Exam 2 Pharmacology (Cardiac Medications)
Adrenergic receptor that relieves severe pain A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2
B. Alpha 2
It is a nursing priority to report which of these laboratory test results, if identified in a patient who is prescribed metoprolol (Lopressor), to the prescriber? A. Creatinine 1.2 mg/dL B. Ejection fraction on echocardiogram of 20% C. Hemoglobin A1c (glycosylated hemoglobin) 5.5% D. Sinus rhythm on electrocardiogram (ECG)
B. Ejection fraction on echocardiogram of 20%
ACE inhibitors play only a minor role in the management of heart failure. They have not been studied in this disease process and the benefits do not seem to play a significant role. True False
False. ACE inhibitors are a cornerstone of HF therapy and have been widely studied in their benefits by inhibiting the RAAS. ACE inhibitors improve functional status and prolong life for the HF patient.
A patient is receiving methyldopa 250 mg twice a day. Vital signs are BP 170/90 mm Hg, P 92, and R 20. The nurse is reviewing new laboratory test results, which include ALT 35 international units/L, creatinine 0.8 mg/dL, BUN 20 mg/dL, Coombs' test positive, sodium 145 mEq/L, and potassium 4.8 mEq/L. The nurse should do what? A. Administer the medication and continue to as- sess the patient. B. Administer the medication and notify the pre- scriber of the vital signs and laboratory results. C. Hold the medication and notify the prescriber of the vital signs and laboratory results. D. Hold the medication and page the prescriber STAT.
A. Administer the medication and continue to as- sess the patient.
ACE inhibitors play only a minor role in the management of heart failure. They have not been studied in this disease process and the benefits do not seem to play a significant role. True False
False. ACE inhibitors are a cornerstone of HF therapy and have been widely studied in their benefits by inhibiting the RAAS. ACE inhibitors improve functional status and prolong life for the HF patient.
The generic names of beta1 and beta2 receptor antagonists share what common suffix? A. -azole B. -lol C. -osin D. -sartan
A. -azole
It would be a priority to teach orthostatic BP precautions to which patient receiving a diuretic? A. 142/90 mm Hg lying and 110/68 sitting B. 140/82 mmHg lying and 125/78 sitting C. 126/80 mm HG lying and 120/72 sitting D. 130/90 mm Hg lying and 118/88 mmHg sitting
A. 142/90 mm Hg lying and 110/68 sitting Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position
The nurse takes orthostatic BP readings before administering diuretics to a group of patients. It would be a priority to teach orthostatic BP precau- tions to a patient with which orthostatic blood pressure readings? A. 150/90 mm Hg lying; 125/70 mm Hg sitting B. 140/82 mm Hg lying; 125/72 mm Hg sitting C. 130/90 mm Hg lying; 118/78 mm Hg sitting D. 116/70 mm Hg lying; 110/68 mm Hg sitting
A. 150/90 mm Hg lying; 125/70 mm Hg sitting
Which one of the following inhibits receptors at angiotensin-converting enzyme (ACE) and increases levels of bradykinin? A. ACE inhibitor B. ARB C. DRI D. Calcium channel blocker
A. ACE inhibitors inhibits receptors at the angiotensin-converting enzyme (ACE) stopping the conversion of angiotensin I to angiotensin II and increases levels of bradykinin.
It is a priority for the nurse to evaluate which laboratory test result before administering alfuzosin (Uroxatral) to a patient? A. AST/ALT B. BUN/creatinine C. FBS/A1c D. Na+/K+
A. AST/ALT
Which of these conditions, if identified in the history of a patient receiving a drug classified as a first-generation beta blocker, would be a concern to the nurse? (Select all that apply.) A. AV heart block B. COPD C. Depression D. Diabetes mellitus E. Severe allergic reaction to bee stings
A. AV heart block B. COPD C. Depression D. Diabetes mellitus E. Severe allergic reaction to bee stings
Which drug works highest on the RAAS cascade? A. Aliskiren (Tekturna) B. Lisinopril (Zestril) C. Losartan (Cozaar)
A. Aliskiren (Tekturna)
Adrenergic receptor that causes vasoconstriction A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2
A. Alpha 1
Which food is a good source of potassium when a patient is prescribed a potassium-wasting diuretic? (Select all that apply.) A. Baked potato B. Cantaloupe C. Pork D. Raisins E. Spinach
A. Baked potato B. Cantaloupe D. Raisins E. Spinach
A patient is receiving methyldopa. Which laboratory tests should be monitored throughout therapy? (Select all that apply.) A. Bilirubin and Coombs' test B. Hematocrit and hemoglobin C. Potassium and sodium D. Self-metered blood glucose and A1c E. Troponin T and electrocardiogram
A. Bilirubin and Coombs' test B. Hematocrit and hemoglobin
A patient in chronic renal failure has been retain- ing fluid despite dialysis. Which diuretic would the nurse expect to administer? A. Bumetanide B. Hydrochlorothiazide (Oretic, HydroDIURIL) C. Metolazone (Zaroxolyn) D. Spironolactone (Aldactone)
A. Bumetanide
Which laboratory test results should the nurse monitor when a patient is prescribed a high-ceiling diuretic? (Select all that apply.) A. Electrolytes B. Glucose C. LDL/HDL D. Uric acid E. WBC
A. Electrolytes B. Glucose C. LDL/HDL D. Uric acid
Which drug is frequently given IV over 1-2 min? A. Furosemide B. Clonidine C. Lorazepam D. Methyldopa
A. Furosemide
Potassium loss can be significant and often needs to be repleted to avoid cardiac arrhythmia. A. Furosemide (Lasix) B. DHP Ca channel blocker C. Metoprolol (Lopressor) D. Clonidine (Catapres)
A. Furosemide (Lasix)
The nurse knows there are several sites of action for antihypertensive drugs. Which drug classes work to lower the blood pressure by working at the renal tubules? (Select all that apply) A. High ceiling loop diuretics B. Thiazide diurectics C. Calcium channel blockers D. Potassium sparing diuretics E. Vascular Alpha1 inhibitors
A. High ceiling loop diuretics B. Thiazide diurectics D. Potassium sparing diuretics
Which over the counter medication can counteract the effects of diuretics and is important to teach the patient to avoid the long term use of this drug? A. Ibuprofen (NSAID) B. Fexofenadine (antihistamine) C. Multivitamin D. Loratadine (antihistamine)
A. Ibuprofen NSAIDS blunt the effects of diurectic effects, especially with long term use.
Prominent symptoms of heart failure include: (Select all that apply) A. Jugular vein distension B. Fatigue C. Orthopnea D. Peripheral edema E. Weight gain from fluid retention F. Dermatitis G. Shortness of breath when walking to the bathroom H. Headache I. Faint peripheral pulses
A. Jugular vein distension B. Fatigue C. Orthopnea D. Peripheral edema E. Weight gain from fluid retention G. Shortness of breath when walking to the bathroom
Which antihypertensive agents are not good for renal impairment? A. Potassium sparing diuretics B. Ace Inhibitor - Lisinopril/Zestril C. ARB - Losartan/Cozaar D. Macrolide - Doxycycline/Doxy
A. Potassium sparing diuretics
A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and contact the prescriber if which assessment finding is present? A. Pulse 50 beats/min B. BP 150/85 mm Hg C. Constipation C. Dizziness with position changes
A. Pulse 50 beats/min
There are major goals in therapy with Stage C heart failure. They include: Select all that apply, A. Retarding progression of cardiac remodeling and LV dysfunction B. Improvement of functional status and quality of life C. Palliative care and end of life care and comfort D. Prolongation of life E. Relief of pulmonary and peripheral congestion F. Correcting all damage to the heart
A. Retarding progression of cardiac remodeling and LV dysfunction B. Improvement of functional status and quality of life D. Prolongation of life E. Relief of pulmonary and peripheral congestion
Benefits of lowering the blood pressure from hypertension include: (Select all that apply) A. Risk of heart failure is reduced B. Reduces risk of breast cancer C. Life is prolonged D. Stroke incidence is reduced E. Morbidity is decreased
A. Risk of heart failure is reduced C. Life is prolonged D. Stroke incidence is reduced E. Morbidity is decreased
This drug prolongs survival of heart failure patients by blocking aldosterone receptors and preventing heart remodeling, heart and vascular fibrosis, baroreceptor dysfunction, and dysrhythmias, in addition to mild reduction in blood volume by increasing excretion of water and sodium with conservation of potassium. A. Spironolactone (Aldosterone receptor antagonist) B. Valsartan (Angiotensin receptor blockers - ARB) C. Metoprolol (Beta adrenergic receptor blockers) D. Hydrochlorothiazide HCTZ (Thiazide diurectic)
A. Spironolactone (Aldosterone receptor antagonist) is a potassium sparing diuretic so it excretes water and sodium but retains potassium.
The resident writes an order for IV nitroprusside 80 mcg/min. What precautions should the nurse take while administering this medication? Use good clinical judgement. (Select all that apply.) A. The nurse should keep the patient supine to avoid dizziness and postural hypotension B. The nurse should monitor the blood pressure every 4 hours C. The nurse should monitor the heart rate continuously and the blood pressure every 4-8 hours D. The nurse should monitor the patient and his blood pressure continuously E. The nurse should use an IV pump for safety so the pump will deliver a consistent dose.
A. The nurse should keep the patient supine to avoid dizziness and postural hypotension D. The nurse should monitor the patient and his blood pressure continuously E. The nurse should use an IV pump for safety so the pump will deliver a consistent dose.
Does the adverse effect of cough from ACE inhibition occur right away? A. Usually, but it can occur later in treatment B. It usually happens after years of use C. D/t histamine, the cough usually occurs in the first 1-2 days of treatment
A. Usually, but it can occur later in treatment
Which Calcium channel blocker (CCB) works better on the cardiac mylocyte? A) Verapamil (Non DHP) B) Nifedipine (DHP)
A. Verapamil (Non-DHP) works better on the cardiac mylocyte as it also affects the SA and AV nodes.
Which population does the research indicate that Digoxin may be hazardous to the patient's health? A. Women B. Aftrican American C. Elders D. Caucasian
A. Women It is not completely understood but use of Digoxin in women did show a significant increase in mortality. It may have to do with toxic levels of digoxin.
Elevation of B-natriuretic peptide (BNP) suggests HF because BNP is released when the: A. heart's chambers stretch B. heart does not get enough oxygen C. heart beats faster D. heart muscle thickens
A. heart's chambers stretch
The nurse is teaching a 56-year-old truck driver about taking clonidine. It is very important to explain that the patient should take the medication in what way? A. As two doses 12 hours apart B. With a larger dose at bedtime C. With food D. On an empty stomach
B. With a larger dose at bedtime
Of the drugs that target the RAAS cascade, which one has the adverse effect of a cough? A. Spirolactone B. ACE inhibitor C. ARB
B. ACE inhibitor
Which ethnic population of patients most benefits from a fixed dose of hydralazine and isosorbide (BiDil) for the use in heart failure? A. Hispanic B. African American C. Asian D. Mediterranean
B. African American
What assessment finding would warrant withholding a beta blocker and consulting the prescriber? A. Apical pulse 48 beats/min B. BP 110/70 mm Hg C. 2+ ankle edema D. Capillary blood sugar 90 mg/dL
B. BP 110/70 mm Hg
This drug slows the heart rate, reduces the force of contraction, improves left ventricle ejection fractions, increases exercise tolerance, and prolongs survival by slowing the progression of HF. A. Sympathomimetic drugs (dobutamine) B. Beta adrenergic receptor blockers - beta blockers (Metoprolol) C. Vasodilator (Hydralazine) D. Potassium sparing diurectic (triameterene)
B. Beta adrenergic receptor blockers - beta blockers (Metoprolol) Beta blockers act to slow down the heart rate, reduces the force of contraction, improves left ventricle ejection fractions, increases exercise tolerance, and prolongs survival by slowing the progression of HF.
The drug vasodilates the arteries which can cause reflex tachycardia with fast acting formulations. A. Furosemide (Lasix) B. DHP Ca channel blocker C. Metoprolol (Lopressor) D. Clonidine (Catapres)
B. DHP Ca channel blocker
Direct-acting adrenergic drugs mimic the action of what? (Select all that apply.) A. Acetylcholine (ACh) B. Dopamine C. Epinephrine (epi) D. Norepinephrine (NE)
B. Dopamine C. Epinephrine (epi) D. Norepinephrine (NE)
The nurse is teaching a patient who has been prescribed clonidine for hypertension. Which statement suggests a need for additional teaching? A. Effects like drowsiness should get better after I take the drug for several weeks." B. I should stop taking the drug if I experience weird dreams." C. I should inform all of my health care providers that I am taking this drug." D. Increasing fiber and fluid in my diet can de- crease the risk of constipation.
B. I should stop taking the drug if I experience weird dreams."
A patient has just been prescribed prazosin (Minipress). Which statement from the patient would indicate a need for further teaching? A. I should avoid driving and other hazardous activities for 12-24 hours after I first take this medication or have a dose increase. B. I should take the medication first thing in the morning. C. I should sit on the edge of the bed for a few minutes before standing up when I get up in the morning. D. I should be sitting or lying 30-60 minutes after I take the first dose of this medication.
B. I should take the medication first thing in the morning.
Which over-the-counter medication can counteract the effects of diuretics? A. Acetaminophen B. Ibuprofen C. Iron D. Multiple vitamins
B. Ibuprofen
The following are true of the mechanism of action of digoxin. Select all that apply. A. It blocks beta adrenergic receptors and slows the heart rate and reduces the force of contraction. B. It indirectly decreases aldosterone production resulting less vasoconstriction C. t prolongs survival of HF patients by blocking aldosterone receptors and preventing remodeling. D. It increases myocardial contractility by inhibiting sodium, potassium-ATPase E. It exerts a positive inotropic action on the heart F. It promotes calcium accumulation within the myocytes which augments contractile force.
B. It indirectly decreases aldosterone production resulting less vasoconstriction D. It increases myocardial contractility by inhibiting sodium, potassium-ATPase E. It exerts a positive inotropic action on the heart F. It promotes calcium accumulation within the myocytes which augments contractile force.
ACE is chemically the same as the enzyme kinase II, which stimulates the breakdown of bradykinin. A patient may experience which adverse effect from taking an ACE inhibitor, reflecting accumulation of bradykinin? A. Hyponatremia B. Nagging dry cough C. Skin rash to the torso D. Hyperkalemia
B. Nagging dry cough from increased Bradykinin in the lungs
A possible explanation for why digoxin has not demonstrated an improvement in mortality is that the drug does not: A. increase cardiac output B. improve heart remodeling C. increase urine production D. decrease heart rate
B. improve heart remodeling
The generic names of alpha 1 receptor antagonists share what common suffix? A. -azole B. -lol C. -osin D. -sartan
C. -osin
Because of the risk of hyperkalemia, the nurse consults the prescriber and monitors potassium levels if a patient is prescribed spironolactone and a drug with which suffix? (Select all that apply.) A. -floxacin B. -olol C. -pril D. -sartan E. -statin
C. -pril D. -sartan
Because of the risk of hyperkalemia, the nurse consults the prescriber and monitors potassium levels if a patient was prescribed spironolactone and which other drug? A. Cephalosporin (Keflex) B. HMG-CoA statin agent (Simvastatin) C. Ace inhibitor (Lisinopril) D. Beta blocker agent (propranolol)
C. Ace inhibitor (Lisinopril) Use of potassium sparing diuretics with ACE inhibitors (drugs with suffix -pril), can rise the potassium level and cause abnormal heart rhythms.
Adrenergic receptor that causes increases force of myocardial contraction A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2
C. Beta 1
A patient with left-sided HF has been prescribed a high-ceiling diuretic. Which assessment most accurately reflects a therapeutic effect of this drug? A. Drop in systolic blood pressure of 10 mm Hg B. Normal heart sounds C. Clear lung sounds D. Pulse 80 and regular
C. Clear lung sounds
Which of these new assessment findings, if identified 1 hour after administering metoprolol (Lopressor), would be a priority to report to the prescriber? A. Drop in apical pulse from 80 to 65 beats/min B. Warm, flushed, dry skin C. Crackles throughout lung fields D. Headache
C. Crackles throughout lung fields
What findings in a patient with HF would warrant that the nurse not administer digoxin and notify the prescriber? A. Blood pressure 100/76 mm Hg B. Potassium 5.3 mEq/L C. Digoxin 2.4 ng/mL D. Heart rate 100 beats/minute
C. Digoxin 2.4 ng/mL
A patient with coronary artery disease is receiving terazosin for hypertension. It would be a priority for the nurse to report to the prescriber which effect of the drug? A. Drop of 15 mm Hg in systolic BP with position changes B. Headache C. Increase in pulse of 20 beats/min D. Nasal congestion
C. Increase in pulse of 20 beats/min Terazosin can cause orthostatic hypotension [a drop in SBP of .20mmHg} and reflex tachycardia [increased heart rate in response to stimulus conveyed through the cardiac nerves
A patient who has been diagnosed with HF and type 2 diabetes mellitus (T2DM) has been prescribed furosemide (Lasix) 20 mg by mouth once a day. Based on the effect of furosemide on the patient's T2DM, it is important for the nurse to assess this patient for which symptoms? A. Irritability, paresthesias, and muscle weakness B. Diaphoresis, shakiness, and tachycardia C. Increased thirst; confusion; and dry, hot skin D. Nausea, vomiting, and diarrhea
C. Increased thirst; confusion; and dry, hot skin
A 48 year old black male with a history of type 2 diabetes mellitus comes to the emergency department with a frontal headache and generalized complaints of "not feeling well." Upon examination, his BP is 210/120 mm Hg, his pulse is 98, and his respirations are 24 and labored. When is it important to lower this patient's BP within 1 hour rather than slowly as for most hypertensive patients? A. When the nurse is busiest and has multiple patients and this will help to move the patient to the medical surgical unit faster. B. When the patient has had chronic hypertension for > 3 months C. Lowering BP within 1 hour is necessary when associated with organ damage, such as papilledema, intracranial hemorrhage, myocardial infarction, or heart failure. D. When the patient's BP drops > 20 mmHg upon standing.
C. Lowering BP within 1 hour is necessary when associated with organ damage, such as papilledema, intracranial hemorrhage, myocardial infarction, or heart failure.
We will teach you to take your pulse avoid it becoming too low. A. Furosemide (Lasix) B. DHP Ca channel blocker C. Metoprolol (Lopressor) D. Clonidine (Catapres)
C. Metoprolol (Lopressor)
A patient has been prescribed furosemide (Lasix). Which symptom is a priority for the nurse to monitor that suggests possible excessive loss of potassium? A. Hunger and fatigue B. 4+ deep tendon reflexes C. Muscle weakness and cramping D. Tall, tented T waves on ECG
C. Muscle weakness and cramping are symptoms associated with hypokalemia.
A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as: A) Unstable angina B) Variant angina C) Stable angina D) Prinzmetal angina
C. Stable angina is predictable.
It would be a priority to withhold clonidine and report which laboratory test result? A. ALT 55 IU/L B. Creatinine 1.4 mg/dL C. hCG 900 IU/mL D. WBC 10,500/mm3
C. hCG 900 IU/mL Clonidine is not recommended for pregnant women because of possible fetal harm.
Adrenergic receptor that promotes bronchodilation A. Alpha 1 B. Alpha 2 C. Beta 1 D. Beta 2
D. Beta 2
Do not stop taking the drug without prescriber's directions due to rebound hypertension that can put you at risk for a stroke. A. Furosemide (Lasix) B. DHP Ca channel blocker C. Metoprolol (Lopressor) D. Clonidine (Catapres)
D. Clonidine (Catapres)
Which drug has biggest potential to cause toxicities of other drugs (IE: Digoxin)? A. Spironolactone B. Lisinopril C. Nifedipine D. Furosemide
D. Furosemide LOOP DIURETICS since they diuresis aggressively which is why they are used in CHF.
This drug is effective when kidney function is impaired, reduces blood volume, can cause hypokalemia, and increase the risk of digoxin toxicity when both are prescribed. A. Angiotensin-converting enzyme inhibitor - ACEI (Captopril) B. Beta adrenergic receptor blockers (Metoprolol) C. Cardiac glycoside (Digoxin) D. High ceiling loop diuretics (Furosemide)
D. High ceiling loop diuretics (Furosemide) Loop diuretics (Furosemide) are effective when kidney function is impaired, reduces blood volume, can cause hypokalemia, and increase the risk of digoxin toxicity when both are prescribed.
Which agent should be avoided in a person with a history of gout? A. Doxazosin B. Clonidine C. Methyldopa D. Hydochlorothiazide
D. Hydochlorothiazide
The patient has improved significantly. The prescriber orders hydralazine, metoprolol, and hydrochlorothiazide on a long-term basis to control her blood pressure. The instructor asks the student to explain the rationale for this combination of medications. Which explanation is correct? A. Hydralazine works on the RAAS to reduce edema. Metoprolol is a calcium channel blocker used to control heart rate. Hydrochlorothiazide is an aterial vasodilator to treat her resistant hypertension. B. Hydralazine is a calcium channel blocker used to control heart rate. Metoprolol is an arterial vasodilator to treat dizziness. Hydrochlorothiazide is a diuretic prescribed to treat her hypertension. C. Hydralazine works by causing sedation which reduces the patients anxiety. Metoprolol is a diuretic which treats the fluid retension. Hydrochlorothiazide is a beta blocker that slows the heart rate to avoid tachycardia. D. Hydralazine is an arterial vasodilator to treat her resistant hypertension. Metoprolol is a beta blocker that slows the heart rate and is prescribed to treat the adverse effect of reflex tachycardia. Hydrochlorothiazide is a diuretic prescribed to treat the adverse effect of fluid retention.
D. Hydralazine is an arterial vasodilator to treat her resistant hypertension. Metoprolol is a beta blocker that slows the heart rate and is prescribed to treat the adverse effect of reflex tachycardia. Hydrochlorothiazide is a diuretic prescribed to treat the adverse effect of fluid retention.
A patient has been prescribed an ACE inhibitor and an Aldosterone antagonist daily. Recently she has been working to avoid salt to reduce her blood pressure further and decides to use a salt substitute. Which of these ECG findings would suggest hyperkalemia? A. Absent p wave B. Prolonged QT interval C. Prolonged QRS complex D. Peaked, tall T waves
D. Peaked, tall T waves
A patient who is prescribed an alpha1-adrenergic antagonist for high blood pressure is brought into the emergency department after taking sildenafil (Viagra) supplied by a friend. The priority for the nurse is to assess for and follow orders to prevent what effects? A. Atrial fibrillation and palpitations B. Migraine headache and photophobia C. Prolonged erection and discomfort D. Severe hypotension and vascular collapse
D. Severe hypotension and vascular collapse Sidlenafil when used in combination with alpha blockers, may cause a severe drop in blood pressure, lightheadedness, dizziness, or fainting.
Which drug is listed as a diuretic and as a RAAS system drug? A. Aliskiren (Tekturna) B. Lisinopril (Zestril) C. Losartan (Cozaar) D. Spironolactone (Aldactone)
D. Spironolactone (Aldactone)
What considerations do all of the RAAS drugs have in common? A. They all have the potential of causing hypoglycemia and are safe for pregnancy B. They all have the potential of causing hyperkalemia and have risks for pregnancy C. They all the potential to dehydrate patients and have risks for falls D. They all have the potential to worsen asthma symptoms and have risks for children
D. They all have the potential to worsen asthma symptoms and have risks for children
It is a priority for the nurse to monitor for excessive cardio suppression when a patient is prescribed metoprolol and what other drug? A. Atorvastatin (Lipitor) B. Hydrochlorothiazide (HydroDIURIL) C. Terazosin (Hytrin) D. Verapamil (Calan)
D. Verapamil (Calan) Combining a beta blocker with a CCB can produce excessive cardio suppression
The nurse is preparing to administer mannitol (Osmitrol) to a patient. The nurse notes crystals in a clear solution. What should the nurse do first? A. Administer the solution. B. Discard the solution. C. Use an inline filter. D. Warm the solution to dissolve the crystals.
D. Warm the solution to dissolve the crystals.
Which of these findings would be of most concern to the nurse if a patient is prescribed propranolol (Inderal)? A. Apical pulse 94 beats/min B. BP 157/88 mm Hg C. Urinary urgency D. Wheezing
D. Wheezing Blocking of beta receptors in the lung can cause bronchoconstriction
A patient who is prescribed valsartan (Diovan) does not mention that she is taking Yasmin, an oral contraceptive that contains the potassium-saving ingredient drospirenone. She is admitted to the ED with chest pain. Which ECG finding suggests that the combination of drugs is causing hyperkalemia? a. Prolonged ST interval b. Tall, tented T waves c. Depressed ST segments d. Extra P waves
b. Tall, tented T waves
The nurse recognizes that the generic names of ACE inhibitor drugs end in which suffix? a. -mycin b. -olol c. -pril d. -sartan
c. -pril
Direct Renin Inhibitors (Tekturna/Aliskiren) have a significant role in reducing the symptoms of heart failure and are approved for this therapeutic use True False
False, Tekturna is only approved for hypertension use.
Direct Renin Inhibitors (Tekturna/Aliskiren) have a significant role in reducing the symptoms of heart failure and are approved for this therapeutic use. True False
False, Tekturna is only approved for hypertension use.
What would not stimulate renin release by the kidneys? a. Dehydration b. Hemorrhage c. Hypernatremia d. Stimulation of beta1-adrenergic receptors
c. Hypernatremia
A 78 year old patient is seen in the emergency department in hypertensive crisis. She is 5 feet and 2 inches tall and weighs 125 pounds. Her BP is 230/130 mm Hg and she is very edematous. She has a history of alcohol abuse. IV nitroprusside sodium at 0.3 mcg/kg/min is prescribed. The nurse assess the solution to be sure it is not deeply colored blue, green, or dark red. The nurse knows that a faint brown color to freshly prepared solutions is acceptable. The drug is administered in a large vein using an infusion pump while protecting the solution from light with aluminum foil covering. The patient suddenly becomes diaphoretic and complains of nausea, palpitations, and headache. What should the nurse do? The nurse should check a radial pulse and a BP. If the BP has dropped more than 30 mm Hg in 2 minutes, continue the infusion and recheck in another 2 minutes. True False
False. Check the BP and notify the prescriber. If the BP has dropped more than 30 mm Hg in 2 minutes, stop the infusion.
Which symptoms suggest ototoxicity when a patient has been prescribed a high-ceiling diuretic? a. Photophobia b. Telangiectasia c. Tinnitus d. Xeroderma
c. Tinnitus
The nurse recognizes that the generic names of ARB drugs end in which suffix? a. -mycin b. -olol c. -pril d. -sartan
d. -sartan
When a patient is prescribed an ACE inhibitor, it is a priority to teach the patient not to take which OTC drug without consulting the prescriber? a. Antacids b. Cough suppressant c. Laxative d. NSAID
d. NSAID Aspirin, ibuprofen, and other NSAIDs may reduce the antihypertensive effects of ACE inhibitors.
The nurse is reviewing the lab values for a patient who has been prescribed lithium carbonate for bipolar disorder and furosemide for heart failure (HF). Which result would be a reason for concern? a. Chloride 100 mEq/L b. Magnesium 1.8 mEq/L c. Potassium 4.1 mEq/L d. Sodium 128 mEq/L
d. Sodium 128 mEq/L
A nurse understands how drugs that block the effects of angiotensin II can be beneficial for heart failure patients. What information would not be correct about ARBs? a. The drug improves cardiac function primarily by decreasing electrical conduction through cardiac tissue. b. The drug can help heart function by increasing excretion of sodium and water by the kidneys. c. The drug can decrease the formation of patho- logic changes in cardiac structure. d. The drug can help heart function by preventing pathologic changes to the structure and function of blood vessels.
a. The drug improves cardiac function primarily by decreasing electrical conduction through cardiac tissue.
A patient who has been taking an ACE inhibitor for hypertension is concerned because she has just discovered that she is 7 weeks pregnant. The nurse knows that research suggests that if the patient stops taking the ACE inhibitor now, the risk for adverse effects on the fetus is a. unknown. b. low. c. medium. d. high.
a. unknown.
A 20-year-old patient has been prescribed spironolactone (Aldactone) for primary polycystic ovary syndrome (POS). Developmentally, what would be a priority nursing diagnosis? a. Activity intolerance related to loss of sodium b. Altered body image related to hirsutism and deepening of the voice c. Decisional conflict related to treatment options d. Fluid volume excess related to excessive salt intake
b. Altered body image related to hirsutism and deepening of the voice
ARB drugs are similar to ACE inhibitors except that they are also associated with a decreased potential for which adverse effect? a. Cancer b. Cough c. Fetal harm d. Renal failure
b. Cough
According to the American College of Cardiology/American Heart Association, patients in Stage D have advanced structural heart disease and marked symptoms of HF at rest, despite treatment with maximal dosages of medications. An implantable left ventricle mechanical assist device can be used as a "bridge" in patients awaiting a transplant and to prolong life in those who are not transplant eligible. True False
True
Isosorbide dinitrate plus hydralazine are combined and used to treat heart failure. They are an alternative to ACE inhibitors or ARBs. True False
True
Isosorbide dinitrate plus hydralazine are combined and used to treat heart failure. They are an alternative to ACE inhibitors or ARBs. True False
True
Which adverse effect, reflecting accumulation of bradykinin, may a patient may experience from taking an ACE inhibitor? a. Dehydration b. Dry cough c. Hyperkalemia d. Hyponatremia
b. Dry cough
Do all diuretics have health risks for the diabetic? Yes No
Yes, caution should be taken when using diuretics in diabetics.
Do all diuretics have risks for K+ imbalance? Yes No
Yes, loop diuretics have most pronounced hypokalemia while K+ sparing diuretics have more risk for hyperkalemia
A patient who is prescribed an ACE inhibitor complains of tongue swelling and is experiencing obvious dyspnea. What is the priority action by the nurse? a. Administer prescribed PRN epinephrine b. Assess BP c. Assess lung sounds d. Consult the prescriber
a. Administer prescribed PRN epinephrine Angioedema is a potentially fatal reaction that devel- ops in up to 1% of patients. Symptoms, which result from increased capillary permeability, include giant wheals and edema of the tongue, glottis, and phar- ynx. Severe reactions should be treated with subcutaneous epinephrine.
When the nurse is scheduled to administer lisinopril to a patient, which laboratory values should be reviewed? (Select all that apply.) a. Creatinine b. Fasting blood sugar c. Sodium d. Potassium e. Uric acid
a. Creatinine c. Sodium d. Potassium e. Uric acid
It would be a priority to teach orthostatic BP precautions to a patient before the first dose of an ACE inhibitor if laboratory tests include which result? a. ALT 35 IU/L b. BUN 24 mg/dL c. Potassium 4.1 mEq/L d. Sodium 132 mg/dL
d. Sodium 132 mg/dL A precipitous drop in blood pressure may occur following the first dse of an ACE inhibitor. This reaction is caused by widespread vasodilation secondary to abrupt lowering of angiotensin II levels. First-dose hypotension is most likely in patients with severe hyperten- sion, in patients taking diuretics, and in patients who are sodium- depleted or volume-depleted.
Which of these ECG findings would suggest hy- perkalemia in a patient who is prescribed an ACE inhibitor and who was using a salt substitute? a. Flat T waves b. Prolonged QT interval c. Shortened QT interval d. Tall, peaked T waves
d. Tall, peaked T waves
What is the recommended diuretic for initial therapy of essential hypertension? a. High-ceiling diuretic b. Osmotic c. Potassium-sparing diuretic d. Thiazide
d. Thiazide
