chap 16: Drugs affecting the Cardiovascular and Renal systems

Question 1

1. 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:
2. Hypokalemia
3. Impotence
4. Decreased renal function
5. Inability to concentrate

Answer 1

3. Decreased renal function

Question 2

2. Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they:
3. Improve insulin sensitivity
4. Improve renal hemodynamics
5. Reduce the production of angiotensin II
6. All of the above

Answer 2

4. All of the above

Question 3

3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?
4. Swelling of the tongue or hoarseness are the most common symptoms.
5. It appears to be related to the decrease in aldosterone production.
6. Presence of a dry, hacky cough indicates a high risk for this adverse response.
7. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week.

Answer 3

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

Question 4

4. 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?
5. Stable angina because it decreases the thickening of vascular walls due to decreased modified release.
6. Heart failure because it reduces remodeling of injured myocardial tissues.
7. Both 1 and 2 are true and the reasons are correct.
8. Both 1 and 2 are true but the reasons are wrong.
9. Neither 1 nor 2 are true.

Answer 4

3. Both 1 and 2 are true and the reasons are correct.

Question 5

5. Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:
6. Is stronger than the ACE inhibitor
7. Does not produce a dry, hacky cough
8. Has no effect on the renal system
9. Reduces sodium and water retention

Answer 5

2. Does not produce a dry, hacky cough

Question 6

6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because:
7. Cimetidine is metabolized by the CYP 3A4 isoenzymes
8. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
9. Both 1 and 2
10. Neither 1 nor 2

Answer 6

3. Both 1 and 2

Question 7

7. Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
8. White blood cell counts with the drug dosage increased for elevations above 10,000 feet
9. Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal
10. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
11. Serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL

Answer 7

3. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL

Question 8

8. Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:
9. Decreases the amount of calcium inside the cell
10. Reduces stroke volume
11. Increases the activity of the Na+/K+/ATPase pump indirectly
12. Decreases heart rate

Answer 8

1. Decreases the amount of calcium inside the cell

Question 9

9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?
10. Bradycardia
11. Hepatic impairment
12. Increased contractility
13. Edema of the hands and feet

Answer 9

4. Edema of the hands and feet

Question 10

10. Patient teaching related to amlodipine includes:
11. Increase calcium intake to prevent osteoporosis from a calcium blockade.
12. Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it.
13. Avoid grapefruit juice as it affects the metabolism of this drug.
14. Rise slowly from a supine position to reduce orthostatic hypotension.

Answer 10

3. Avoid grapefruit juice as it affects the metabolism of this drug.

Question 11

11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
12. Started at about half the usual dosage
13. Not increased over the usual dosage for an adult
14. Given once daily because of memory issues in the older adult
15. Withheld if she experiences gastroesophageal reflux

Answer 11

1. Started at about half the usual dosage

Question 12

12. Larry has heart failure, which is being treated with digoxin because it exhibits:
13. Negative inotropism
14. Positive chronotropism
15. Both 1 and 2
16. Neither 1 nor 2

Answer 12

4. Neither 1 nor 2

Question 13

13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:
14. Hemoglobin
15. Serum potassium
16. Blood urea nitrogen
17. Serum glucose

Answer 13

2. Serum potassium

Question 14

14. Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.
15. Older adults because of reduced renal function
16. Administration of aldosterone antagonist diuretics because of decreased potassium levels
17. Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin
18. Doses between 0.25 and 0.5 mg/day

Answer 14

1. Older adults because of reduced renal function

Question 15

15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:
16. Within 6 hours of the last dose
17. Because a reference point is needed in adjusting a dose
18. After three half-lives from the starting of the drug
19. When a patient has stable renal function

Answer 15

2. Because a reference point is needed in adjusting a dose

Question 16

16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate:
17. Widening of the area of infarction
18. Onset of congestive heart failure
19. An electrolyte imbalance involving potassium
20. Renal dysfunction

Answer 16

2. Onset of congestive heart failure

Question 17

17. Which of the following is true about procainamide and its dosing schedule?
18. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.
19. Gastrointestinal adverse effects are common so the drug should be taken with food.
20. Adherence can be improved by using a sustained release formulation that can be given once daily.
21. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Answer 17

4. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 18

18. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:
19. Notify your health-care provider immediately if you have visual change.
20. Monitor your own blood pressure and pulse daily.
21. Take a hot shower or bath if you feel dizzy.
22. Use a sunscreen on exposed body surfaces.

Answer 18

3. Take a hot shower or bath if you feel dizzy.

Question 19

19. 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?
20. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
21. Amiodarone damages the thyroid gland and can result in inflammation of that gland, causing hyperthyroidism.
22. Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given.
23. Amiodarone can cause corneal deposits in up to 25% of patients.

Answer 19

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

Question 20

20. 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:
21. It is a long-acting drug with potential for toxicity.
22. Nitrate tolerance can develop.
23. Orthostatic hypotension is a common adverse effect.
24. It must be taken with milk or food.

Answer 20

2. Nitrate tolerance can develop.

Question 21

21. 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:
22. This is a parasympathetic response to the vasodilating effects of the drug.
23. Headaches are common side effects with these drugs. How severe are they?
24. This is associated with your smoking. Let’s work on having you stop smoking.
25. This is not related to your medication. Are you under a lot of stress?

Answer 21

2. Headaches are common side effects with these drugs. How severe are they?

Question 22

22. In teaching about the use of sublingual nitroglycerine, the patient should be instructed:
23. To swallow the tablet with a full glass of water
24. To place one tablet under the tongue if chest pain occurs and allow it to dissolve
25. To take one tablet every 5 minutes until the chest pain goes away
26. That it should “burn” when placed under the tongue or it is no longer effective

Answer 22

2. To place one tablet under the tongue if chest pain occurs and allow it to dissolve

Question 23

23. 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:
24. Become a vegetarian because this disorder is associated with eating red meat.
25. Stop taking the drug if abdominal cramps and diarrhea develop.
26. Report muscle weakness or tenderness and dark urine to his provider immediately.
27. Expect “hot flash” sensations during the first 2 weeks of therapy.

Answer 23

3. Report muscle weakness or tenderness and dark urine to his provider immediately.

Question 24

24. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
25. Elevated serum transaminase
26. Increased serum creatinine
27. Elevated creatinine kinase
28. Increased white blood cell counts

Answer 24

4. Increased white blood cell counts

Question 25

25. Because of the pattern of cholesterol synthesis, reductase inhibitors are given:
26. In the evening in a single daily dose
27. Twice daily in the morning and the evening
28. With each meal and at bedtime
29. In the morning before eating

Answer 25

1. In the evening in a single daily dose

Question 26

26. 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 laboratory results should be monitored?
27. Serum alanine aminotransferase
28. Serum amylase
29. Serum creatinine
30. Phenylketonuria

Answer 26

3. Serum creatinine

Question 27

27. Niaspan is less likely to cause which side effect that is common to niacin?
28. Gastrointestinal irritation
29. Cutaneous flushing
30. Dehydration
31. Headaches

Answer 27

2. Cutaneous flushing

Question 28

28. 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?
29. Reactive airway disease/asthma
30. Inflammatory bowel disease
31. Allergy to aspirin
32. Gallbladder disease

Answer 28

4. Gallbladder disease

Question 29

29. 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.
30. Reductase inhibitors, due to an increased risk for rhabdomyolysis
31. Bile-acid sequestering resins, due to interference with folic acid absorption
32. Grapefruit juice, due to interference with metabolism
33. Niacin, due to decreased gemfibrozil activity

Answer 29

1. Reductase inhibitors, due to an increased risk for rhabdomyolysis

Question 30

30. Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug:
31. Blocks synthesis of cholesterol in the liver
32. Exchanges chloride ions for negatively charged acids in the bowel
33. Increases HDL levels the most among the classes
34. Blocks the lipoprotein lipase pathway

Answer 30

1. Blocks synthesis of cholesterol in the liver

Question 31

31. Because of their site of action, bile acid sequestering resins:
32. Should be administered separately from other drugs by at least 4 hours
33. May increase the risk for bleeding
34. Both 1 and 2
35. Neither 1 nor 2

Answer 31

1. Should be administered separately from other drugs by at least 4 hours

Question 32

32. Colestipol comes in a powdered form. The patient is taught to:
33. Take the powder dry and follow it with at least 8 ounces of water
34. Take it with a meal to enhance its action on fatty food
35. Mix the powder with 4 to 6 ounces of milk or fruit juice
36. Take after the evening meal to coincide with cholesterol synthesis

Answer 32

3. Mix the powder with 4 to 6 ounces of milk or fruit juice

Question 33

33. The choice of diuretic to use in treating hypertension is based on:
34. Presence of diabetes with loop diuretics being used for these patients
35. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range
36. Ethnicity with aldosterone antagonists best for African Americans and older adults
37. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL

Answer 33

2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range

Question 34

34. Direct renin inhibitors have the following properties. They:
35. Are primarily generic drugs
36. Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy
37. Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact
38. “Shut down” the entire RAAS cycle

Answer 34

4. “Shut down” the entire RAAS cycle

Question 35

35. When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?
36. Both have major issues with a dry, irritating cough
37. Both contribute to some retention of potassium
38. ARBs have a stronger impact on hypertension control than ACE medications
39. ARBs have stronger diabetes mellitus renal protection properties than ACE medications

Answer 35

2. Both contribute to some retention of potassium

Question 36

36. What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:
37. Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present
38. Who start these medications never progress to renal nephropathy
39. With early renal dysfunction will see it reverse when on ACE medications
40. Without renal issues are the only ones who benefit from ACE protection

Answer 36

1. Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present

Question 37

37. What dermatological issue is linked to Amiodarone use?
38. Increased risk of basal cell carcinoma
39. Flare up of any prior psoriasis problems
40. Development of plantar warts
41. Progressive change of skin tone toward a blue spectrum

Answer 37

4. Progressive change of skin tone toward a blue

Question 38

38. Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
39. Increased risk of priapism
40. Profound hypotension
41. Development of blue discoloration to the visual field
42. Inactivation of the ED medication effect

Answer 38

2. Profound hypotension