Drugs Affecting the Cardiovascular and Renal Systems
Drugs Affecting the Cardiovascular and Renal Systems
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:
a) Hypokalemia
b) Impotence
c) Decreased renal function
d) Inability to concentrate
Answer. Decreased renal function
2. Angiotensin-converting enzyme 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
Answer. All of the above
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?
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. Swelling of the tongue or hoarseness are the most common symptoms. Drugs Affecting the Cardiovascular and Renal Systems.
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?
a) Stable angina because it decreases the thickening of vascular walls due to decreased modified release.
b) Heart failure because it reduces remodeling of injured myocardial tissues.
c) Both 1 and 2 are true and the reasons are correct.
d) Both 1 and 2 are true but the reasons are wrong.
e) Neither 1 nor 2 are true.
Answer. Both 1 and 2 are true and the reasons are correct. Drugs Affecting the Cardiovascular and Renal Systems.
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:
a) Is stronger than the ACE inhibitor
b) Does not produce a dry, hacky cough
c) Has no effect on the renal system
d) Reduces sodium and water retention
Answer. Does not produce a dry, hacky cough
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6. While taking an angiotensin II receptor blocker (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. Drugs Affecting the Cardiovascular and Renal Systems.
b) Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Both 1 and 2
7. Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should include:
a) White blood cell counts with the drug dosage increased for elevations above 10,000 feet
b) Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal
c) Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
d) Serum glucose levels with the drug dosage increased for levels greater than 120 mg/Dl
Answer. Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
8. 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. Drugs Affecting the Cardiovascular and Renal Systems.
Answer. Decreases the amount of calcium inside the cell. Drugs Affecting the Cardiovascular and Renal Systems.
9. 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
Answer. Edema of the hands and feet
10. Patient teaching related to amlodipine includes:
a) Increase calcium intake to prevent osteoporosis from a 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.
Answer. Avoid grapefruit juice as it affects the metabolism of this drug.
11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
a) Started at about half the usual dosage
b) Not increased over the usual dosage for an adult. Drugs Affecting the Cardiovascular and Renal Systems.
c) Given once daily because of memory issues in the older adult
d) Withheld if she experiences gastroesophageal reflux
Answer. Started at about half the usual dosage
12. Larry has heart failure, which is being treated with digoxin because it exhibits:
a) Negative inotropism
b) Positive chronotropism
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Neither 1 nor 2
13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:
a) Hemoglobin
b) Serum potassium
c) Blood urea nitrogen
d) Serum glucose
Answer. Serum potassium. Drugs Affecting the Cardiovascular and Renal Systems.
14. Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.
a) Older adults because of reduced renal function
b) Administration of aldosterone antagonist diuretics because of decreased potassium levels
c) Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin
d) Doses between 0.25 and 0.5 mg/day
Answer. Older adults because of reduced renal function. Drugs Affecting the Cardiovascular and Renal Systems.
15. 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
Answer. Because a reference point is needed in adjusting a dose
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:
a) Widening of the area of infarction
b) Onset of congestive heart failure
c) An electrolyte imbalance involving potassium
d) Renal dysfunction
Answer. Onset of congestive heart failure
17. 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.
Answer. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.
18. 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.
Answer. Take a hot shower or bath if you feel dizzy. Drugs Affecting the Cardiovascular and Renal Systems. Drugs Affecting the Cardiovascular and Renal Systems.
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?
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.
Answer. Nitrate tolerance can develop.
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:
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.
Answer. Nitrate tolerance can develop.
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:
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?
Answer. To place one tablet under the tongue if chest pain occurs and allow it to dissolve. Drugs Affecting the Cardiovascular and Renal Systems.
22. 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
Answer. To place one tablet under the tongue if chest pain occurs and allow it to dissolve. Drugs Affecting the Cardiovascular and Renal Systems.
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:
a) Become a vegetarian because 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.
Answer. Report muscle weakness or tenderness and dark urine to his provider immediately
24. 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 cell counts
Answer. In the evening in a single daily dose
25. 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
Answer. In the evening in a single daily dose. Drugs Affecting the Cardiovascular and Renal Systems.
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?
a) Serum alanine aminotransferase
b) Serum amylase
c) Serum creatinine
d) Phenylketonuria
Answer. Serum creatinine. Drugs Affecting the Cardiovascular and Renal Systems.
27. Niaspan is less likely to cause which side effect that is common to niacin?
a) Gastrointestinal irritation
b) Cutaneous flushing
c) Dehydration
d) Headaches
Answer. Cutaneous flushing
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?
a) Reactive airway disease/asthma
b) Inflammatory bowel disease
c) Allergy to aspirin
d) Gallbladder disease
Answer. Gallbladder disease
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.
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
Answer. Reductase inhibitors, due to an increased risk for rhabdomyolysis. Drugs Affecting the Cardiovascular and Renal Systems.
30. 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
Answer. Exchanges chloride ions for negatively charged acids in the bowel. Drugs Affecting the Cardiovascular and Renal Systems.
31. Because of their site of action, bile acid sequestering resins:
a) Should be administered separately from other drugs by at least 4 hours
b) May increase the risk for bleeding
c) Both 1 and 2
d) Neither 1 nor 2
Answer. Should be administered separately from other drugs by at least 4 hours
32. 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
Answer. Mix the powder with 4 to 6 ounces of milk or fruit juice
33. 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-40mL/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
Answer. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range. Drugs Affecting the Cardiovascular and Renal Systems.
34. Direct renin inhibitors have the following properties. They:
a) Are primarily generic drugs
b) Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy
c) Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact
d) Shut down” the entire RAAS cycle
Answer. Shut down” the entire RAAS cycle. Drugs Affecting the Cardiovascular and Renal Systems.
35. When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?
a) Both have major issues with a dry, irritating cough
b) Both contribute to some retention of potassium
c) ARBs have a stronger impact on hypertension control than ACE medications
d) ARBs have stronger diabetes mellitus renal protection properties than ACE medications
Answer. Both contribute to some retention of potassium
36. What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:
a) Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present
b) Who start these medications never progress to renal nephropathy
c) With early renal dysfunction will see it reverse when on ACE medications
d) Without renal issues are the only ones who benefit from ACE protection
Answer. Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present
37. What dermatological issue is linked to Amiodarone use?
a) Increased risk of basal cell carcinoma
b) Flare up of any prior psoriasis problems
c) Development of plantar warts
d) Progressive change of skin tone toward a blue spectrum. Drugs Affecting the Cardiovascular and Renal Systems.
Answer. Progressive change of skin tone toward a blue spectrum
38. Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?
a) Increased risk of priapism
b) Profound hypotension
c) Development of blue discoloration to the visual field
d) Inactivation of the ED medication effect
Answer. Profound hypotension