Question 1

Patient teaching related to amlodipine includes:

Accepted Answer

Amlodipine is metabolized by the liver enzyme CYP3A4, and grapefruit juice can inhibit this enzyme, leading to increased levels of the drug in the bloodstream and potential toxicity.

Question 2

Despite good blood pressure control, an NP might change a patient's drug from an ACE inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:

Accepted Answer

ARBs are often chosen over ACE inhibitors because they do not cause the dry, hacking cough that is a common side effect of ACE inhibitors. This is due to the different mechanisms by which they act on the renin-angiotensin system.

Question 3

ACE inhibitors are useful in a variety of disorders. Which of the following statements is true about both their usefulness in a particular disorder and the reason for their use?

Accepted Answer

ACE inhibitors are useful to prevent heart failure because they reduce remodeling of injured myocardial tissues. They are also useful to prevent stable angina because they decrease the thickening of vascular walls due to decreased modified release.

Question 4

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

Accepted Answer

Both cimetidine and nonsteroidal anti-inflammatory drugs can interact with ARBs. Cimetidine is metabolized by the CYP3A4 isoenzymes, which can lead to increased levels of ARBs in the body. Nonsteroidal anti-inflammatory drugs can reduce prostaglandin levels, which can lead to decreased blood pressure and increased risk of renal impairment.

Question 5

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

Accepted Answer

Procainamide should be taken at evenly spaced intervals around the clock to maintain consistent blood levels and therapeutic effect.

Question 6

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

Accepted Answer

Older adults often have altered pharmacokinetics and increased sensitivity to medications, so starting at about half the usual dosage is recommended to minimize side effects and adjust as needed.

Question 7

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:

Accepted Answer

Nitrate tolerance can develop with continuous exposure, so a nitrate-free interval is recommended to prevent this, hence the specific dosing schedule.

Question 8

Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they:

Accepted Answer

ACE inhibitors are beneficial in diabetic patients because they improve insulin sensitivity, improve renal hemodynamics, and reduce the production of angiotensin II, all of which are crucial in managing hypertension in these patients.

Question 9

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

Accepted Answer

Furosemide can cause hypokalemia, which can increase the risk of digoxin toxicity. Therefore, monitoring serum potassium is important.

Question 10

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

Accepted Answer

Taking a hot shower or bath if feeling dizzy is not recommended because it can lower blood pressure further, potentially worsening dizziness or leading to fainting. The other options are appropriate for a patient taking amiodarone.

Question 11

A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of the following statements is true about this adverse response?

Accepted Answer

Angioedema associated with ACE inhibitors is characterized by rapid swelling of the deep layers of the skin, often affecting the face, tongue, and throat, which can lead to difficulty breathing. It is not directly related to aldosterone production, cough, or the time it takes to build up a blood level of the drug.

Question 12

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 has been ordered. Which is a correct response?

Accepted Answer

Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.

Question 13

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

Accepted Answer

Digoxin is used in heart failure for its positive inotropic effects (increases the force of heart muscle contraction) and negative chronotropic effects (decreases heart rate), which are not listed among the options provided.

Question 14

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

Accepted Answer

These symptoms are indicative of congestive heart failure, a condition that can be exacerbated or precipitated by medications like procainamide, especially in patients with a history of myocardial infarction.

Question 15

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

Accepted Answer

Calcium channel blockers work by decreasing the amount of calcium that enters the cells of the heart and blood vessel walls, leading to relaxation of the blood vessels and a decrease in blood pressure. This mechanism does not directly involve reducing stroke volume, increasing the activity of the Na+/K+/ATPase pump, or decreasing heart rate, although a decrease in heart rate can be an indirect effect of some calcium channel blockers.

Question 16

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

Accepted Answer

Monitoring serum digoxin levels is important to adjust dosage and ensure therapeutic levels are maintained without reaching toxicity.

Question 17

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

Accepted Answer

Older adults often have reduced renal function, which can lead to decreased clearance of digoxin and increased risk of toxicity.

Question 18

Ray has been diagnosed with hypertension and it is determined that an angiotensin-converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for:

Accepted Answer

Angiotensin-converting enzyme (ACE) inhibitors can affect renal function, particularly in patients who already have kidney issues. It's important to assess renal function before prescribing ACE inhibitors to ensure the medication does not exacerbate any pre-existing renal impairment.

Question 19

Laboratory monitoring for patients on ACE inhibitors or ARBs should include:

Accepted Answer

Serum creatinine levels should be monitored in patients on ACE inhibitors or ARBs because these medications can affect kidney function. A dosage adjustment may be necessary if serum creatinine levels are significantly elevated.

Question 20

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

Accepted Answer

Dihydropyridine-type calcium channel blockers, such as nifedipine, often cause peripheral edema, including edema of the hands and feet, as an adverse effect.

Quiz 13: Drugs Affecting the Cardiovascular and Renal Systems