NURSING NSG 6005 week 5 quiz study guide Latest
Chapter 14. Drugs Affecting the Autonomic Nervous System
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Ch
...
NURSING NSG 6005 week 5 quiz study guide Latest
Chapter 14. Drugs Affecting the Autonomic Nervous System
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. 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:
1. Increases peripheral vasoconstriction
2. Decreases detrusor muscle contractility
3. Lowers supine blood pressure more than standing pressure
4. Relaxes smooth muscle in the bladder neck
2. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:
1. Take the dose at bedtime
2. Sit up slowly and dangle their feet before standing
3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
4. Weigh daily and report weight gain of greater than 2 pounds in one day
3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
1. Not miss a dose or stop taking the drug because of potential rebound hypertension
2. Increase fiber in the diet to treat any diarrhea that may occur
3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
4. Avoid sitting for long periods, as this can lead to deep vein thrombosis
4. Clonidine has several off-label uses, including:
1. Alcohol and nicotine withdrawal
2. Post-herpetic neuralgia
3. Both 1 and 2
4. Neither 1 nor 2
5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
1. Increasing heart rate to improve cardiac output
2. Reducing vascular smooth muscle tone
3. Increasing aldosterone-mediated volume activity
4. Reducing aqueous humor production
6. Which of the following adverse effects are less likely in a beta1-selective blocker?
1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decreased triglycerides and cholesterol
7. Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol.
You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol?
1. Extend the dosage interval.
2. Decrease the dose by 75%.
3. Take no action because this value is expected in the older adult.
4. Schedule a serum creatinine level to validate the CrCl value.
8. Beta blockers are the drugs of choice for exertional angina because they:
1. Improve myocardial oxygen supply by vasodilating the coronary arteries
2. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
3. Both 1 and 2
4. Neither 1 nor 2
9. Adherence to beta blocker therapy may be affected by their:
1. Short half-lives requiring twice daily dosing
2. Tendency to elevate lipid levels
3. Effects on the male genitalia, which may produce impotence
4. None of the above
10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:
1. Symptoms are severe
2. Patient has not responded to other therapies
3. Patient has concurrent hypertension
4. Left ventricular dysfunction is diagnosed
11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
1. Angina
2. Coronary artery disease
3. Both 1 and 2
4. Neither 1 nor 2
12. To prevent life-threatening events from rapid withdrawal of a beta blocker:
1. The dosage interval should be increased by 1 hour each day.
2. An alpha blocker should be added to the treatment regimen before withdrawal.
3. The dosage should be tapered over a period of weeks.
4. The dosage should be decreased by one-half every 4 days.
13. 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?
1. Dizziness
2. Increased heart rate
3. Nervousness and shakiness
4. Diaphoresis
14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
1. Vasodilate the peripheral vasculature
2. Decrease cardiac output
3. Increase renal vascular resistance
4. Reduce atherosclerosis secondary to elevated serum lipoproteins
15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?
1. Histamine 2 blockers
2. Quinolones
3. Serotonin re-uptake inhibitors
4. All of the above
16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
1. White
2. Asian
3. African American
4. Native American
17. Bethanechol:
1. Increases detrusor muscle tone to empty the bladder
2. Decreases gastric acid secretion to treat peptic ulcer disease
3. Stimulates voluntary muscle tone to improve strength
4. Reduces bronchial airway constriction to treat asthma
18. Clinical dosing of Bethanechol:
1. Begins at the highest effective dose to obtain a rapid response
2. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved
3. Requires dosing only once daily
4. Is the same for both the oral and parenteral route
19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
1. Levothyroxine
2. Prilosec
3. Dulcolax
4. Diphenhydramine
20. Anticholinesterase inhibitors are used to treat:
1. Peptic ulcer disease
2. Myasthenia gravis
3. Both 1 and 2
4. Neither 1 nor 2
21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
1. Donepezil
2. Memantine
3. Rivastigmine
4. Galantamine
22. Taking which drug with food maximizes it bioavailability?
1. Donepezil
2. Galantamine
3. Rivastigmine
4. Memantine
23. Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women?
1. Memantine
2. Pyridostigmine
3. Galantamine
4. Rivastigmine
24. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:
1. Dizziness and headache
2. Nausea
3. Decreased salivation
4. Fasciculations of voluntary muscles
25. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?
1. Tacrine
2. Donepezil
3. Memantine
4. Pyridostigmine
26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?
1. Vasodilation and decreased heart rate
2. Increased secretion of gastric acid and motility of the GI smooth muscle
3. Release of dopamine at the pleasure center
4. Stimulation of the locus coeruleus
27. Nicotine gum products are:
1. Chewed to release the nicotine and then swallowed for a systemic effect
2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release
3. Bound to exchange resins so the nicotine is only released during chewing
4. Approximately the same in nicotine content as smoking two cigarettes
28. Nicotine replacement therapy (NRT):
1. Is widely distributed in the body only when the gum products are used
2. Does not cross the placenta and so is safe for pregnant women
3. Delays healing of esophagitis and peptic ulcers
4. Has no drug interactions when a transdermal patch is used
29. Success rates for smoking cessation using NRT:
1. Are about the same regardless of the method chosen
2. Vary from 40% to 50% at 12 months
3. Both 1 and 2
4. Neither 1 nor 2
30. Cholinergic blockers are used to:
1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines
2. Control tremors and relax smooth muscle in Parkinson’s disease
3. Inhibit the muscarinic action of ACh on bladder muscle
4. All of the above
31. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.
2. Additive antimuscarinic effects may occur with antihistamines.
3. Cholinergic blockers may decrease the sedative effects of hypnotics.
4. Cholinergic blockers are contraindicated with antipsychotics.
32. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:
1. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired.
2. Swallow the tablet 1 hour before traveling where motion sickness is possible.
3. Place the tablet under the tongue and allow it to dissolve.
4. Change the transdermal disk daily for maximal effect.
33. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:
1. Continue the tamsulosin because the side effect will resolve with continued treatment.
2. Discontinue the tamsulosin and start doxazosin.
3. Have him double his fluid intake and stand more slowly.
4. Prescribe meclizine as needed for the dizziness.
34. You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?
1. Donepezil
2. Tacrine
3. Doxazosin
4. Verapamil
35. A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?
1. Acetaminophen
2. Estradiol
3. Donepezil
4. Bethanechol
36. Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications?
1. Carvedilol
2. Donepezil
3. Bethanechol
4. Tacrine
37. Activation of central alpha2 receptors results in inhibition of cardioacceleration and
centers in the brain.
1. Vasodilation
2. Vasoconstriction
3. Cardiovascular
4. Respiratory
Chapter 14. Drugs Affecting the Autonomic Nervous System Answer Section
MULTIPLE CHOICE
1. ANS: 4 PTS: 1
2. ANS: 3 PTS: 1
3. ANS: 1 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 2 PTS: 1
7. ANS: 1 PTS: 1
8. ANS: 2 PTS: 1
9. ANS: 3 PTS: 1
10. ANS: 4 PTS: 1
11. ANS: 3 PTS: 1
12. ANS: 4 PTS: 1
13. ANS: 4 PTS: 1
14. ANS: 1 PTS: 1
15. ANS: 4 PTS: 1
16. ANS: 3 PTS: 1
17. ANS: 1 PTS: 1
18. ANS: 2 PTS: 1
19. ANS: 4 PTS: 1
20. ANS: 2 PTS: 1
21. ANS: 2 PTS: 1
22. ANS: 3 PTS: 1
23. ANS: 2 PTS: 1
24. ANS: 4 PTS: 1
25. ANS: 2 PTS: 1
26. ANS: 1 PTS: 1
27. ANS: 3 PTS: 1
28. ANS: 3 PTS: 1
29. ANS: 2 PTS: 1
30. ANS: 4 PTS: 1
31. ANS: 1 PTS: 1
32. ANS: 2 PTS: 1
33. ANS: 2 PTS: 1
34. ANS: 1 PTS: 1
35. ANS: 4 PTS: 1
36. ANS: 1 PTS: 1
37. ANS: 2 PTS: 1
Chapter 18. Drugs Affecting the Hematopoietic System
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:
1. Ibuprofen 400 mg three times a day
2. Acetaminophen, not to exceed 4 grams per day
3. Prescribe acetaminophen with codeine
4. Aspirin 640 mg three times a day
2. Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:
1. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case.
2. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness.
3. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission.
4. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times.
3. The safest drug to use to treat pregnant women who require anticoagulant therapy is:
1. Low-molecular-weight heparin
2. Warfarin
3. Aspirin
4. Heparin
4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?
1. Pregnant women
2. Elderly men
3. Overweight or obese patients
4. Patients with multiple comorbidities
5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be:
1. Administer one dose of low-molecular weight heparin 24 hours before travel.
2. Prescribe one dose of warfarin to be taken the day of travel.
3. Consult with a hematologist regarding a treatment plan for Cecil.
4. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.
6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?
1. He has arthritis and this will help with the inflammation and pain.
2. Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
3. Aspirin acidifies the urine and he needs this for prostrate health.
4. He has a history of GI bleed, and one aspirin a day is a safe dosage.
7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated?
1. Tinnitus
2. Diarrhea
3. Hearing loss
4. Photosensitivity
8. Patient education when prescribing clopidogrel includes:
1. Do not take any herbal products without discussing it with the provider.
2. Monitor urine output closely and contact the provider if it decreases.
3. Clopidogrel can be constipating, use a stool softener if needed.
4. The patient will need regular anticoagulant studies while on clopidogrel.
9. For patients taking warfarin, INRs are best drawn:
1. Monthly throughout therapy
2. Three times a week throughout therapy
3. Two hours after the last dose of warfarin to get an accurate peak level
4. In the morning if the patient takes their warfarin at night
10. Patients receiving heparin therapy require monitoring of:
1. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
2. Electrolytes for elevated potassium levels in the first 24 hours of therapy
3. INR throughout therapy to stay within the range of 2.0
4. Blood pressure for hypertension that may occur in the first 2 days of treatment
11. The routine monitoring recommended for low molecular weight heparin is:
1. INR every 2 days until stable, then weekly
2. aPTT every week while on therapy
3. Factor Xa levels if the patient is pregnant
4. White blood cell count every 2 weeks
12. When writing a prescription for warfarin it is common to write on the prescription.
1. OK to substitute for generic
2. The brand name of warfarin and Do Not Substitute
3. PRN refills
4. Refills for 1 year
13. Education of patients who are taking warfarin includes discussing their diet. Instructions include:
1. Avoiding all vitamin K-containing foods
2. Avoiding high-vitamin K-containing foods
3. Increasing intake of iron-containing foods
4. Making sure they eat 35 grams of fiber daily
14. Patients who are being treated with epoetin alfa need to be monitored for the development of:
1. Thrombocytopenia
2. Neutropenia
3. Hypertension
4. Gout
15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:
1. ESAs no longer be prescribed to patients with chronic renal failure
2. The risk of tumor development be explained to cancer patients on ESA therapy
3. Patients should no longer receive ESA therapy to prepare for allogenic transfusions
4. ESAs be prescribed only to patients younger than age 60 years
16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:
1. 6 weeks if they are a cancer patient
2. 1 week if they have chronic renal failure
3. 2 weeks if they are taking it for allogenic transfusion
4. Each week throughout therapy
17. Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:
1. Folic acid to prevent megaloblastic anemia
2. Iron, to start when the epogen starts
3. An antihypertensive to counter the adverse effects of epogen
4. Vitamin B12 to prevent pernicious anemia
18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes:
1. Reticulocyte count 1 week after therapy is started
2. Complete blood count every 2 weeks throughout therapy
3. Hemoglobin level at 1 week of therapy
4. INR weekly throughout therapy
19. Patient education regarding taking iron replacements includes:
1. Doubling the dose if they miss a dose to maintain therapeutic levels
2. Taking the iron with milk or crackers if it upsets their stomach
3. Iron is best taken on an empty stomach with juice
4. Antacids such as Tums may help the upset stomach caused by iron therapy
20. Patients with pernicious anemia require treatment with:
1. Iron
2. Folic acid
3. Epogen alpha
4. Vitamin B12
21. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:
1. Hematocrit levels start to rise
2. Hemoglobin levels return to normal
3. Reticulocyte count begins to rise
4. Vitamin B12 levels return to normal
22. Patients who are beginning therapy with vitamin B12 need to be monitored for:
1. Hypertensive crisis that may occur in the first 36 hours
2. Hypokalemia that occurs in the first 48 hours
3. Leukopenia that occurs at 1 to 3 weeks of therapy
4. Thrombocytopenia that may occur at any time in therapy
Chapter 18. Drugs Affecting the Hematopoietic System Answer Section
MULTIPLE CHOICE
1. ANS: 2 PTS: 1
2. ANS: 2 PTS: 1
3. ANS: 4 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 4 PTS: 1
6. ANS: 2 PTS: 1
7. ANS: 1 PTS: 1
8. ANS: 1 PTS: 1
9. ANS: 4 PTS: 1
10. ANS: 1 PTS: 1
11. ANS: 3 PTS: 1
12. ANS: 2 PTS: 1
13. ANS: 2 PTS: 1
14. ANS: 1 PTS: 1
15. ANS: 2 PTS: 1
16. ANS: 1 PTS: 1
17. ANS: 2 PTS: 1
18. ANS: 1 PTS: 1
19. ANS: 3 PTS: 1
20. ANS: 4 PTS: 1
21. ANS: 2 PTS: 1
22. ANS: 3 PTS: 1
Chapter 27. Anemia
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Pernicious anemia is treated with:
1. Folic acid supplements
2. Thiamine supplements
3. Vitamin B12
4. Iron
2. Premature infants require iron supplementation with:
1. 10 mg/day of iron
2. 2 mg/kg per day until age 12 months
3. 7 mg/day in their diet
4. 1 mg/kg per day until they are receiving adequate intake of iron from foods
3. Breastfed infants should receive iron supplementation of:
1. 3 mg/kg per day
2. 6 mg/kg per day
3. 1 mg/kg per day
4. Breastfed babies do not need iron supplementation
4. Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be:
1. 18 mg/day of iron supplementation
2. 6 mg/kg per day of iron supplementation
3. 325 mg ferrous sulfate per day
4. 325 mg ferrous sulfate tid
5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:
1. 18 mg/day of iron supplementation
2. 6 mg/kg per day of elemental iron
3. 325 mg ferrous sulfate per day
4. 325 mg ferrous sulfate tid
6. Monitoring for a patient taking iron to treat iron deficiency anemia is:
1. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started
2. Complete blood count every 4 weeks throughout treatment
3. Annual complete blood count
4. Reticulocyte count in 4 weeks
7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include:
1. Take the iron with milk if it upsets her stomach.
2. Antacids may help with the nausea and GI upset caused by iron.
3. Increase fluids and fiber to treat constipation.
4. Iron is best tolerated if it is taken at the same time as her other medications.
8. Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy?
1. 40 mcg/day
2. 200 mcg/day
3. 800 mcg/day
4. 2 gm/day
9. Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is:
1. Oral folic acid 1 to 2 mg per day
2. Oral folic acid 1 gram per day
3. IM folate weekly for at least 6 months
4. Oral folic acid 400 mcg daily
10. Patients who are being treated for folate deficiency require monitoring of:
1. Complete blood count every 4 weeks
2. Hematocrit and hemoglobin at 1 week and then at 8 weeks
3. Reticulocyte count at 1 week
4. Folate levels every 4 weeks until hemoglobin stabilizes
11. The treatment of vitamin B12 deficiency is:
1. 1,000 mcg daily of oral cobalamin
2. 2 gm per day of oral cobalamin
3. Vitamin B12 100 mcg/day IM
4. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week
12. The dosage of Vitamin B12 to initially treat pernicious anemia is:
1. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month
2. Vitamin B12 IM monthly
3. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month
4. Oral cobalamin 1,000 mcg daily
13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?
1. Reticulocyte count, hemoglobin, and hematocrit
2. Iron
3. Vitamin B12
4. All of the above
14. should be monitored when vitamin B12 therapy is started.
1. Serum calcium
2. Serum potassium
3. Ferritin
4. C-reactive protein
15. Anemia due to chronic renal failure is treated with:
1. Epoetin alfa (Epogen)
2. Ferrous sulfate
3. Vitamin B12
4. Hydroxyurea
Chapter 27. Anemia Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 2 PTS: 1
3. ANS: 3 PTS: 1
4. ANS: 4 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 1 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 3 PTS: 1
9. ANS: 1 PTS: 1
10. ANS: 2 PTS: 1
11. ANS: 1 PTS: 1
12. ANS: 3 PTS: 1
13. ANS: 4 PTS: 1
14. ANS: 2 PTS: 1
15. ANS: 1 PTS: 1
Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?
1. Calcium channel blockers
2. Beta blockers
3. Angiotensin-converting-enzyme (ACE) inhibitors
4. Aspirin
2. Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:
1. Pulmonary embolism
2. Pneumonia
3. Gastroesophageal reflux
4. All of the above
3. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:
1. I
2. II
3. III4. IV
4. Patients at high risk for developing significant coronary heart disease are those with:
1. LDL values between 100 and 130
2. Systolic blood pressure between 120 and 130
3. Class III angina
4. Obesity
5. To reduce mortality, all patients with angina, regardless of class, should be on:
1. Aspirin 81 to 325 mg/d
2. Nitroglycerin sublingually for chest pain
3. ACE inhibitors or angiotensin receptor blockers
4. Digoxin
6. Patients who have angina, regardless of class, who are also diabetic, should be on:
1. Nitrates
2. Beta blockers
3. ACE inhibitors
4. Calcium channel blockers
7. Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.
1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac
workload.
2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload.
3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply.
4. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function.
8. Nitrates are especially helpful for patients with angina who also have:
1. Heart failure
2. Hypertension
3. Both 1 and 2
4. Neither 1 nor 2
9. Beta blockers are especially helpful for patients with exertional angina who also have:
1. Arrhythmias
2. Hypothyroidism
3. Hyperlipidemia
4. Atherosclerosis
10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?
1. These drugs are useful for immediate symptom relief when the patient is certain it is angina.
2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away.
3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911.
4. All of the above
11. Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7
a.m. and 2 p.m. because:
1. Long-acting forms have a higher risk for toxicity.
2. Orthostatic hypotension is a common adverse effect.
3. It must be taken with milk or food.
4. Nitrate tolerance can develop.
12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:
1. Nitrates increase MOS and beta blockers increase MOD.
2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.
3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease.
4. All of the above
13. Drug choices to treat angina in older adults differ from those of younger adults only in:
1. Consideration of risk factors for diseases associated with and increased in aging
2. The placement of drug therapy as a treatment choice before lifestyle changes are tried
3. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult
4. Those with higher risk for silent myocardial infarction
14. Which of the following drugs has been associated with increased risk for myocardial infarction in women?
1. Aspirin
2. Beta blockers
3. Estrogen replacement
4. Lipid-lowering agents
15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:
1. Patients often require multiple drugs
2. A large number of angina patients are older adults on fixed incomes
3. Generic formulations may be cheaper but are rarely bioequivalent
4. Lack of drug selectivity may result in increased adverse reactions
16. Situations that suggest referral to a specialist is appropriate include:
1. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors
2. When a post-myocardial infarction patient develops new-onset angina
3. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina
4. All of the above
17. The rationale for prescribing calcium blockers for angina can be based on the need for:
1. Increased inotropic effect in the heart
2. Increasing peripheral perfusion
3. Keeping heart rates high enough to ensure perfusion of coronary arteries
4. Help with rate control
18. Medications are typically started for angina patients when:
1. The first permanent EKG changes occur
2. The start of class I or II symptoms
3. The events trigger a trip to the emergency department
4. When troponin levels become altered
19. The most common cause of angina is:
1. Vasospasm of the coronary arteries
2. Atherosclerosis
3. Platelet aggregation
4. Low systemic oxygen
20. Ranolazine is used in angina patients to:
1. Dilate plaque-filled arteries
2. Inhibit platelet aggregation
3. Restrict late sodium flow in the myocytes
4. Induce vasoconstriction in the periphery to open coronary vessels
21. When is aspirin (ASA) used in angina patients?
1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons.
2. ASA should only be used in men.
3. ASA has no role in angina, but is useful in MI prevention.
4. The impact of ASA is best at the time of an angina attack.
Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 4 PTS: 1
3. ANS: 2 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 1 PTS: 1
6. ANS: 3 PTS: 1
7. ANS: 2 PTS: 1
8. ANS: 3 PTS: 1
9. ANS: 1 PTS: 1
10. ANS: 3 PTS: 1
11. ANS: 4 PTS: 1
12. ANS: 2 PTS: 1
13. ANS: 1 PTS: 1
14. ANS: 3 PTS: 1
15. ANS: 3 PTS: 1
16. ANS: 4 PTS: 1
17. ANS: 4 PTS: 1
18. ANS: 2 PTS: 1
19. ANS: 2 PTS: 1
20. ANS: 3 PTS: 1
21. ANS: 1 PTS: 1
Chapter 36. Heart Failure
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?
1. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently.
2. Reduced formation of cross-bridges so that contractile force decreases.
3. Activation of the sympathetic nervous system that increases heart rate and preload.
4. Decreased renal blood flow that decreases oxygen supply to the kidneys.
2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include:
1. Myocardial ischemia and injury secondary to myocardial infarction
2. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction
3. Increased demands of the heart beyond its ability to adapt secondary to anemia
4. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension
3. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage:
1. A
2. B
3. C
4. D
4. Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is:
1. Chest x-rays that show cephalization and measure heart size
2. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction
3. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage
4. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction
5. Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with:
1. Drugs for hypertension and hyperlipidemia, if they exist
2. Lifestyle management including diet, exercise, and smoking cessation only
3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart failure only
4. No drugs are used in this early stage
6. Class I recommendations for stage A heart failure include:
1. Aerobic exercise within tolerance levels to prevent the development of heart failure
2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
3. Beta blockers for all patients regardless of cardiac history
4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias
7. Stage B patients should have beta blockers added to their heart failure treatment regimen when:
1. They have an ejection fraction less than 40%
2. They have had a recent MI
3. Both 1 and 2
4. Neither 1 nor 2
8. Increased life expectancy for patients with heart failure has been associated with the use of:
1. ACE inhibitors, especially when started early in the disease process
2. All beta blockers regardless of selectivity
3. Thiazide and loop diuretics
4. Cardiac glycosides
9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?
1. Diuretics reduce preload associated with fluid retention.
2. Diuretics can be used earlier than stage C when the goal is control of hypertension.
3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism.
4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).
10. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:
1. Ejection fractions above 40%
2. An audible S3
3. Mitral stenosis as a primary cause for heart failure
4. Renal insufficiency
11. Which of the following classes of drugs is contraindicated in heart failure?
1. Nitrates
2. Long-acting dihydropyridines
3. Calcium channel blockers
4. Alpha-beta blockers
12. Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is:
1. Aldosterone antagonists
2. Eplerenone
3. ACE inhibitors
4. ARBs
13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?
1. Diuretics
2. ARBs
3. Beta blockers
4. Nitrates
14. 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:
1. Symptoms markedly worsen or the patient becomes hypotensive and has syncope
2. There is evidence of progressive renal insufficiency or failure
3. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic
4. Any of the above
15. ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?
1. Elderly patients with reduced renal clearance
2. Pregnant women
3. Women under age 30
4. 1 and 2
16. What assessment that can be done at home is the most reliable for making decisions to change HF medications?
1. Weight
2. BP
3. Heart rate
4. Serum Glucose
17. Evidence is strong that the timing of HF interventions are best initiated when:
1. The person enters stage C
2. The person has functional disabilities
3. At the earliest indication
4. When stage IV is determined
18. HF patients frequently take more than one drug. When are anticoagulants typically used?
1. When the patient enters stage III
2. Only in cases of diastolic failure
3. When there is concurrent A Fib
4. In all cases
19. What can chest x-rays contribute to the diagnosis and management of HF?
1. They have no role.
2. They can give very precise pictures of pulmonary fluid status.
3. They provide an idea of general cardiac size and pulmonary great vessel distribution.
4. They can confirm the diagnosis.
Chapter 36. Heart Failure Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 1 PTS: 1
3. ANS: 3 PTS: 1
4. ANS: 2 PTS: 1
5. ANS: 1 PTS: 1
6. ANS: 4 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 1 PTS: 1
9. ANS: 4 PTS: 1
10. ANS: 2 PTS: 1
11. ANS: 3 PTS: 1
12. ANS: 3 PTS: 1
13. ANS: 3 PTS: 1
14. ANS: 4 PTS: 1
15. ANS: 4 PTS: 1
16. ANS: 1 PTS: 1
17. ANS: 3 PTS: 1
18. ANS: 3 PTS: 1
19. ANS: 3 PTS: 1
Chapter 39. Hyperlipidemia
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The overall goal of treating hyperlipidemia is:
1. Maintain an LDL level of less than 160 mg/dL
2. To reduce atherogenesis
3. Lowering apo B, one of the apoliproteins
4. All of the above
2. When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?
1. Total LDL
2. Fasting HDL
3. Coronary artery disease risk level
4. Fasting total cholesterol
3. First-line therapy for hyperlipidemia is:
1. Statins
2. Niacin
3. Lifestyle changes
4. Bile acid-binding resins
4. James is a 45-year-old patient with an LDL level of 120 and normal triglycerides. Appropriate first- line therapy for James may include diet counseling, increased physical activity, and:
1. A statin
2. Niacin
3. Sterols
4. A fibric acid derivative
5. Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be:
1. A statin
2. Niacin
3. Sterols
4. A fibric acid derivative
6. Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:
1. A statin
2. Niacin
3. A fibric acid derivative
4. Determined by her risk factors
7. Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3 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:
1. Discontinue the statin and change to a fibric acid derivative.
2. Discontinue the statin and change to ezetimibe.
3. Continue the statin and add in ezetimibe.
4. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia.
8. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman?
1. A statin
2. Niacin
3. Fibric acid derivative
4. Bile acid-binding resins
9. Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a:
1. Sterol
2. Niacin
3. Fibric acid derivative
4. Bile acid-binding resin
10. Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in 6 months.
1. Statins
2. Niacin
3. Sterols
4. Bile acid-binding resins
11. Monitoring of a patient who is on a lipid-lowering drug includes:
1. Fasting total cholesterol every 6 months
2. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks
3. Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after 6 weeks of therapy
4. All of the above
12. Before starting therapy with a statin, the following baseline laboratory values should be evaluated:
1. Complete blood count
2. Liver function (ALT/AST) and creatine kinase
3. C-reactive protein
4. All of the above
13. When starting a patient on a statin, education would include:
1. If they stop the medication their lipid levels will return to pretreatment levels.
2. Medication is a supplement to diet therapy and exercise.
3. If they have any muscle aches or pain, they should contact their provider.
4. All of the above
14. Omega 3 fatty acids are best used to help treat:
1. High HDL
2. Low LDL
3. High triglycerides
4. Any high lipid value
15. When are statins traditionally ordered to be taken?
1. At bedtime
2. At noon
3. At breakfast
4. With the evening meal
16. Which the following persons should not have a statin medication ordered?
1. Someone with 3 first- or second-degree family members with history of muscle issues when started on statins
2. Someone with high lipids, but low BMI
3. Premenopausal woman with recent history of hysterectomy
4. Prediabetic male with known metabolic syndrome
17. Fiber supplements are great options for elderly patients who have the concurrent problem of:
1. End-stage renal failure on fluid restriction
2. Recurrent episodes of diarrhea several times a day
3. Long-term issues of constipation
4. Needing to take multiple medications around the clock every 2 hours
18. What is considered the order of statin strength from lowest effect to highest?
1. Lovastatin, Simvastatin, Rosuvastatin
2. Rosuvastatin, Lovastatin, Atorvastatin
3. Atorvastatin, Rosuvastatin, Simvastatin
4. Simvastatin, Atorvastatin, Lovastatin
Chapter 39. Hyperlipidemia Answer Section
MULTIPLE CHOICE
1. ANS: 2 PTS: 1
2. ANS: 3 PTS: 1
3. ANS: 3 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 1 PTS: 1
6. ANS: 4 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 4 PTS: 1
9. ANS: 3 PTS: 1
10. ANS: 3 PTS: 1
11. ANS: 2 PTS: 1
12. ANS: 2 PTS: 1
13. ANS: 4 PTS: 1
14. ANS: 3 PTS: 1
15. ANS: 4 PTS: 1
16. ANS: 1 PTS: 1
17. ANS: 3 PTS: 1
18. ANS: 1 PTS: 1
Chapter 40. Hypertension
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. 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:
1. Increase renin secretion
2. Decrease the production of aldosterone
3. Deplete body sodium and reduce fluid volume
4. Decrease blood viscosity
2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also
need to receive the following supplement:
1. Potassium
2. Calcium
3. Magnesium
4. Phosphates
3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
1. Those with orthostatic hypertension
2. African Americans
3. Those with stable angina
4. Diabetics
4. Beta blockers treat hypertension because they:
1. Reduce peripheral resistance
2. Vasoconstrict coronary arteries
3. Reduce norepinephrine
4. Reduce angiotensin II production
5. Which of the following disease processes could be made worse by taking a nonselective beta blocker?
1. Asthma
2. Diabetes
3. Both might worsen
4. Beta blockade does not affect these disorders
6. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:
1. Heart failure
2. Angina
3. Myocardial infarction
4. Dyslipidemia
7. Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:
1. Reduce sodium and water retention
2. Decrease vasoconstriction
3. Increase vasodilation
4. All of the above
8. Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes:
1. Pregnancy
2. Renal parenchymal disease
3. Stable angina
4. Dyslipidemia
9. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?
1. Beta blockers
2. Diuretics
3. Nondihydropyridine calcium channel blockers
4. Angiotensin II receptor blockers
10. If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents?
1. ACE inhibitors
2. Beta blockers
3. Calcium channel blockers
4. Diuretics
11. Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true?
1. Hypertension is a chronic disease where patients may be taking drugs for a long time.
2. Most patients will require more than one drug to treat the hypertension.
3. The cost includes the price of any routine or special laboratory tests that a specific drug may require.
4. Few antihypertensive drugs come in generic formulations.
12. Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement?
1. 15
2. 30
3. 60
4. 90
13. Blood pressure checks in children:
1. Should occur with their annual physical examinations after 6 years of age
2. Require a blood pressure cuff that is one-third the diameter of the child’s arm
3. Should be done during every health-care visit after 3 years of age
4. Require additional laboratory tests such as serum creatinine
14. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:
1. Lifestyle changes are difficult to achieve and maintain.
2. Adverse drug reactions are common and often fall into the categories more associated with nonadherence.
3. Costs of drugs and monitoring with laboratory tests can be expensive.
4. All of the above
15. Lifestyle modifications for patients with prehypertension or hypertension include:
1. Diet and increase exercise to achieve a BMI greater than 25.
2. Drink 4 ounces of red wine at least once per week.
3. Adopt the dietary approaches to stop hypertension (DASH) diet.
4. Increase potassium intake.
16. Which diuretic agents typically do not need potassium supplementation?
1. The loop diuretics
2. The thiazide diuretics
3. The aldosterone inhibitors
4. They all need supplementation
17. Aldactone family medications are frequently used when the hypertensive patient also has:
1. Hyperkalemia
2. Advancing liver dysfunction
3. The need for birth control
4. Rheumatoid arthritis
18. Hypertensive African Americans are typically listed as not being as responsive to which drug groups?
1. ACE inhibitors
2. Calcium channel blockers
3. Diuretics
4. Bidil (hydralazine family of medications)
19. What educational points concerning fluid intake must be covered with diuretic prescriptions?
1. Fluid should be restricted when on them.
2. Fluids should contain at least one salty item daily.
3. Fluid intake should remain near normal for optimal performance.
4. Avoidance of potassium-rich fluids is encouraged.
20. What is a common side effect concern with hypertensive medications and all individuals, but especially the elderly?
1. Risk of falls
2. Triggering of a hypertensive crisis
3. Erectile priapism
4. Risk for bladder cancer development
Chapter 40. Hypertension Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 1 PTS: 1
3. ANS: 2 PTS: 1
4. ANS: 1 PTS: 1
5. ANS: 3 PTS: 1
6. ANS: 3 PTS: 1
7. ANS: 4 PTS: 1
8. ANS: 2 PTS: 1
9. ANS: 3 PTS: 1
10. ANS: 4 PTS: 1
11. ANS: 4 PTS: 1
12. ANS: 2 PTS: 1
13. ANS: 3 PTS: 1
14. ANS: 4 PTS: 1
15. ANS: 3 PTS: 1
16. ANS: 3 PTS: 1
17. ANS: 2 PTS: 1
18. ANS: 1 PTS: 1
19. ANS: 3 PTS: 1
20. ANS: 1 PTS: 1
Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a reevaluation in six months.
a) Statins
b) Niacin c) Sterols
d) Bile acid-binding resins
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
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
Beta blocker treat hypertension because they: a) Reduce peripheral resistance
b) Vasoconstriction coronary arteries
c) Reduce norepinephrine
d) Reduce angiotension II production
The treatment for vitamin B12 deficiency is: a) 1,000 mcg daily of oral cobalamin
b) 2 gm/day of oral cobalamin
c) 100 mcg/day vitamin B12 IM
d) 500 mcg/dose nasal cyanocobalamin two sprays once a week
Isosorbide dinitrate is a long-acting nitrate given twice daily (BID). The schedule for administration is 7 a.m. and 2 p.m. because:
a) Long-acting forms have a higher risk for toxicity.
b) Orthostatic hypotension is a common adverse effect.
c) It must be taken with milk or food. d) Nitrate tolerance can develop.
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
Premature infants require iron supplementation with:
a) 10mg/day of iron
b) 2 mg/kg per day until the age of twelve-months
c) 7 mg/day in diet
d) 1 mg/kg per day until there is adequate intake of iron from foods
Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be:
a) Atorvastatin (Lipitor) b) Niacin (Niaspan)
c) Simvastatin and ezetimibe (Vytorin)
d) Gemfibrozil (Lopid)
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.
Art is a fifty-five-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?”
Patients who are being treated for folate deficiency require monitoring of:
a) Complete blood count every four weeks
b) Hematocrit and hemoglobin at one week and then at eight weeks
c) Reticulocyte count at one week
d) Folate levels every four weeks until the hemoglobin stabilizes
Rodrigo has been prescribed procainamide after an episode of MI. 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
Dulcea has type II 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
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) GI 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.
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 dissolve
c) To take one tablet every five minutes until the chest pain goes away
d) That it should “burn” when placed under the tongue or it is no longer effective
Treatments for heart failure, including drug therapy, are based on the stages developed by the American Heart Association and the American College of Cardiology. Stage A patients are:
a) Treated with drugs for hypertension and hyperlipidemia, if they exist
b) Taught lifestyle management, including diet, exercise, and smoking cessation only
c) Treated with ACE inhibitors to directly affect the heart failure only
d) Not given any drugs in this early stage
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
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