pharm quiz 2

A patient is in the emergency department with a new onset of rapid-rate atrial flutter, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia? A. diltiazem (Cardizem) B. atenolol (Tenormin) C. lidocaine D. adenosine (Adenocard)

A. diltiazem (Cardizem)

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

B. never abruptly stop taking the medication

When administering nitroprusside (Nipride) intravenously, the nurse would monitor for which sign of toxicity? (Select all that apply.) A) Abdominal pain B) Diaphoresis C) Fever D) Muscle twitching E) Hypertension

A) Abdominal pain B) Diaphoresis D) Muscle twitching

For which potential side effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.) Bluish skin discoloration Hyperglycemia Hypothyroidism Photosensitivity

A) Bluish skin discoloration C) Hypothyroidism D) Photosensitivity Potential side effects from amiodarone include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, decreased libido, hepatitis, pulmonary toxicity

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."

A. "After I stop taking this medication I will let my physician know." 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.

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.

A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS). B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II.

Which of the following patient-teaching instructions is appropriate for a patient taking an antidysrhythmic drug? Select all that apply. A. "Do not chew or crush extended-release forms of medication. "B. "Take the medication with food if gastrointestinal distress occurs." C. "If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken." D. "Take the medications with an antacid if gastrointestinal distress occurs." E. "Limit or avoid the use of caffeine." F. "The presence of a capsule in the stool should be reported to the physician immediately."

A. "Do not chew or crush extended-release forms of medication." B. "Take the medication with food if gastrointestinal distress occurs." E. "Limit or avoid the use of caffeine."

. 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."

A. "I use an inhaler at home for asthma."

. 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)."

A. "They prevent Angiotensin II Type I Receptors from binding with Angiotensin II."

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.

A. A 50-year-old female with systolic dysfunction heart failure. 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 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 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

A. Decreases SVR (systemic vascular resistance) and blood pressure C. Kidneys will excrete water and sodium D. Kidneys will retain potassium. 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).

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

A. Furosemide 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 and hypomagnesemia also increases Digoxin toxicity.

. 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

A. Hypertension C. Diabetic nephropathy in type 2 diabetics E. Heart failure

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

A. Negative inotropic effect C. Negative chronotropic effect E. Negative 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.

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.

A. The patient reports seeing yellow-greenish halos and is vomiting. 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.

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

A. Vasodilation D. Sodium excretion F. Water excretion

The nurse needs to administer adenosine to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember? A. The onset of action occurs in 5 minutes. B. The medication must be given as a slow intravenous (IV) push. C.Asystole may occur for a few seconds after administration .D.The medication has a long half-life, and therefore duration of action is very long.

ANS: C Adenosine has an extremely short half-life of less than 10 seconds; its onset occurs within 1 minute; and it must be given as a fast IV push injection. In addition, a very brief episode of asystole may occur after administration.

When starting a patient on antidysrhythmic therapy, the nurse should remember that which problem is a potential adverse effect of any antidysrhythmic drug? A. Deficiency of fat-soluble vitamins B. Hyperkalemia C. Heart failure D. Dysrhythmias

ANS: D Many antidysrhythmics are themselves capable of producing new dysrhythmias (the prodysrhythmic effect). The other options are not adverse effects of antidysrhythmic drugs.

10. 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."

B. "I will avoid using salt substitutes that contain potassium." 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.

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."

B. "I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice."

. 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."

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

A patient has hypertension along with type I diabetes mellitus and proteinuria. The nurse anticipates that a drug from which drug class will be ordered for its renal-protective effects? A. Beta-blockers B. ACE inhibitors C. Diuretics D. Calcium channel blockers

B. ACE inhibitors (non-prodrugs captopril and lisinpril) doesn't need to be turn into an active form in the liver. (protect the kidneys by reducing the GFR pressure and the number one choice with cardiovascular and diabetes)

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.

B. Anorexia 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

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

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.

Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? A. Measure urine output and specific gravity. B. Check apical pulse and blood pressure .C. Evaluate peripheral pulses and level of consciousness. D. Obtain temperature and pulse oximetry on room air.

B. Check apical pulse and blood pressure

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

B. Diltiazem 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.

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

B. EKG shows 3rd Degree Atrioventricular Block 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.

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

B. Felodipine C. Nifedipine 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 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

B. Heart rate 35 beats per minute E. Dyspnea F. Patient is severely drowsy G. EKG shows 3rd degree AV block

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

B. High in fiber

2. 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

B. Losartan

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

B. Lungs C. GI system 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).

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

B. Positive Inotropic D. Negative Dromotropic E. Negative Chrontropic 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.

9. 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.

B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop 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.

Which of the following nursing diagnoses is appropriate for a patient receiving antidysrhythmics? A. Risk for infection B. Risk for injury C. Deficient fluid volume D. Urinary retention

B. Risk for injury

A patient will be discharged on quinidine sulfate extended-release tablets for the treatment of ventricular ectopy. The nurse will include which instruction in the teaching plan? A. Stop the medication once the cardiac symptoms subside. B. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur. C. Sunscreen products should be used when outside because of increased photosensitivity. D. Any tablet or capsule visible in the stool indicates an absorption problem and should be reported immediately.

B. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur.

A patient is taking an ACE Inhibitor and Spironolactone. It is a 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

B. To limit foods high in potassium 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 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

B. Vascular smooth muscle C. Cardiac nodal tissue E. Cardiac myocytes

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."

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."

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."

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.

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."

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." 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.

7. 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.

C. EKG shows tall, peaked t-waves.

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

C. Heart E. Kidneys

The nurse understands adenosine (Adenocard) is used to treat which condition? A. Atrial fibrillation B. Second-degree atrioventricular block C. Paroxysmal supraventricular tachycardia (PSVT) D. Atrial flutter

C. Paroxysmal supraventricular tachycardia (PSVT)

8. 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

C. Swelling in the face 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 the face (mouth, eyes, tongue, lips, dyspnea, swelling of extremities). It most commonly occurs in African American patients.

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.

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.

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

C. norepinephrine and epinephrine; sympathetic nervous system

4. 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)

C. vasoconstriction; aldosterone

Sodium channel blockers are considered which class of antiarrhythmic drugs? Class I Class II Class III Class IV

Class I

Carvedilol (Coreg) is classified as a A) beta-blocking drug .B) alpha1-blocking drug .C) Dual action alpha1 and beta-receptor blocker. D) Calcium channel blocker.

Dual-action alpha1 and beta receptor blocker.(Carvedilol blocks both the alpha1 and beta receptors of the adrenergic nervous system.

The nurse would monitor for reflex tachycardia in a patient receiving which classification of antihypertensive drugs? A) Calcium channel blockers B) Cardioselective beta-blockers C) Nonselective beta-blockers D) Direct-acting vasodilators

D) Direct-acting vasodilators HYDRALAZINE (APRESOLINE), minoxidil

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."

D. "This medication can decrease potassium levels. So, I will consume a diet rich in potassium to help keep my level normal."

Which drug class is used to treat both hypertension and antidysrhythmias? A. Direct-acting vasodilators B. Alpha-adrenergic-blocking C. Sodium channel blockers D. Calcium channel blockers

D. Calcium channel blockers

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

D. Cardiac glycosides

Calcium channel blockers have which pharmacodynamic effect? A. Positive chronotropic B. Shortened refractory period C. Positive inotropic D. Coronary vasodilation

D. Coronary vasodilation

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

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.

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

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.

The nurse would question an order for a calcium channel blocking drug in a patient with which condition? A) Angina pectoris B) Increased intracranial pressure C) Hypotension D) Dysrhythmia

Hypotension (Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.)

Adenosine is used to treat which condition? Atrial fibrillation Atrial flutter Paroxysmal supraventricular tachycardia (PSVT) Second-degree atrioventricular block

Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT.

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

Potassium 6.8 mEq/L

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.

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.

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.

Which would be a priority assessment prior to administering eplerenone (Inspra) which is an aldosterone blocker? A) Serum electrolytes B) Level of consciousness C) Patient's knowledge level D) Thiocyanate levels

Serum electrolytes Eplerenone (Inspra) is contraindicated in patients with an elevated serum potassium level (greater than 5.5 mEq/L) or severe renal impairment, Therefore, it is imperative that the nurse assess the patient's most recent serum electrolytes before administering this medication.)

select all that apply: adverse effects of quanidine, a sodium channel blocker? headache diarrhea cinchonism constipation hypertension cardiotoxicity arterial embolism tachycardia

headache diarrhea cinchonism cardiotoxicity arterial embolism

most common cause of digoxin toxicity

hypokalemia

The nurse monitors the patient taking digoxin and furosemide (Lasix) for which of these complications? Seizures Hypertension Hyperreflexia Ventricular dysrhythmias

Ventricular dysrhythmias Digoxin is used to treat heart failure and cardiac dysrhythmias. In the presence of a low potassium level, the risk of serious digoxin-induced toxicity (ventricular dysrhythmias) is greatly increased. Because high-ceiling diuretics promote potassium loss, use of these drugs in combination with digoxin can increase the risk of dysrhythmias. The potassium level should be checked routinely, and when indicated, a potassium supplement or a potassium-sparing diuretic should be given.

the nurse is switching from an ace inhibitor to ARNI, what should she /he be sure to do?

allow 36-hour washout period to avoid angioedema

which medication should the nurse choose to treat patient with class II-IV heart failure? ACE inhibitor ARBS diuretics angiotensin receptor neprilysin inhibitor (entresto)

angiotensin receptor neprilysin inhibitor (entresto)

To prevent the occurrence of cinchonism in a patient prescribed quinidine, the nurse emphasizes the importance of wearing sunscreen. changing positions slowly .avoiding ingestion of antacids. increasing dietary intake of potassium.

avoiding ingestion of antacids. Cinchonism can result from concurrent use of antacids and quinidine secondary to blocked renal excretion of the quinidine.

When giving adenosine, it is important to remember to give it as a fast intravenous push. give it as a slow intravenous push over 5 minutes. offer it with food or milk. prepare to set up for an intravenous drip infusion.

give it as a fast intravenous push.

when are potassium channel blockers such as amiodarone used?

life threatening arrythmias that have not responded to other therapies such as recurrent ventricular fib and recurrent unstable ventricular tachycardia

Which would the nurse question if ordered concurrently with ACE inhibitors? A) furosemide (Lasix) B) morphine C) Colace D) potassium

potassium ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium.)

ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by A) preventing the formation of angiotensin II. B) enhancing sodium and water resorption. C) increasing the breakdown of bradykinin. D) preventing aldosterone secretion.

preventing aldosterone secretion(ACE inhibitors block the formation of angiotensin II, whereas angiotensin receptor blockers allow the formation of angiotensin II but block its effect at the receptors. Without the receptors stimulated (because of either drug), aldosterone is not produced, diminishing the reabsorption of sodium and water.)

Amiodarone toxicity is evidenced in which body system? Renal Hepatic Pulmonary Hematologic

pulmonary

digoxin is considered a

second line drug; benefits limited to symptom relief