PQ Ch 16/14 Diuretics
While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because: 1. Cimetidine is metabolized by the CYP 3A4 isoenzymes 2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels 3. Both 1 and 2 4. Neither 1 nor 2
. Both 1 and 2 1. Cimetidine (H2RA) is metabolized by the CYP 3A4 isoenzymes 2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true? 1. Both have major issues with a dry, irritating cough 2. Both contribute to some retention of potassium 3. ARBs have a stronger impact on hypertension control than ACE medications 4. ARBs have stronger diabetes mellitus renal protection properties than ACE medications
. Both contribute to some retention of potassium
Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: A. Increase renin secretion. B. Decrease the production of aldosterone. C. Deplete body sodium and reduce fluid volume. D. Decrease blood viscosity.
. Deplete body sodium and reduce fluid volume.
The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response? 1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism. 2. Amiodarone damages the thyroid gland and can result in inflammation of that gland, causing hyperthyroidism. 3. Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given. 4. Amiodarone can cause corneal deposits in up to 25% of patients.
1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: 1. Decreases the amount of calcium inside the cell 2. Reduces stroke volume 3. Increases the activity of the Na+/K+/ATPase pump indirectly 4. Decreases heart rate
1. Decreases the amount of calcium inside the cell
Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. 1. Older adults because of reduced renal function 2. Administration of aldosterone antagonist diuretics because of decreased potassium levels 3. Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin 4. Doses between 0.25 and 0.5 mg/day
1. Older adults because of reduced renal function
Many patients with hyperlipidemia are treated with more than one drug. Combining afibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. 1. Reductase inhibitors, due to an increased risk for rhabdomyolysis 2. Bile-acid sequestering resins, due to interference with folic acid absorption 3. Grapefruit juice, due to interference with metabolism 4. Niacin, due to decreased gemfibrozil activity
1. Reductase inhibitors, due to an increased risk for rhabdomyolysis
Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use? 1. Stable angina because it decreases the thickening of vascular walls due to decrease modified release. 2. Heart failure because it reduces remodeling of injured myocardial tissues. 3. Both 1 and 2 are true and the reasons are correct. 4. Both 1 and 2 are true but the reasons are wrong. 5. Neither 1 nor 2 are true
1. Stable angina because it decreases the thickening of vascular walls due to decrease modified release. 2. Heart failure because it reduces remodeling of injured myocardial tissues.
A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? 1. Swelling of the tongue or hoarseness are the most common symptoms. 2. It appears to be related to the decrease in aldosterone production. 3. Presence of a dry, hacky cough indicates a high risk for this adverse response. 4. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week.
1. Swelling of the tongue or hoarseness are the most common symptoms.
Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: 1. Within 6 hours of the last dose 2. Because a reference point is needed in adjusting a dose 3. After three half-lives from the starting of the drug 4. When a patient has stable renal function
2. Because a reference point is needed in adjusting a dose
Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug: 1. Blocks synthesis of cholesterol in the liver 2. Exchanges chloride ions for negatively charged acids in the bowel 3. Increases HDL levels the most among the classes 4. Blocks the lipoprotein lipase pathway
2. Exchanges chloride ions for negatively charged acids in the bowel
The choice of diuretic to use in treating hypertension is based on: 1. Presence of diabetes with loop diuretics being used for these patients 2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range 3. Ethnicity with aldosterone antagonists best for African Americans and older adults 4. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL
2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: 1. It is a long-acting drug with potential for toxicity. 2. Nitrate tolerance can develop. 3. Orthostatic hypotension is a common adverse effect. 4. It must be taken with milk or food
2. Nitrate tolerance can develop.
Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: 1. Widening of the area of infarction 2. Onset of congestive heart failure 3. An electrolyte imbalance involving potassium 4. Renal dysfunction
2. Onset of congestive heart failure
Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: 1. Hemoglobin 2. Serum potassium 3. Blood urea nitrogen 4. Serum glucose
2. Serum potassium
16: Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: 1. Hypokalemia 2. Impotence 3. Decreased renal function 4. Inability to concentrate
3. Decreased renal function
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: 1. Become a vegetarian because this disorder is associated with eating red meat. 2. Stop taking the drug if abdominal cramps and diarrhea develop. 3. Report muscle weakness or tenderness and dark urine to his provider immediately. 4. Expect "hot flash" sensations during the first 2 weeks of therapy.
3. Report muscle weakness or tenderness and dark urine to his provider immediately.
Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extendedrelease form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored? 1. Serum alanine aminotransferase 2. Serum amylase 3. Serum creatinine 4. Phenylketonuria
3. Serum creatinine
Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include: 1. White blood cell counts with the drug dosage increased for elevations above 10,000 feet 2. Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal 3. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL 4. Serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL
3. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT: 1. Notify your health-care provider immediately if you have visual change. 2. Monitor your own blood pressure and pulse daily. 3. Take a hot shower or bath if you feel dizzy. 4. Use a sunscreen on exposed body surfaces.
3. Take a hot shower or bath if you feel dizzy.
Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they: 1. Improve insulin sensitivity 2. Improve renal hemodynamics 3. Reduce the production of angiotensin II 4. All of the above
4. All of the above 1. Improve insulin sensitivity 2. Improve renal hemodynamics 3. Reduce the production of angiotensin II
Which of the following is true about procainamide and its dosing schedule? 1. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen. 2. Gastrointestinal adverse effects are common so the drug should be taken with food. 3. Adherence can be improved by using a sustained release formulation that can be given once daily. 4. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.
4. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.
Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? 1. Bradycardia 2. Hepatic impairment 3. Increased contractility 4. Edema of the hands and feet
4. Edema of the hands and feet
Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? 1. Reactive airway disease/asthma 2. Inflammatory bowel disease 3. Allergy to aspirin 4. Gallbladder disease
4. Gallbladder disease
Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor? 1. Elevated serum transaminase 2. Increased serum creatinine 3. Elevated creatinine kinase 4. Increased white blood cell counts
4. Increased white blood cell counts
Larry has heart failure, which is being treated with digoxin because it exhibits: 1. Negative inotropism 2. Positive chronotropism 3. Both 1 and 2 4. Neither 1 nor 2
4. Neither 1 nor 2 Positive inotropsim and Negative chronotropism (increases muscle contraction and decreases heart rate)
A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug? A. Decreased stroke volume B. Increased stroke volume C. Decreased myocardial contractility D. Increased myocardial contractility
A. Decreased stroke volume
Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual lab work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? A. Extend the dosage interval B. Decrease the dose by 75% C. Take no action since this value is expected in the older adult D. Schedule a serum creatinine level to validate the CrCl value
A. Extend the dosage interval
Bethanechol: A. Increases detrusor muscle tone to empty the bladder B. Decreases gastric acid secretion to treat peptic ulcer disease C. Stimulates voluntary muscle tone to improve strength D. Reduces bronchial airway constriction to treat asthma
A. Increases detrusor muscle tone to empty the bladder
John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: A. Not miss a dose or stop taking the drug because of potential rebound hypertension B. Increase fiber in the diet to treat any diarrhea that may occur C. Reduce fluid intake to less than 2 liters per day to prevent fluid retention D. Avoid sitting for long periods, as this can lead to deep vein thrombosis
A. Not miss a dose or stop taking the drug because of potential rebound hypertension
Beta blockers treat hypertension because they: A. Reduce peripheral resistance. B. Vasoconstrict coronary arteries. C. Reduce norepinephrine. D. Reduce angiotensin II production.
A. Reduce peripheral resistance.
A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response? A. Swelling of the tongue and hoarseness are the most common symptoms. B. It appears to be related to a decrease in aldosterone production. C. The presence of a dry, hacky cough indicates a high risk for this adverse response. D. Because it takes time to build up a blood level, it occurs after being on the drug for about one week
A. Swelling of the tongue and hoarseness are the most common symptoms.
Combined alpha-beta antagonists are used to reduce progression of heart failure because they: A. Vasodilate the peripheral vasculature B. Decrease cardiac output C. Increase renal vascular resistance D. Reduce atherosclerosis secondary to elevated serum lipoproteins
A. Vasodilate the peripheral vasculature
15. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss: a. adding a calcium channel blocker to this patient's drug regimen. b. lowering doses of the antihypertensive medications. c. ordering a high-potassium diet. d. adding spironolactone to the drug regimen.
ANS: A In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient's blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated.
13. Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions? a. Hydrochlorothiazide and nadolol b. Hydralazine and minoxidil c. Spironolactone and amiloride d. Trichlormethiazide and hydrochlorothiazide
ANS: A When two or more drugs are used to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are vasodilators. Spironolactone and amiloride are potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics.
17. The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug? a. Angiotensin-converting enzyme (ACE) inhibitor b. Hydralazine (Apresoline) c. Magnesium sulfate d. Sodium nitroprusside
ANS: B The drug of choice for lowering blood pressure in a patient with severe preeclampsia is hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of their potential for fetal harm.
. A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching? a. "I should continue following the DASH diet when adding this drug." b. "I should not take an ACE inhibitor when adding this drug." c. "I will need to take potassium supplements when adding this drug." d. "I will not experience a significant increase in diuresis when adding this drug."
ANS: C Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Patients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis.
11. A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her? a. Controlling her blood pressure will decrease her risk of preeclampsia. b. Ask the provider about changing to an ARB during pregnancy. c. Continue taking the ACE inhibitor during her pregnancy. d. Discuss using methyldopa instead while she is pregnant.
ANS: D Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.
Digoxin has a very limited role in the treatment of heart failure. It is used mainly for patients with: A. Ejection fractions above 40% B. An audible S3 C. Mitral stenosis as a primary cause for heart failure D. Renal insufficiency
B. An audible S3
How do beta-adrenergic blocking agents reduce myocardial oxygen demand? A. By inhibiting the stimulation of norepinephrine and epinephrine B. By increasing the production of dopamine and acetylcholine C. By delaying the destruction of acetylcholinesterase and cholinesterase D. By enhancing the sensitivity of alpha receptors and beta receptors
B. By increasing the production of dopamine and acetylcholine
Beta blockers are the drugs of choice for exertional angina because they: A. Improve myocardial oxygen supply by vasodilating the coronary arteries B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance C. Both A and B D. Neither A nor B
B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
Despite good blood pressure control, a nurse practitioner might change a patient's drug from an ACEI to an ARB because the ARB: A. Is stronger than the ACEI B. Does not produce a dry, hacky cough C. Has no effect on the renal system D. Reduces sodium and water retention
B. Does not produce a dry, hacky cough
Which of the following adverse effects are less likely in a beta1-selective blocker? A. Dysrhythmias B. Impaired insulin release C. Reflex orthostatic changes D. Decreased triglycerides and cholesterol
B. Impaired insulin release
Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? A. Donepezil B. Memantine C. Rivastigmine D. Galantamine
B. Memantine
Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: A. Increasing heart rate to improve cardiac output B. Reducing vascular smooth muscle tone C. Increasing aldosterone-mediated volume activity D. Reducing aqueous humor production
B. Reducing vascular smooth muscle tone
Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials include: A. Pregnancy B. Renal parenchymal disease C. Stable angina D. Dyslipidemia
B. Renal parenchymal disease
Clinical dosing of this drug (bethanechol): A. Begins at the highest effective dose to obtain a rapid response B. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved C. Requires dosing only once daily D. Is the same for both the oral and parenteral route
B. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved
Patients who have angina, regardless of class, who are also diabetic should be on: A. Nitrates B. Beta blockers C. ACE inhibitors D. Calcium channel blockers
C. ACE inhibitors
Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? A. White B. Asian C. African American D. Native American
C. African American
Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: A. Angina B. Coronary artery disease C. Both A and B D. Neither A nor B
C. Both A and B
Clonidine has several off-label uses, including: A. Alcohol and nicotine withdrawal B. Post-herpetic neuralgia C. Both A and B D. Neither A nor B
C. Both A and B
Patients at high risk for developing significant coronary heart disease are those with: A. LDL values between 100 and 130 B. Systolic blood pressure between 120 and 130 C. Class III angina D. Obesity
C. Class III angina
Phil is a fifty-four-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is 135 mg/dL, and his triglycerides are elevated. A reasonable change in therapy would be to: A. Discontinue the statin and change to a fibric acid derivative. B. Discontinue the statin and change to ezetimibe. C. Continue the statin and add in ezetimibe. D. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia.
C. Continue the statin and add in ezetimibe.
Ray has been diagnosed with hypertension, and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the nurse practitioner should assess for: A. Hypokalemia B. Impotence C. Decreased renal function D. Inability to concentrate
C. Decreased renal function
Adherence to beta blocker therapy may be affected by their: A. Short half-lives requiring BID dosing B. Tendency to elevate lipid levels C. Effects on the male genitalia, which may produce impotence D. None of the above
C. Effects on the male genitalia, which may produce impotence
First-line therapy for hyperlipidemia is: A. Statins B. Niacin C. Lifestyle changes D. Bile acid-binding resins
C. Lifestyle changes
A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG-CoA reductase inhibitor. What is the primary indication in using this medication? A. Reduce coronary vessel spasm B. Simplify oxygen requirements of the cardiac cells C. Lower cholesterol levels D. Dilate the coronary arteries
C. Lower cholesterol levels
Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: A. Heart failure B. Angina C. MI D. Dyslipidemia
C. MI
To reduce potential adverse effects, patients taking a peripherally acting alpha 1 antagonist should do all of the following EXCEPT: A. Take the dose at bedtime B. Sit up slowly and dangle their feet before standing C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 D. Weigh daily and report weight gain of greater than 2 pounds in one day
C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin? A. Warfarin sodium (Coumadin) B. Enoxaparin (Lovenox) C. Protamine sulfate D. Vitamin K
C. Protamine sulfate
How does propranolol (Inderal) control hypertension? A. Blocks alpha receptors throughout the body B. Increases the diuretic response in the renal tubules C. Reduces the sympathetic stimulation in cardiac muscle D. Inhibits the conversion of angiotensin I to angiotensin II
C. Reduces the sympathetic stimulation in cardiac muscle
Donald has been diagnosed with hyperlipidemia. On the basis of his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: A. Become a vegetarian since this disorder is associated with eating red meat B. Stop taking the drug if abdominal cramps and diarrhea develop C. Report muscle weakness or tenderness and dark urine to his provider immediately D. Expect "hot flash" sensations during the first two weeks of therapy
C. Report muscle weakness or tenderness and dark urine to his provider immediately
Taking which drug with food maximizes it bioavailability? A. Donepezil B. Galantamine C. Rivastigmine D. Memantine
C. Rivastigmine
A patient is taking enalapril (Vasotec). The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for: A. hypernatremia. B. hypertension. C. hyperkalemia. D. hypokalemia.
C. hyperkalemia.
(~ Different chapter) A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual's medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of: A. migraines. B. hypothyroidism. C. myopathy. D. heart failure
C. myopathy
Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis? a. Beta blockers b. Calcium channel blockers c. Ace inhibitors d. Diuretics
Calcium channel blockers
Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? A. Histamine 2 blockers B. Quinolones C. Serotonin re-uptake inhibitors D. All of the above
D. All of the above
Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: A. Symptoms markedly worsen or the patient becomes hypotensive and has syncope. B. There is evidence of progressive renal insufficiency or failure. C. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic. D. All the above options are correct.
D. All the above options are correct
Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: A. Symptoms are severe B. Patient has not responded to other therapies C. Patient has concurrent hypertension D. As soon as LV dysfunction is diagnosed
D. As soon as LV dysfunction is diagnosed
Jamie is a thirty-four-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? A. A statin B. Niacin C. A fibric acid derivative D. Bile acid-binding resins
D. Bile acid-binding resins
Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? A. Dizziness B. Increased heart rate C. Nervousness and shakiness D. Diaphoresis
D. Diaphoresis
Patients are taught to avoid which drug due to its antimuscarinic effects? A. Levothyroxine B. Prilosec C. Dulcolax D. Diphenhydramine
D. Diphenhydramine
If not chosen as the first drug in hypertension treatment, which drug class should be added as the second step because it will enhance the effects of most other agents? A. ACE inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics
D. Diuretics
Chapter 14: Charlie is a 65 year old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: A. Increases peripheral vasoconstriction B. Decreases detrusor muscle contractility C. Lowers supine blood pressure more than standing pressure D. Relaxes smooth muscle in the bladder neck
D. Relaxes smooth muscle in the bladder neck
To prevent life-threatening events from rapid withdrawal of a beta blocker: A. The dosage interval should be increased by 1 hour each day B. An alpha blocker should be added to the treatment regimen before withdrawal C. The dosage should be tapered over a period of weeks D. The dosage should be decreased by one-half every 4 days
D. The dosage should be decreased by one-half every 4 days
When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta-adrenergic blocker? A. Dizziness B. Peripheral edema C. Hyperglycemia D. Wheezing
D. Wheezing
Prior to the administration of a beta-adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action? A. Administer the medication as ordered. B. Reevaluate the patient in 20 minutes. C. Obtain a serum blood level. D. Withhold the medication and notify the health care provider.
D. Withhold the medication and notify the health care provider.
What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds? Rest and increase fluids Diuretics, digoxin, and anti-hypertensive medications Nebulized albuterol and prednisone Anti-coagulation and cardiology evaluatio
Diuretics, digoxin, and anti-hypertensive medications
A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements. Total: 210 LDL: 145 TG 162 HDL 52 What medication would you recommend? a. Low dose statin b. Low dose bile acid sequestrant c. Low dose fibrate d. Fish oil
Low dose statin
8. A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching? a. "Beta blockers block the actions of angiotensin II." b. "Beta blockers decrease heart rate and contractility." c. "Beta blockers decrease peripheral vascular resistance." d. "Beta blockers decrease the release of renin."
NS: A Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin.
12. A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do? a. Notify the provider and discuss ordering a beta blocker for this patient. b. Notify the provider and suggest a thiazide diuretic as initial therapy. c. Order a diet low in sodium and high in potassium for this patient. d. Recheck the patient's blood pressure in 4 hours to verify the result.
NS: A Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI; beta blockers are indicated for patients with preexisting heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition.
9. A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? a. A persistent cough is a known side effect of this drug. b. Eat foods rich in potassium while taking this drug. c. Move slowly from sitting to standing when taking this drug. d. Report shortness of breath while taking this drug.
NS: C The most disturbing side effect of alpha blockers is orthostatic hypotension. Patients taking these drugs should be cautioned to stand up slowly to avoid lightheadedness or falls. A persistent cough is a common side effect of ACE inhibitors. It is not necessary to increase dietary potassium intake when taking this drug. Shortness of breath may occur in individuals with asthma who are taking beta blockers.
You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan? a. Order a CBC and CMP. b. Order lipid level and serum creatine phosphokinase (CPK, creatine kinase) c. Order a 24 hr urine d. Recommend increasing his fluids and rest.
Order lipid level and serum creatine phosphokinase (CPK, creatine kinase).
2. A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? a. ACE inhibitors b. Beta blockers c. Direct-acting vasodilators d. Thiazide diuretics
a. ACE inhibitors ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
3. A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP? a. Hypertension b. Isolated systolic hypertension c. Normal d. Prehypertension
a. Hypertension Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg. When systolic and diastolic BP fall into different categories, classification is based on the higher category. This patient has a hypertensive diastolic BP. Isolated systolic hypertension occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg. Because this patient has an elevated diastolic BP, it is not considered normal. Prehypertension occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg.
6. A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do? a. Notify the provider and ask about adding a beta blocker medication. b. Reassure the patient that the medications are working. c. Remind the patient to move slowly from sitting to standing. d. Request an order for an electrocardiogram.
a. Notify the provider and ask about adding a beta blocker medication. Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common side effect of lowering blood pressure, caused by the baroreceptor reflex. The patient's blood pressure is responding to the medications, but the tachycardia warrants treatment. Reminding the patient to move slowly from sitting to standing is appropriate with any blood pressure medication, but this patient has reflex tachycardia, which must be treated. An electrocardiogram is not indicated.
5. A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about: a. ACE inhibitors and calcium channel blocker medications. b. the DASH diet, sodium restriction, and exercise. c. increased calcium and potassium supplements. d. thiazide diuretics and lifestyle changes
b. the DASH diet, sodium restriction, and exercise.
(~ Ch. 47) 1. A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order: a. a beta blocker. b. a loop diuretic and spironolactone. c. a thiazide diuretic. d. counseling on lifestyle changes.
c. a thiazide diuretic. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists.
14. A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching? a. "Multi-drug therapy often means that drugs may be given in lower doses." b. "Some agents are used to offset adverse effects of other agents." c. "Treatment of hypertension via different mechanisms increases success." d. "Two or more drugs will lower blood pressure more quickly."
d. "Two or more drugs will lower blood pressure more quickly."
18. A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching? a. "I may experience serious long-term problems even if I am not having symptoms." b. "I should report side effects to the provider since other drugs may be substituted." c. "I will need to take medications on a long-term basis." d. "When my symptoms subside, I may discontinue the medications."
d. "When my symptoms subside, I may discontinue the medications."
A patient who has just begun taking an angiotensin-converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurse's best response? A. "Stop taking the medication immediately." B. "Rise to a sitting or standing position slowly; your symptoms will resolve." C "I will schedule you to visit the health care provider today." D "Cut the pill in half and take a reduced dosage."
symptoms will resolve."
