Deck 16: Drugs Affecting the Cardiovascular and Renal Systems

Question 1

Larry has heart failure which is being treated with digoxin because it exhibits:

A) Negative inotropism
B) Positive chronotropism
C) Both A and B
D) Neither A nor B

Answer 1

Neither A nor B

Question 2

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 or hoarseness are the most common symptoms.
B) It appears to be related to the decrease in aldosterone production.
C) 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 1 week.

Answer 2

Swelling of the tongue or hoarseness are the most common symptoms.

Question 3

Rodrigo has been prescribed procainamide after a myocardial infarction.He is monitored for dyspnea,jugular venous distention,and peripheral edema because they may indicate:

A) Widening of the area of infarction
B) Onset of congestive heart failure
C) An electrolyte imbalance involving potassium
D) Renal dysfunction

Answer 3

Onset of congestive heart failure

Question 4

Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?

A) Bradycardia
B) Hepatic impairment
C) Increased contractility
D) Edema of the hands and feet

Question 5

Furosemide is added to a treatment regimen for heart failure which includes digoxin.Monitoring for this combination includes:

A) Hemoglobin
B) Serum potassium
C) Blood urea nitrogen
D) Serum glucose

Question 6

Jacob has hypertension for which a calcium channel blocker has been prescribed.This drug helps control blood pressure because it:

A) Decreases the amount of calcium inside the cell
B) Reduces stroke volume
C) Increases the activity of the Na+/K+/ATPase pump indirectly
D) Decreases heart rate

Question 7

Despite good blood pressure control,a NP might change a patient's drug from an ACEI to an angiotensin II receptor blocker (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

Question 8

ACE inhibitors are the drug of choice in treating hypertension in diabetic patients because they:

A) Improve insulin sensitivity
B) Improve renal hemodynamics
C) Reduce the production of angiotensin II
D) All of the above

Question 9

Serum digoxin levels are monitored for potential toxicity.Monitoring should occur:

A) Within 6 hours of the last dose
B) Because a reference point is needed in adjusting a dose
C) After three half-lives from the starting of the drug
D) When a patient has stable renal function

Question 10

Isosorbide dinitrate is prescribed for a patient with chronic stable angina.This drug is administered twice daily,but the schedule is 7 AM and 2 PM because:

A) It is a long-acting drug with potential for toxicity
B) Nitrate tolerance can develop
C) Orthostatic hypotension is a common adverse effect
D) It must be taken with milk or food

Question 11

While taken an ARB,patients need to avoid certain over-the-counter drugs without first consulting the provider because:

A) Cimetidine is metabolized by the CYP 3A4 isoenzymes
B) Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
C) Both A and B
D) Neither A nor B

Question 12

Ray has been diagnosed with hypertension and an ACE inhibitor is determined to be needed.Prior to prescribing this drug,the NP should assess for:

A) Hypokalemia
B) Impotence
C) Decreased renal function
D) Inability to concentrate

Question 13

Laboratory monitoring for patients on ACEIs or ARBs should include:

A) White blood cells counts with the drug dose increased for elevations above 10,000
B) Liver function tests with the drug dose stopped for ALT values 2 $\times$ normal
C) Serum creatinine levels with the drug dose reduced for values above 2.5 mg/dL
D) Serum glucose levels with the drug dose increased for levels above 120 mg/dL

Question 14

ACE 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?

A) Stable angina because it decreases the thickening of vascular walls to decreased MOD.
B) Heart failure because it reduces remodeling of injured myocardial tissues.
C) Both A and B are true and the reasons are correct
D) Both A and B are true but the reasons are wrong
E) Neither A nor B are true

Question 15

Which of the following is true about procainamide and its dosing schedule?

A) It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.
B) Gastrointestinal adverse effects are common so the drug should be taken with food.
C) Adherence can be improved by using a sustained release formulation that can be given once daily.
D) Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 16

Vera,age 70,has isolated systolic hypertension.Calcium channel blocker doses for her should be:

A) Started at about half the usual dose
B) Not raised above the usual dose for an adult
C) Given once daily due to memory issues in the older adult
D) Withheld if she experiences gastroesophageal reflux

Question 17

Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia.Patient teaching should include all of the following EXCEPT:

A) Notify your health-care provider immediately if you have visual change
B) Monitor your own blood pressure and pulse daily
C) Take a hot shower or bath if you feel dizzy
D) Use a sunscreen on exposed body surfaces

Question 18

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?

A) "Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism."
B) "Amiodarone damages the thyroid gland and can result in inflammation of that gland causing hyperthyroidism."
C) "Amiodarone is a broad spectrum drug with many adverse effects.Many different tests need to be done before it is given."
D) "Amiodarone can cause corneal deposits in up to 25% of patients."

Question 19

Patient teaching related to amlodipine includes:

A) Increase calcium intake to prevent osteoporosis from calcium blockade.
B) Do not crush the tablet;it must be given in liquid form if the patient has trouble swallowing it.
C) Avoid grapefruit juice as it affects the metabolism of this drug.
D) Rise slowly from a supine position to reduce orthostatic hypotension.

Question 20

Which of the following create higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.

A) Older adults due to reduced renal function
B) Administration of aldosterone antagonist diuretics due to decreased potassium levels
C) Taking an antacid for GERD because it increases the absorption of digoxin
D) Doses between 0.25 and 0.5 mg/day

Question 21

Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?

A) Elevated serum transaminase
B) Increased serum creatinine
C) Elevated creatinine kinase
D) Increased white blood cells counts

Question 22

Niaspan is less likely to cause which side effect that is common to niacin?

A) Gastrointestinal irritation
B) Cutaneous flushing
C) Dehydration
D) Headaches

Question 23

Felicity has been prescribed colestipol to treat her hyperlipidemia.Unlike other anti-lipidemics,this drug:

A) Blocks synthesis of cholesterol in the liver
B) Exchanges chloride ions for negatively charged acids in the bowel
C) Increases HDL levels the most among the classes
D) Blocks the lipoprotein lipase pathway

Question 24

Because of the pattern of cholesterol synthesis,reductase inhibitors are given:

A) In the evening in a single daily dose
B) Twice daily in the morning and the evening
C) With each meal and at bedtime
D) In the morning before eating

Question 25

Colestipol comes in a powdered form.The patient is taught to:

A) Take the powder dry and follow it with at least 8 ounces of water
B) Take it with a meal to enhance its action on fatty food
C) Mix the powder with 4 to 6 ounces of milk or fruit juice
D) Take after the evening meal to coincide with cholesterol synthesis

Question 26

In teaching about the use of sublingual nitroglycerine,the patient should be instructed:

A) To swallow the tablet with a full glass of water
B) To place one tablet under the tongue if chest pain occurs and allow it to dissolve
C) To take one tablet every 5 minutes until the chest pain goes away
D) That it should "burn" when placed under the tongue or it is no longer effective

Question 27

Many patients with hyperlipidemia are treated with more than one drug.Combining a fibric 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.

A) Reductase inhibitors,due to an increased risk for rhabdomyolysis
B) Bile-acid sequestering resins,due to interference with folic acid absorption
C) Grapefruit juice,due to interference with metabolism
D) Niacin,due to decreased gemfibrozil activity

Question 28

Janice has elevated LDL,VLDL,and triglyceride levels.Niaspan,an extended-release form of niacin,is chosen to treat her hyperlipidemia.Due to its metabolism and excretion,which of the following labs should be monitored?

A) Serum alanine aminotransferase
B) Serum amylase
C) Serum creatinine
D) Phenylketonuria

Question 29

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:

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 2 weeks of therapy

Question 30

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?

A) Reactive airway disease/asthma
B) Inflammatory bowel disease
C) Allergy to aspirin
D) Gallbladder disease

Question 31

The choice of diuretic to use in treating hypertension is based on:

A) Presence of diabetes with loop diuretics being used for these patients
B) Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range
C) Ethnicity with aldosterone antagonists best for African Americans and older adults
D) Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL

Question 32

Because of their site of action,bile acid sequestering resins:

A) Should be administered separated from other drugs by at least 4 hours
B) May increase the risk for bleeding
C) Both A and B
D) Neither A nor B

Question 33

Which of the following statements is true?

A) Niacin is a B-complex vitamin and taking double the dose of the over-the-counter vitamin will lower LDL and save money.
B) Niacin has been shown to reduce all-cause mortality for patients with CAD if taken in prescription strength.
C) Niacin should be given on an empty stomach to avoid GI irritation.
D) All of the above

Question 34

Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates.He complains of headaches after using his nitrate.An appropriate reply might be:

A) "This is a parasympathetic response to the vasodilating effects of the drug."
B) "Headaches are common side effects with these drugs.How severe are they?"
C) "This is associated with your smoking.Let's work on having you stop smoking."
D) "This is not related to your medication.Are you under a lot of stress?"