monitor my heart rate and blood pressure everyday while taking this medication." C. "While taking this medication I will monitor for a fast heart rate because this is an early indication that my blood glucose level is low." D. "I will report to my physician if I develop shortness of breath, weight gain, or swelling in my feet."

The answer is C. Beta blockers can prevent tachycardia (increased heart rate). An increased heart rate is a sign for most diabetics that they are experiencing a low blood glucose level. Therefore, the patient who is taking beta blocker (especially a nonselective type) needs to be re-educated that a fast heart rate is NOT a reliable way of determining hypoglycemia and should check their blood glucose regularly.

TRUE OR FALSE: If a patient's INR level falls too low, there is a risk of clot formation and the Warfarin (Coumadin) dose needs to be decreased. The answer is False. If a patient's INR level falls too low, there is a risk of clot formation and the Warfarin (Coumadin) dose needs to be INCREASED (not decreased). 11. What is the antidote for Warfarin (Coumadin)? A. Flumazenil B. Narcan C. Protamine Sulfate D. Vitamin K

The answer is D. Vitamin K is the antidote for Warfarin (Coumadin).

A patient has a dose of Spironolactone due at 1000. Which finding below would require the nurse to hold the dose and notify the physician for further orders? A. Magnesium 1.5 mg/dL B. BUN 18 C. Sodium 140 mEq/L D. Potassium 7 mEq/L

The answer is D. A normal potassium level is 3.5-5 mEq/L. Spironolactone can increase potassium levels because it's a potassium-sparing diuretic. Therefore, the nurse should hold the scheduled dose and notify the MD for further orders.

You're providing discharge teaching to a patient that will be taking an Angiotensin II Receptor Blocker (ARB) at home. What statement by the patient requires you to re-educate them about this medication? A."This medication does not cure hypertension. Therefore, I will need to also make lifestyle changes." B. "I will always stand and change positions slowly." C. "A persistent, dry cough is not common with this medication." D. "This medication can decrease potassium levels. So, I will consume a diet rich in potassium to help keep my level normal."

The answer is D. ARBs can cause a HIGH potassium level. Therefore, the patient should avoid consuming a diet rich in potassium and using salt-substitutes with potassium.

Your patient is started on a Heparin drip. You administer a bolus of Heparin and start the drip per protocol as ordered by the physician. What will be your next important nursing action? A. Collect a PT level in 6 hours per protocol. B. Collect an INR level in 4 hours per protocol. C. Collect a Troponin level in 6 hours per protocol. D. Collect an aPTT level in 6 hours per protocol.

The answer is D. An activated partial thromboplastin time (aPTT) is used to measure clotting time in patients who are on Heparin. It is important that the nurse collect an aPTT in 6 hours (some protocols may say 4 hours) after starting the drip. PT and INR are used to measure clotting times in patients who are taking Warfarin (Coumadin). Troponin levels are used in cardiac patients to detect a myocardial infarction.

Which statement below BEST describes how Heparin works as an anticoagulant? A. "It inhibits clotting factors from synthesizing Vitamin K." B. "It inactivates the extrinsic pathways of coagulation." C. "It prevents Factor Xa from activating prothrombin to fibrinogen." D. "It enhances the activation of antihrombin III, which prevents the activation of thrombin and the conversion of fibrinogen to fibrin."

The answer is D. Heparin enhances the activation of antihrombin III, which prevents the activation of thrombin and the conversion of fibrinogen to fibrin. Therefore, this medication INDIRECTLY inhibits thrombin via antithrombin III.

The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic causes diuresis by MAINLY affecting what structure in the nephron? A. Distal convoluted tubule B. Descending limb of the loop of Henle C. Proximal convoluted tubule D. Ascending limb of the loop of Henle

The answer is D. Loop diuretics affect the loop of Henle, specifically the ASCENDING limb (the thick part of this limb).

A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is your next nursing action per protocol? A. Continue with the infusion because no change is needed based on this aPTT. B. Increase the drip rate per protocol because the aPTT is too low. C. Re-draw the aPTT STAT. D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.

The answer is D. The aPTT is 105 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.

An infant is ordered a scheduled dose of Digoxin. The patient's apical pulse rate is 78 bpm. The nurse would: A. Administer the dose as ordered B. Hold the dose and reassess the apical pulse rate in 1 hour C. Skip this dose but administer the next scheduled dose D. Hold the dose and notify the physician

The answer is D. The nurse should hold a dose of Digoxin and notify the physician if the INFANT'S heart rate is less than 90-110 bpm.

You're providing discharge instructions to a patient who will be taking a loop diuretic at home. Which statement by the patient demonstrates they did NOT understand the teaching material and requires that you reinforce some of the teaching points? A. "I will eat a diet rich in potatoes, bananas, avocadoes, strawberries, and spinach." B. "I will weight myself daily and report to my physician if I gain more than 3 lbs in 1 day." C. "I will change position slowly because I can become dizzy easily while taking this medication." D. "This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of fluid per day."

The answer is D. The patient should be educated on the signs and symptoms of dehydration (excessive thirst, fatigue, hypotension etc.). However, they should not be taught to consume 2L or more of fluid per day. Many patients are prescribed loop diuretics to treat issues with fluid volume overload (example heart failure). These patients must monitor how much fluid they are drinking. If too much fluid is consumed this will cancel out the effectiveness of the medication.

Your patient, who is 55-years-old, is prescribed to take Digoxin. What patient finding requires that the nurse hold the dose of Digoxin and notify the physician? A. Digoxin level of 1.2 ng/mL B. Blood glucose 82 C. Heart rate 61 bpm D. Potassium 2.8 mEq/L

The answer is D. The patient's potassium level is low (<3.5 mEq/L). Remember hypokalemia increases the chances of Digoxin toxicity developing. The nurse should notify the MD and hold the ordered dose until further instructions are given by the doctor.

Which statement below BEST describes how Warfarin (Coumadin) works as an anticoagulant? A. "It inhibits the formation of thrombin and fibrin in the clotting process." B. "It increases the production of Factor Xa, which blocks thrombin and decreases the clotting process." C. "It binds to antithrombin and reverses the clotting process." D. "It stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form."

The answer is D. Warfarin (Coumadin) stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form. This is why this drug is part of the Vitamin K antagonist family.

Digoxin is part of what family of drugs? A. Angiotensin-converting enzyme inhibitors B. Beta-blockers C. Angiotensin II receptor blockers D. Cardiac glycosides

The answer is D: cardiac glycosides

True or False: Thiazide diuretics are more potent than loop diuretics and provide immediate diuresis affects.

The answer is FALSE. Thiazide diuretics are NOT more potent than loop diuretics and do not provide immediate diuresis affects like loop diuretics. Loop diuretics inhibit sodium reabsorption in the loop of Henle, which is responsible for about 25% of sodium reabsorption....whereas, thiazide diuretics inhibit sodium reabsorption in the early part of the distal convoluted tubule, which is responsible for about 5-7% of sodium reabsorption. Therefore, the higher percentage of sodium reabsorption inhibited the stronger the effects, which makes loop diuretics more potent.

TRUE or FALSE: Potassium-sparing diuretics are the most effective type of diuretic and are often combined with loop or thiazide diuretics.

The answer is FALSE. Potassium-sparing diuretics are the WEAKEST (not most effective) type of diuretic. However, yes, they are often combined with loop or thiazide diuretics to help prevent HYPOkalemia, which is a common side effect of loop and thiazide diuretics.

Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply: A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II. C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I. D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart.

The answers are A and B. ACE inhibitors inhibits the renin-angiotensin-aldosterone system (RAAS), which will prevent the conversion of Angiotensin I to Angiotensin II. Options C and D are false statements about these medications.

Your patient on Heparin develops Heparin-Induced Thrombocytopenia (HIT). What signs and symptoms in the patient confirm this diagnosis? Select all that apply: A. Decrease in platelet level B. Increase in platelet level C. Development of a new thrombus D. Increase in hemoglobin level

The answers are A and C. HIT is where the body makes antibodies against Heparin because it's binding to platelet factor 4 (a blood protein). This creates antibodies that will bind to the heparin and PF4 complex, which activate the platelets. Small clots will form (hence new clots or worsening of clots) and the platelet count falls...hence thrombocytopenia.

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply: A. A 55-year-old male patient who is post-op day 1 from brain surgery. B. A 45-year-old female patient with a pulmonary embolism. C. A 36-year-old male patient with active peptic ulcer disease. D. A 43-year-old female with uncontrolled atrial fibrillation.

The answers are A and C. These patients are both at risk for major bleeding if placed on an anticoagulant due to their condition (one patient is post-op from brain surgery and the other patient has ulcers that could bleed). Option B and D are candidates from Heparin therapy because the patient in option B has a blood clot (Heparin can prevent it from getting bigger and developing new blood clots), and the patient in option D is at risk for developing a blood clot.

Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply: A. Inactivates bradykinin by breaking it down B. Dilates vessels C. Causes the kidneys to keep sodium and water D. Converts Angiotensin I to Angiotensin II

The answers are A and D. ACE inactivates bradykinin by breaking it down and converts Angiotensin I to Angiotensin II. Option C describes the role of aldosterone, which is influenced by Angiotensin II, and option D describes how ACE Inhibitors work....remember they block the actions of ACE.

A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply: A. The patient reports seeing yellow-greenish halos and is vomiting. B. The patient reports flushing and has enlargement of the gums. C. The patient's heart rate is regular and 80 beats per minute. D. The patient's Digoxin level is 3 ng/mL

The answers are A and D. Calcium channel blockers can increase Digoxin level. Therefore, the patient's Digoxin levels should be monitored closely. A normal Digoxin level is 0.5-2 ng/mL. Signs and symptoms of Digoxin Toxicity is nausea, vomiting, vision changes (seeing yellowish/green halos, blurred vision etc. Option B is an expected side effect from calcium channel blockers and option C is normal.

You're educating a patient's family member about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the family member require you to re-educate them about how this medication works? Select all that apply: A. "This medication will help dissolve the blood clot." B. "This medication will prevent another blood clot from forming." C. "This medication will help prevent the blood clot from becoming bigger in size." D. "This medication starts working immediately after the first dose."

The answers are A and D. Warfarin (Coumadin) does NOT dissolve blood clots. It prevents blood clots from forming, and if one is present, it will help prevent it from becoming bigger. If the blood clot becomes bigger it may break off and travel in blood circulation. This can lead to a pulmonary embolism, heart attack, or stroke. Warfarin (Coumadin) does NOT start working immediately. It takes about 3-5 days of scheduled doses to start achieving a therapeutic INR level. It is very common that a patient will be on Heparin while taking Warfarin until INR levels are therapeutic.

A patient is on a continuous IV Heparin drip. As the nurse you are monitoring for any adverse reactions. Select all the signs and symptoms that would indicate this patient is having an adverse reaction to this medication: A. Hematuria B. Decreasing platelets C. Increased blood glucose D. Low hemoglobin and hematocrit E. Positive stool guaiac test

The answers are A, B, D and E. Hematuria, low hbg/hct and positive stool guaiac test all indicate the patient is bleeding. A decrease in platelet level could indicate the patient is developing Heparin-induced thrombocytopenia, which is also an adverse reaction to Heparin.

Your patient was started on Warfarin (Coumadin) a week ago for the treatment of a DVT. Which findings below would indicate an adverse reaction to this medication? Select all that apply: A. Patient reports a severe and sudden headache B. Melena C. Chvostek's Sign D. Hematuria E. Coffee ground emesis F. Bleeding gums

The answers are A, B, D, E, and F. An adverse reaction would be associated with bleeding. Patients who take Warfarin should be monitored for signs and symptoms that bleeding is occurring internally. Example would be: sudden/severe headache (represents intracranial bleed), melena (dark, tarry stools...represent blood), hematuria (urine reddish or pink), coffee ground emesis (bleeding in the stomach), or bleeding gums....along with tachycardia, hypotension, nosebleeds, or bruising for no reason. Chvostek's Sign is associated with a low calcium level (hypocalcemia).

You're providing discharge teaching to a patient who will be taking Amiloride. Which items below should the patient limit in their diet? Select all that apply: A. Salt-substitutes B. Spinach C. Bananas D. Rice E. Cheese

The answers are A, B, and C. All of these items are high in potassium. Amiloride is a potassium-sparing diuretic that can increase the blood levels of potassium. Therefore, the patient should limit these items.

Which patients below may be prescribed a loop diuretic based on their diagnosis? Select all that apply: A. A 58-year-old male with congestive heart failure. B. A 69-year-old female with pulmonary edema. C. A 45-year-old male with hypercalcemia. D. A 50-year-old male experiencing a gout attack.

The answers are A, B, and C. Option D is not a candidate for loop diuretics because these medications can increase uric acid levels, which is already an issue for this patient with a gout attack (remember gout occurs due to increase uric acids levels). Loop diuretics help remove extra fluid from the blood. This is helpful for patients with heart failure and pulmonary edema. Loop diuretics also decrease calcium reabsorption (hence causing the calcium to be excreted rather than staying in the blood), and this would help treat a high calcium level (hypercalcemia).

Select all the TRUE statements about the medication Heparin: A. Heparin can be used during pregnancy. B. Heparin has a short half-life. C. Heparin works to affect the intrinsic pathways of clotting. D. Heparin can be administered orally, intravenously, or subcutaneously.

The answers are A, B, and C. The option that is wrong is D. Heparin can NOT be administered orally....only subq or IV.

A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply: A. Decreases SVR (systemic vascular resistance) and blood pressure B. Constriction of the vessels C. Kidneys will excrete water and sodium D. Kidneys will retain potassium. E. Increases SVR (systemic vascular resistance) and blood pressure

The answers are A, C, and D. ACE inhibitors will cause the opposite effects of Angiotensin II, which is a major vasoconstrictor and triggers the release of aldosterone (remember this substance will cause the kidneys to keep sodium and water and excrete potassium). However, ACE Inhibitors will perform the opposite effects by decreasing the blood pressure via vasodilation of vessels (which decreases SVR) and causes the kidneys to excrete water and sodium and retain potassium (hence the nurse must monitor for hyperkalemia).

What conditions are Angiotensin II Receptor Blockers (ARBs) used to treat? Select all that apply: A. Hypertension B. Renal stenosis C. Diabetic nephropathy in type 2 diabetics D. Atrial flutter E. Heart failure

The answers are A, C, and E. ARBs can treat hypertension, diabetic nephropathy in type 2 diabetics (which is kidney disease in type 2 diabetics), and heart failure.

You're developing a plan of care for a patient with fluid volume overload related to heart failure exacerbation. The physician has prescribed an IV loop diuretic. What nursing interventions will you include in the patient's plan of care? Select all that apply: A. Perform and assess daily weights. B. Educate the patient about consuming a low potassium diet. C. Strict measuring of the patient's daily intake and output. D. Encourage the patient to drink 2 L of fluids per day. E. Assess lung sounds every shift.

The answers are A, C, and E. The patient with heart failure exacerbation can experience fluid volume overload because the heart is failing to pump blood forward. This causes blood to backflow into the lungs causing pulmonary edema and respiratory distress. In addition, it can cause edema in the extremities. A loop diuretic will help remove this extra fluid by altering the way the kidneys reabsorb sodium and water. Due to the way loop diuretic works by removing extra fluid, the nurse should monitor the patient for dehydration, effectiveness of the medication (decrease in edema, clear lung fields), electrolyte imbalances, and measuring intake and output. Therefore daily weights, measuring I and O's, and assessing lungs sounds are the answers. Option B is not the answer because the patient should be consuming a diet with potassium (loop diuretics can decrease the potassium level). Option D is wrong because this is too much fluid for a patient to consume with heart failure. This medication would be unable to do its job if the patient consumed 2L of fluid per day...it would not be effective.

A patient is prescribed Verapamil for treatment of a supraventricular arrhythmia. As the nurse you know that this calcium channel blocker will help control the heart rate and rhythm by causing which of the following changes in the heart? Select all that apply: A. Negative inotropic effect B. Positive inotropic effect C. Negative chronotropic effect D. Positive chronotropic effect E. Negative dromotropic effect F. Positive dromotropic effect

The answers are A, C, and E. Verapamil is a calcium channel blocker that is a non-dihydropyridine (phenylalkylamine). It decreases the contractility of the heart muscle cells, which decreases the strength of heart contractions, and this causes a NEGATIVE inotropic effect. In addition, Verapamil decreases the contraction of nodal tissue cells, specifically the SA and AV nodal tissue. Therefore, by decreasing the SA node (pacemaker of the heart), the heart rate will decrease, and this causes a NEGATIVE chronotropic effect. And by decreasing the AV node (gatekeeper), the speed of conduction will decrease, which will cause a NEGATIVE dromotropic effect.

Select all the pharmacodynamic effects of angiotensin II receptor blockers (ARBs): A. Vasodilation B. Vasoconstriction C. Sodium conservation D. Sodium excretion E. Water conservation F. Water excretion

The answers are A, D, and F. ARBs prevent Angiotensin II Type I Receptors from binding with Angiotension II. This leads to vasodilation of vessels and decreases the release of aldosterone, which leads to sodium and water excretion (potassium is conserved...so watch out for hyperkalemia).

You're developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient's plan of care? Select all that apply: A. Encourage the patient to limit the consumption of bananas, avocadoes, spinach, strawberries, and potatoes. B. Measure the patient's intake and output daily. C. Weigh the patient daily using a bedside scale. D. Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia.

The answers are B and C. Option A is wrong because the nurse should encourage the patient to consume (NOT limit) these foods because they are high in potassium. Remember thiazide diuretics waste potassium. Option D is wrong because these medications can cause electrolyte imbalances like hypercalcemia and HYPOkalemia (NOT hyperkalemia). Options B and C are correct because these medication increase urination (hence they cause fluid depletion)...therefore, the nurse must monitor the patient's fluid status.

Based on your nursing knowledge of how thiazide diuretics work, which patients below would benefit from these types of medications? Select all that apply: A. A patient with a glomerular filtration rate (GFR) of less than 30 cc/hr. B. A patient with a recurrent history of renal calcium calculi. C. A patient with primary hypertension. D. A patient with heart failure and frequent gout attacks. E. A patient with diabetes that has uncontrolled hyperglycemia.

The answers are B and C. Why? Option B: thiazide diuretics help INCREASE reabsorption of calcium into the blood (hence causes hypercalcemia)...therefore it removes it from the urine and can help prevent renal calculi that are composed of calcium. Option C: thiazide diuretics help remove extra fluid volume in the blood and this can decrease blood pressure. Thiazides are not for patients who have a decrease in renal function (example GFR of less than 30 cc/hr), gout attacks (they can cause an increase in uric acid levels), and uncontrolled hyperglycemia (they increase blood glucose levels).

Which potassium-sparing diuretics are known to antagonize aldosterone in order to cause diuresis? Select all that apply: A. Triamterene B. Spironolactone C. Amiloride D. Eplerenone

The answers are B and D. Spironolactone and Eplerenone are types of potassium-sparing diuretics that are known as the aldosterone antagnoists or aldosterone receptor blockers. These medications work against aldosterone (hence the name aldosterone "antagnoists"). Aldosterone normally works to influence epithelial sodium channels and the sodium-potassium pumps in the distal tubule and collecting duct by increasing this number. This leads to the reabsorption of sodium into the bloodstream from the filtrate and secretion of potassium into the filtrate from the blood. However, when this is inhibited (due to these medications) sodium is NOT reabsorbed back into the blood and potassium is NOT secreted into the filtrate but stays in the blood (hence this can lead to HYPERkalemia). Triamterene and Amiloride are potassium-sparing diuretics, BUT they work to inhibit the epithelial sodium channels, which causes the same affects as the aldosterone antagonists but in a different way.

You're providing discharge teaching to a patient who will be going home on Warfarin (Coumadin). Which statements by the patient demonstrate they understood the educational material provided? Select all that apply: A. "I will switch and use a hard bristle toothbrush." B. "When I shave I will be sure to use an electric razor." C. "I will be sure that I eat a diet rich in spinach, kale, and broccoli." D. "I will avoid drinking any alcoholic beverages."

The answers are B and D. A patient should use a SOFT bristle toothbrush rather than a hard bristle to prevent damaging the gums (this can lead to bleeding). Also, the patient should maintain a normal diet, but avoid consuming excessive amounts of green leafy vegetables (like spinach, kale, broccoli, lettuce etc.) because this can alter how the medication works. The patient should AVOID alcoholic beverages and use electric razors.

A patient is prescribed Diltiazem for the treatment of a cardiac disorder. Which findings below would require the nurse to hold the ordered dose of Diltiazem and notify the physician for further orders? Select all that apply: A. Blood pressure 198/102 B. EKG shows 3rd Degree Atrioventricular Block C. EKG shows Atrial Fibrillation with Rapid Ventricular Response D. Heart Rate 46 beats per minute

The answers are B and D. Diltiazem is a calcium channel blocker that helps treat arrhythmias (supraventricular tachycardia and atrial fibrillation), hypertension, and angina. It is contraindicated if bradycardia or 2nd/3rd AV blocks occur. This is because this medication decreases the function of the SA and AV nodes (which is advantageous if a-fib with rapid ventricular response is occurring). However, if a 2nd degree AV block is presenting or bradycardia, the SA and AV nodes are not working properly and this medication could further impede their function.

Potassium-sparing diuretics alter how sodium is reabsorbed in what part of the nephron? Select all that apply: A. Loop of Henle B. Proximal Convoluted Tubule C. Distal Convoluted Tubule D. Collecting Duct E. Thick ascending limb of the loop of Henle

The answers are C and D. Potassium-sparing diuretics work in the distal parts of the nephron (the late part of the distal tubule and collecting duct) to alter the sodium and potassium exchange within the nephron.

You're providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply: A. "If I feel unwell, it is okay that I miss a dose." B. "I will avoid using salt substitutes that contain potassium." C. "I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication". D. "I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor."

The answers are B and D. It is very important a patient does not miss a dose of this medication (even if they are unwell) because this medication can cause rebound hypertension. Also, the patient should avoid salt substitutes with potassium and AVOID consuming foods high in potassium (like the foods in option C) because this medication causes the kidneys to retain potassium. The patient should monitor their blood pressure and pulse rate regularly and report any significant changes to their doctor.

Which type of calcium channel blockers below are considered non-dihydropyridines and can provide anti-arrhythmic effects? Select all that apply: A. Nifedipine B. Diltiazem C. Amlodipine D. Verapamil

The answers are B and D. Verapamil and Diltiazem are calcium channel blockers that are non-dihydropyridine. They are more selective to the myocardium when compared to dihydropyridine (Nifedipine and Amlodipine), which are more selective to the vascular system. Therefore, non-dihydropyridines can provide anti-arrhythmic effects.

Select all the beta blocker medications listed below that affect ONLY beta 1 receptors: A. Timolol B. Atenolol C. Metoprolol D. Esmolol

The answers are B, C, D. Atenolol, Metoprolol, and Esmolol are selective and affect ONLY beta 1 receptors, which are found in the heart and kidneys. Timolol is a nonselective beta blocker and affects both beta 1 and beta 2 receptors.

Beta 2 receptors can be found in the? Select all that apply: A. Heart B. Lungs C. GI system D. Kidneys E. Vascular smooth muscle F. Skeletal muscle

The answers are B, C, E, and F. Beta 2 receptors can be found in the lungs (bronchioles), GI system, vascular smooth muscle, skeletal muscle and even the ciliary body of the eye (not listed).

Your patient will be started on a thiazide diuretic to help manage blood pressure. Select all the medications below that are considered a type of thiazide diuretic: A. Furosemide B. Indapamine C. Hydrochlorothiazide D. Spironolactone E. Metolazone F. Chlorothiazide

The answers are B, C, E, and F. Option A is a loop diuretic, and option D is a potassium-sparing diuretic.

What conditions below are potassium-sparing diuretics ordered to treat? Select all that apply: A. Edema due to renal failure B. Hyperaldosteronism C. Hypertension D. Hypokalemia secondary to loop or thiazide diuretic usage

The answers are B, C, and D. Potassium-sparing diuretics are NOT for patients who have renal failure (therefore, option A is wrong). Yes, they treat edema/swelling due to heart failure, liver impairment, or nephrotic syndrome, but are contraindicated in patients with renal failure. However, potassium-sparing diuretics help treat hyperaldosteronism (specifically Spironolactone). Hyperaldosteronism is where the body produces too much aldosterone, which leads to low potassium levels, high sodium levels, and hypertension. Spironolactone will antagonize the aldosterone and decrease it. Many times potassium-sparing diuretics are ordered with loop or thiazide diuretics to treat hypertension. In addition, since potassium-sparing diuretics increase the blood level of potassium, they may be ordered for patients who are experiencing hypokalemia while taking diuretics that waste potassium (loop or thiazide diuretics).

Your patient is prescribed a calcium channel blocker. As the nurse you know that these medication works to block calcium channels in what areas of the body? Select all that apply: A. Vagal nerve cells B. Vascular smooth muscle C. Cardiac nodal tissue D. Peripheral nervous cells E. Cardiac myocytes

The answers are B, C, and E. Calcium channel blockers work to block the L-type calcium channels in the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue. When the calcium channels of these areas are blocked they will decrease contraction of these cells, which will provide vasodilation, decrease in heart rate, and decrease in strength of heart contractions. Remember there are different types of calcium channel blockers, and some are more selective to the vascular smooth muscle, while some are more selective to the myocardium.

Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply: A. Verapamil B. Felodipine C. Nifedipine D. Diltiazem E. Amlodipine

The answers are B, C, and E. Remember the "dipine" medications are known as the dihydropyridines, and they are more vascular selective. This is why they are great at treating hypertension because they cause vasodilation due to inhibiting the calcium channels in the vascular smooth muscle. This leads to the relaxation of these vessels and in turn decreases arterial blood pressure.

What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic? Select all that apply: A. Hyperkalemia B. Hypocalcemia C. Hypernatremia D. Hypokalemia E. Hypomagnesemia

The answers are B, D, and E. Loop diuretics can cause hypokalemia, hyponatremia, and hypomagnesemia.

What EARLY signs and symptoms should the nurse assess for in a patient taking Digoxin that could indicate toxicity of this drug? Select all that apply: A. Dysrhythmias B. Anorexia C. Drowsiness D. Nausea E. Vomiting

The answers are B, D, and E. GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.

What signs and symptoms below would demonstrate a patient is experiencing an overdose of a beta blocker medication? Select all that apply: A. Blood pressure 200/110 B. Heart rate 35 beats per minute C. EKG shows atrial fibrillation with rapid ventricular rate (RVR) D. Patient is maniac and agitated E. Dyspnea F. Patient is severely drowsy G. EKG shows 3rd degree AV block

The answers are B, E, F, and G. Signs and symptoms of beta blocker overdose would be the opposite of the effects of the sympathetic nervous system. Beta blockers slow down the heart rate (overdose: severe bradycardia...heart rate of 35 and heart block 2nd or 3rd degree), decrease blood pressure (overdose: severe hypotension), and severely drowsy (due to very slow heart rate and decreased cardiac output to the brain).

Select all the medications below that are considered loop diuretics: A. Chlorothiazide B. Bumetanide C. Triamterene D. Spironolactone E. Furosemide F. Torsemide G. Hydrochlorothiazide

The answers are B, E, and F. Options A and G are thiazide diuretics, and Options C and D are potassium-sparing diuretics.

An adult patient is being discharged home on Digoxin. Which statements below verbalized by the patient demonstrates they understand how to properly take this medication? Select all that apply: A. "I will limit by intake of foods high in potassium." B. "I will not take this medication and notify the physician if my heart rate is less than 70 bpm." C. "I will measure my pulse rate before every dose I take." D. "It is important that I immediately report any vision changes I may experience while taking this medication."

The answers are C and D. The patient should always measure their pulse rate before taking each dose of Digoxin and hold the dose if it is less than 60 bpm (this is for adults). The patient should not restrict foods high in potassium because this could lead to hypokalemia, which can lead to Digoxin toxicity. Vision changes should be reported because this could indicate Digoxin toxicity.

Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply: A. Hyperkalemia B. Persistent, dry cough C. Swelling in the face D. Thin and shiny skin in the lower extremities E. Difficulty breathing

The answers are C and E. Angioedema is swelling deep in the skin (dermis and subcutaneous tissue).....it's very dangerous! Signs and symptoms include: swelling in face (mouth, eyes, tongue, lips, dyspnea, swelling of extremities). It most commonly occurs in African American patients.

Beta 1 receptors can be found in the? Select all that apply: A. GI tract B. Uterus C. Heart D. Lungs E. Kidneys F. Vascular smooth muscle

The answers are C and E. Beta 1 receptors can be found in the HEART and KIDNEYS.

A 55-year-old-male with hypertension is prescribed a thiazide diuretic. The patient has a health history of diabetes type I and gout. What lab results below represent some known side effects of this medication and requires the nurse to report the lab results to the physician? Select all that apply: A. Potassium 5.2 mEq/L B. Calcium 9 mg/L C. Blood glucose 300 mg/dL D. Ammonia 20 mcg/dL E. Uric acid level 15 mg/dL F. Blood glucose 45 mg/dL

The answers are C and E. Thiazide diuretics can cause an increase in blood glucose (hyperglycemia), hyperuricemia (high uric acid levels...this increases a gout attack), hypokalemia (low potassium levels), and hypercalcemia (high calcium levels). Due to the patient's health history of diabetes and gout, the nurse should monitor the patient's glucose and uric acid levels. A normal blood glucose level is about 70-100 mg/dL, and a normal uric acid level varies for female and males...with anything greater than 7 for males or 6 for female being considered high. Therefore, the patient's uric acid level of 15 mg/dL and glucose of 300 mg/dL is abnormal and should be reported.

Which patients below are NOT candidates for Warfarin (Coumadin)? Select all that apply: A. A 45-year-old male patient with alcoholism and an active GI ulcer. B. A 55-year-old female with a heart valve replacement. C. A 36-year-old female with a deep vein thrombosis. D. A 52-year-old male who needs a liver transplant.

The answers are: A and D... Option A is NOT a candidate because active ulcer disease places the patient at risk for bleeding while taking Warfarin (Coumadin). In addition, patients should NOT drink alcohol while taking Warfarin (Coumadin) because it majorly affects how the drug works. Option D is NOT a candidate because of the liver disease. Warfarin affects the liver's clotting factors. Option B and D would benefit because both are at risk for a blood clots (especially option B). While Option C already has a blood clot, Warfarin (Coumadin) would help prevent it from becoming larger and new clots from forming.

Digoxin helps the heart pump more efficiently by altering the inotropic, chronotropic, and dromotropic actions of the heart. Select all the options below that accurately describe these actions created by Digoxin: a. Positive Chronotropic b. Positive Inotropic c. Negative Inotropic d. Negative Dromotropic e. Negative Chrontropic f. Positive Dromotropic

The answers are: B, D, and E. Digoxin creates a positive inotropic, negative chronotropic, and negative dromotropic action on the heart. This helps the heart's contraction to be stronger while it pumps at a slower rate. Therefore, the heart will empty more efficiently (less back flow of blood) and this will increase stroke volume, which will increase cardiac output.

Warfarin (Coumadin) affects the formation of certain clotting factors. Select below ALL the clotting factors this medication affects: A. I B. V C. II D. VII E. XI F. X G. IX

The answers are: C, D, F, and G. Warfarin (Coumadin) affects FOUR clotting factors that require vitamin K to form. These clotting factors are: 2, 7, 9, and 10 (II, VII, IX, X)