Practice Questions: Cardiovascular Drugs

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

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

Cholestyramine has been prescribed for a patient. Which instruction should the nurse include in patient teaching? a. Cholestyramine can impair absorption of fat-soluble vitamins. b. Stop taking the drug if you develop constipation. c. Take cholestyramine with other drugs you are prescribed to enhance absorption. d. Do not take the medication if the formula is cloudy after mixing with water.

a. Cholestyramine can impair absorption of fat-soluble vitamins. Cholestyramine is a bile acid sequestrant. Cholestyramine can impair absorption of fat-soluble vitamins (A, D, E, and K); vitamin supplements may be required. Cholestyramine causes constipation; patients should be informed that constipation can be minimized by increasing dietary fiber and fluids. A mild laxative may be used if needed. Instruct patients taking cholestyramine or colestipol to notify the prescriber if constipation becomes bothersome, in which case a switch to colesevelam should be considered. Cholestyramine can bind with other drugs and prevent their absorption. Advise patients to administer other medications 1 hour before or 4 hours after cholestyramine. Cholestyramine powder should be mixed with water, fruit juice, soup, or pulpy fruit (for example, applesauce, crushed pineapple) to reduce the risk of esophageal irritation and impaction. Inform patients that the sequestrants are not water soluble, therefore the mixtures will be cloudy suspensions, not clear solutions.

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

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

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

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

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

b. "I should report any muscle weakness or nausea." Digoxin toxicity manifests with dysrhythmias, bradycardia, muscles weakness, anorexia, nausea, vomiting, fatigue, and visual disturbances.

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

b. Furosemide [Lasix] and propranolol [Inderal] Minoxidil may cause adverse responses (for example, reflex tachycardia, expansion of blood volume, pericardial effusion). Minoxidil should be used with a beta blocker (for example, propranolol) plus intensive diuretic therapy (for example, furosemide).

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

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

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

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

The nurse will teach a patient who is prescribed niacin [Niacor] to prevent flushing of the face by doing what? a. Drinking a full glass of water after taking the medication b. Taking 325 mg of aspirin 30 minutes before each dose c. Ingesting a meal before taking the medication d. Increasing dietary fiber before and after each dose

b. Taking 325 mg of aspirin 30 minutes before each dose Aspirin reduces flushing by preventing the synthesis of prostaglandins, which mediate the flushing response.

A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time? a. With any meal b. With the evening meal c. 1 hour before breakfast d. 2 hours after a meal

b. With the evening meal Lovastatin should be taken with the evening meal to increase absorption. Cholesterol synthesis normally increases during the night; statins are most effective when given in the evening.

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

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

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

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

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

d. A 32-year-old patient with blood pressure of 142/94 mm Hg who is sedentary Stages 1 and 2 hypertension should be treated with both lifestyle changes and drug therapy to control blood pressure.

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

d. A patient with a hypertensive crisis in the intensive care unit Sodium nitroprusside is used to treat hypertensive emergencies. The medication is administered intravenously, with continuous monitoring of blood pressure.