pharm unit 3 cv formative quiz

A patient, who was just prescribed lisinopril for hypertension, calls the clinic complaining of a persistent, non-productive, dry cough. What is the nurse's best action?

Document the finding and notify the provider, anticipating a potential change to an ARB like losartan.

Instruct the patient to buy an over-the-counter cough suppressant (e.g., dextromethorphan) to manage the symptom.

Reassure the patient that this is a common side effect that will go away on its own in a few weeks.

Tell the patient to stop the medication immediately and go to the ER, as this indicates a severe allergic reaction.

Document the finding and notify the provider, anticipating a potential change to an ARB like losartan.

A patient in the ED reports that their 'tongue and lips feel swollen' after taking their first dose of enalapril. The nurse assesses the patient and notes swelling of the lips and tongue. What is the nurse's priority action?

Notify the provider immediately and prepare for emergency airway management.

Administer an oral antihistamine like diphenhydramine.

Instruct the patient to drink cold water to reduce the swelling.

Document the finding as a common side effect and continue to monitor.

Notify the provider immediately and prepare for emergency airway management

What is the primary reason an ACE inhibitor (like lisinopril) or an ARB (like losartan) is prescribed for a patient with diabetes and hypertension?

They are the only drugs that lower blood pressure in diabetic patients.

They are less expensive than all other blood pressure medications.

They help to lower the patient's blood glucose levels (A1c).

They provide a special protective effect on the kidneys to prevent diabetic nephropathy.

They provide a special protective effect on the kidneys to prevent diabetic nephropathy.

A nurse is teaching a 26-year-old female patient about her new prescription for losartan (an ARB). What is the most important piece of information to include?

The patient will need to have her liver enzymes checked weekly.

The patient must use effective birth control and notify the provider immediately if she plans to or becomes pregnant.

The patient should avoid all forms of exercise, as the drug can cause muscle wasting.

The patient should take the medication with grapefruit juice to increase its effect.

The patient must use effective birth control and notify the provider immediately if she plans to or becomes pregnant.

A patient on an ACE inhibitor for heart failure is also taking ibuprofen 800 mg three times daily for severe arthritis. The nurse should monitor this patient closely for what complication?

Worsening kidney function and fluid retention

Improved blood pressure control

A severe, dry cough

Hypokalemia (low potassium)

Worsening kidney function and fluid retention

A patient with heart failure is prescribed lisinopril. The nurse knows this drug helps in heart failure primarily by...

Increasing the force of the heart's contraction (positive inotropy).

Thickening the blood to improve circulation.

Decreasing afterload (the pressure the heart pumps against) by relaxing arteries.

ignificantly increasing the heart rate (positive chronotropy).

Decreasing afterload (the pressure the heart pumps against) by relaxing arteries.

A patient started amlodipine 5 mg one week ago for hypertension. Which patient complaint is the most common and expected side effect of this medication?

A very slow heart rate (bradycardia)

A persistent, dry cough

Swelling in the feet and ankles

High potassium (hyperkalemia)

Swelling in the feet and ankles

How do dihydropyridine calcium channel blockers, like amlodipine (Norvasc), primarily lower blood pressure?

They relax the smooth muscle in peripheral arteries, causing vasodilation.

They block the RAAS system in the kidneys.

They slow down the heart rate and reduce cardiac output.

They cause the kidneys to excrete large amounts of fluid (diuresis).

They relax the smooth muscle in peripheral arteries, causing vasodilation.

A patient is prescribed amlodipine. Which of the following complaints should the nurse teach the patient is a common, non-dangerous side effect related to vasodilation?

Swelling of the tongue and lips

Productive, rattling cough

Chest pain and shortness of breath

Headache, flushing, and dizziness

Headache, flushing, and dizziness

What is the key difference between a dihydropyridine CCB (like nifedipine) and a non-dihydropyridine CCB (like diltiazem)?

Diltiazem often causes a dry cough, while nifedipine causes peripheral edema.

Nifedipine works only on the heart, while diltiazem works only on the blood vessels.

Diltiazem works on both blood vessels AND the heart (to slow the rate), while nifedipine primarily works only on blood vessels.

Nifedipine is safe in pregnancy, while diltiazem is not.

Diltiazem works on both blood vessels AND the heart (to slow the rate), while nifedipine primarily works only on blood vessels.

A patient with hypertension and stable angina is prescribed amlodipine. The patient asks, 'How does this pill help my chest pain?' What is the nurse's best response?

It blocks the pain signals from your heart so you don't feel the angina.

It slows your heart rate down so your heart doesn't have to work as hard.

It widens the arteries that supply your heart with blood, which increases oxygen to the heart muscle.

It thins your blood so it's easier for your heart to pump.

It widens the arteries that supply your heart with blood, which increases oxygen to the heart muscle.

According to the ACC/AHA hypertension guidelines, a dihydropyridine CCB (like amlodipine) is often a preferred first-line choice for which patient population?

Patients under 30 with no comorbidities.

Patients who also have gout.

African American patients with uncomplicated hypertension.

Patients who have a history of heart failure.

African American patients with uncomplicated hypertension.

A patient with new-onset atrial fibrillation with a heart rate of 140 bpm and BP of 150/90 needs rate control. Why would amlodipine be an inappropriate choice?

Amlodipine is known to cause atrial fibrillation.

Amlodipine will lower the heart rate too much and cause heart block.

Amlodipine is contraindicated in patients with hypertension.

Amlodipine will lower the blood pressure, but it will not slow down the patient's heart rate.

Amlodipine will lower the blood pressure, but it will not slow down the patient's heart rate.

A nurse is preparing to administer a scheduled dose of metoprolol to a patient. Which assessment finding would cause the nurse to hold the medication and notify the provider?

Blood pressure 138/88 mmHg

Patient complaint of fatigue

Respiratory rate 18/min

Heart rate 52 bpm

Heart rate 52 bpm

A provider has prescribed propranolol (a non-selective beta-blocker) for a patient. The nurse must question this order if the patient has a history of which condition?

Asthma

Hyperthyroidism

Gout

Hypertension

Asthma

A patient taking metoprolol for 6 months states, 'I want to stop this pill. It makes me feel tired and I don't like it.' What is the nurse's most important teaching point?

It's fine to stop the pill, but you must monitor your blood pressure at home for a week.

You must not stop this drug suddenly. It can cause a 'rebound' effect with severe high blood pressure or a heart attack.

Try taking the pill at night instead of in the morning; that might help with the fatigue.

Tiredness is not a side effect of this drug; you should see your doctor for other causes.

You must not stop this drug suddenly. It can cause a 'rebound' effect with severe high blood pressure or a heart attack.

A patient with type 1 diabetes is prescribed a beta-blocker after a heart attack. What is the priority education the nurse must provide?

Beta-blockers will cause your blood sugar to increase, so you'll need more insulin.

Beta-blockers can mask the signs of low blood sugar, like shakiness and a fast heart rate.

You must stop taking your metformin while you are on the beta-blocker.

You must check your blood pressure before checking your blood sugar.

Beta-blockers can mask the signs of low blood sugar, like shakiness and a fast heart rate.

A patient asks the nurse, 'How does this metoprolol pill work?' What is the best simple explanation?

It's a 'water pill' that helps you pee out extra salt and fluid.

It relaxes your blood vessels to make them wider, which lowers pressure.

It stops a hormone in your kidneys from being activated.

It blocks the 'fight or flight' (NE, adrenaline) signals, which slows your heart rate and makes it pump with less force.

It blocks the 'fight or flight' (NE, adrenaline) signals, which slows your heart rate and makes it pump with less force.

Why is a 'cardioselective' beta-blocker, like metoprolol, generally preferred over a 'non-selective' one, like propranolol?

Metoprolol is much stronger at lowering blood pressure.

Metoprolol does not cause fatigue or sexual dysfunction.

Metoprolol is safe to stop abruptly, while propranolol is not.

Metoprolol only blocks B1 (heart) receptors and does not affect B2 (lung) receptors.

Metoprolol only blocks B1 (heart) receptors and does not affect B2 (lung) receptors.

A patient on a beta-blocker complains of dizziness when getting up from his chair. The nurse should identify this as what common side effect and provide what instruction?

Side Effect: Bradycardia; Instruction: Lie down and elevate your feet.

Side Effect: Rebound hypertension; Instruction: Take an extra dose of your pill.

Side Effect: Hypoglycemia; Instruction: Check your blood sugar immediately.

Side Effect: Orthostatic hypotension; Instruction: Change positions slowly.

Side Effect: Orthostatic hypotension; Instruction: Change positions slowly.

A patient is newly diagnosed with uncomplicated hypertension. Which diuretic is most often prescribed as a first-line treatment for this condition?

Mannitol (Osmitrol)

Hydrochlorothiazide (HCTZ)

Furosemide (Lasix)

Spironolactone (Aldactone)

Hydrochlorothiazide (HCTZ)

A patient taking hydrochlorothiazide (HCTZ) is at risk for which of the following electrolyte imbalances?

Hyperkalemia (high potassium)

Hypernatremia (high sodium)

Hypokalemia (low potassium)

Hypocalcemia (low calcium)

Hypokalemia (low potassium)

The nurse is teaching a patient about their new prescription for furosemide (Lasix). What is the best instruction to provide about the timing of the dose?

You must take this pill at the exact same time every day, like 12:00 noon

Take the medication right at bedtime to prevent dizziness.

Take the medication with your evening meal.

Take the medication in the morning.

Take the medication in the morning.

What is the primary difference between furosemide (a loop diuretic) and spironolactone (a potassium-sparing diuretic)?

Furosemide is taken as a pill; spironolactone is only given IV.

Furosemide is safe in pregnancy; spironolactone is not.

Furosemide lowers BP; spironolactone does not.

Furosemide causes potassium loss, while spironolactone causes potassium retention.

Furosemide causes potassium loss, while spironolactone causes potassium retention.

A patient is prescribed both lisinopril (an ACEi) and spironolactone. The nurse knows to monitor the patient closely for which potential complication?

Severe hypokalemia (low potassium)

Severe hyperkalemia (high potassium)

A persistent, dry cough

Rebound hypertension

Severe hyperkalemia (high potassium)

A patient on diuretic therapy for hypertension is instructed to monitor themselves at home. What is the single best indicator of fluid balance that the nurse should teach the patient to track daily?

The amount of salt they eat

Their pulse rate

Their daily weight

Their blood pressure

Their daily weight

A patient is being discharged on warfarin (Coumadin). Which lab test will be used to monitor the therapeutic effect of this drug?

D-Dimer

Prothrombin Time (PT) and International Normalized Ratio (INR)

Platelet Count

Activated Partial Thromboplastin Time (aPTT)

Prothrombin Time (PT) and International Normalized Ratio (INR)

A patient has a critically high INR of 8.0 and is actively bleeding. The nurse should anticipate an order for which antidote for warfarin toxicity?

Protamine Sulfate

Vitamin K

Digoxin immune Fab (Digibind)

Naloxone (Narcan)

Vitamin K

A patient is on a continuous IV heparin infusion for a DVT. Their most recent aPTT is 150 seconds (ref is 25-35 seconds). What is the nurse's priority action?

Increase the infusion rate to reach the goal aPTT of 200.

Administer the antidote, Vitamin K.

Stop the infusion immediately and notify the provider.

Continue the infusion, as this is a therapeutic level.

Stop the infusion immediately and notify the provider.

What is the primary advantage of using a direct oral anticoagulant (DOAC) like apixaban (Eliquis) instead of warfarin?

It is much less expensive than warfarin.

It has an antidote that is easier to give (a simple pill).

It works by helping your platelets stick together better.

It does not require routine lab monitoring (like INR).

It does not require routine lab monitoring (like INR).

A nurse is teaching a patient about warfarin (Coumadin) and diet. Which statement by the patient indicates a need for further teaching (is wrong)?

I will use a soft-bristle toothbrush and an electric razor.

I will need to come to the clinic for regular blood tests.

I must avoid all green leafy vegetables, like spinach and kale, for as long as I am on this drug.

I should report any dark, tarry stools to my doctor right away.

I must avoid all green leafy vegetables, like spinach and kale, for as long as I am on this drug.

A patient receiving a heparin infusion for 5 days suddenly develops a platelet count of 45,000/mm³ (baseline was 250,000). The nurse should suspect what complication?

Warfarin-induced skin necrosis.

Aplastic anemia.

Normal therapeutic effect of heparin.

Heparin-Induced Thrombocytopenia (HIT).

Heparin-Induced Thrombocytopenia (HIT).

A patient is prescribed both heparin (IV) and warfarin (oral) at the same time. The patient asks, 'Why am I taking two blood thinners?' What is the nurse's best response?

The heparin is for your blood clot, and the warfarin is to prevent a stroke.

The two drugs work on different parts of the clotting cascade to make you 'extra thin'.

This is likely a mistake. I will call the pharmacy to correct it.

Warfarin takes 3-5 days to reach a therapeutic level, so we use heparin as a 'bridge' until the warfarin is working.

Warfarin takes 3-5 days to reach a therapeutic level, so we use heparin as a 'bridge' until the warfarin is working.

A nurse is teaching a patient about bleeding precautions. Which statement by the patient indicates they understand the teaching?

I should call my doctor immediately if I have a nosebleed that won't stop.

I will need to stop my anticoagulant if I get a small papercut.

I cannot participate in any sports, including walking.

I can take aspirin or ibuprofen for my arthritis pain.

I should call my doctor immediately if I have a nosebleed that won't stop.

A patient taking simvastatin (Zocor) calls the clinic complaining of 'terrible muscle pain' in their legs that they've never had before. What is the nurse's best instruction?

Question 35 options:

This is a normal side effect. Take some ibuprofen and it will go away.

You are probably just dehydrated. Drink 2-3 glasses of water and rest.

Try taking the medication in the morning instead of at night.

You should stop taking the drug and come in to be seen by the provider today.

You should stop taking the drug and come in to be seen by the provider today.

Which of the following lab tests should be monitored periodically for a patient on long-term atorvastatin therapy?

International Normalized Ratio (INR)

Serum Potassium

Liver Function Tests (AST/ALT)

Apical Heart Rate

Liver Function Tests (AST/ALT)

A nurse is teaching a 28-year-old female patient about her new prescription for atorvastatin. What is the most important teaching point for this specific patient?

You must use a reliable form of birth control, as this drug is Category X in pregnancy.

You must take the pill at night for it to work.

You must stop taking the drug if you get muscle aches.

You must use a reliable form of birth control, as this drug is Category X in pregnancy.

Which of the following would be an expected therapeutic outcome for a patient who is compliant with their atorvastatin therapy?

A decrease in the INR.

An increase in the AST and ALT (liver enzymes).

A rise in serum creatinine.

A decrease in the LDL cholesterol level.

A decrease in the LDL cholesterol level.

A patient in supraventricular tachycardia (SVT) with a heart rate of 180 bpm is ordered IV adenosine. What is the priority nursing action for administering this drug?

Push the medication slowly, over 2-3 minutes, to prevent a drop in blood pressure.

Dilute the medication in 50 mL of normal saline and infuse it over 10 minutes.

Push the medication as a rapid IV bolus (1-2 seconds) followed by a fast saline flush.

Check the patient's potassium level before giving the drug.

Push the medication as a rapid IV bolus (1-2 seconds) followed by a fast saline flush.

A nurse is preparing to administer a scheduled dose of oral diltiazem (Cardizem) to a patient with atrial fibrillation. Which assessment finding would cause the nurse to hold the dose?

Patient has 1+ peripheral edema.

Heart rate 52 bpm

Blood pressure 148/90 mmHg

Patient complaint of a mild headache.

Heart rate 52 bpm

A patient is receiving a continuous IV lidocaine infusion for ventricular tachycardia. The nurse assesses the patient and notes new-onset confusion, slurred speech, and paresthesia (tingling) around the mouth. The nurse should suspect what?

hypoglycemia

Lidocaine (neuro) toxicity

An allergic reaction

A CVA stroke

Lidocaine (neuro) toxicity

A patient has atrial fibrillation with a heart rate of 130 bpm. Why would a provider order diltiazem (a non-dihydropyridine CCB) instead of amlodipine (a dihydropyridine CCB)?

Amlodipine causes a dry, hacking cough.

Diltiazem has a lower risk of causing bradycardia.

Diltiazem controls heart rate by slowing AV nodal conduction, while amlodipine does not.

Amlodipine is not as effective at lowering blood pressure.

Diltiazem controls heart rate by slowing AV nodal conduction, while amlodipine does not.

Lidocaine is a Class Ib antidysrhythmic (Na Blocker). It is used to treat which specific type of dysrhythmia?

Ventricular tachycardia (V-tach).

Supraventricular tachycardia (SVT).

Sinus bradycardia.

Atrial fibrillation or atrial flutter.

Ventricular tachycardia (V-tach).

A patient's aPTT result comes back at 120 seconds (therapeutic range is 60-80 seconds). The patient is on a heparin infusion. What is the nurse's priority action?

Stop the heparin infusion and notify the provider.

Increase the heparin infusion rate to reach the goal.

Continue the infusion, as this is a safe level.

Administer the antidote, Vitamin K.

Stop the heparin infusion and notify the provider.

A patient is receiving alteplase (tPA), a thrombolytic, for an acute MI. The nurse knows this drug works by...

Reversing the effects of heparin.

Making the platelets less sticky.

Dissolving the fibrin that is holding the clot together.

Preventing new clots from forming.

Dissolving the fibrin that is holding the clot together.

A patient in the ED is being evaluated for an ischemic stroke and is a potential candidate for alteplase (tPA). Which of the following is an absolute contraindication for giving this drug?

The patient has a history of a broken leg 2 years ago.

The patient takes aspirin 81 mg daily.

The patient reports a recent history of a hemorrhagic stroke.

The patient's blood pressure is 160/90 mmHg.

The patient reports a recent history of a hemorrhagic stroke.

A nurse is teaching a patient why they are prescribed a low-dose (81 mg) aspirin every day to prevent a future heart attack. What is the best explanation?

Aspirin makes your platelets 'less sticky' so they can't clump together to form a clot.

Aspirin is a 'blood thinner' that stops your blood from clotting at all.

Aspirin dissolves any small clots that are already in your arteries.

Aspirin is a strong painkiller that will prevent chest pain

Aspirin makes your platelets 'less sticky' so they can't clump together to form a clot.

A nurse is teaching a patient about long-term amiodarone therapy. Which patient statement indicates they understand the most critical and life-threatening side effect?

I should call my doctor immediately if I get a new, persistent dry cough or feel short of breath.

I understand my skin might turn a bluish-gray color on my face and arms.

I know I will need to get regular blood tests to check my thyroid and liver.

I will need to get my eyes checked every year because the drug can affect my vision.

I should call my doctor immediately if I get a new, persistent dry cough or feel short of breath.

A nurse is teaching a patient about bleeding precautions for anticoagulant therapy. Which statement by the patient indicates they understand the teaching?

I only need to call the doctor if I see bright red blood, not dark stools that's ok.

I will use a soft-bristle toothbrush and an electric razor.

I should eat a lot more green leafy vegetables to protect my blood.

I'm glad I can still take ibuprofen for my arthritis pain.

I will use a soft-bristle toothbrush and an electric razor.

A nurse is teaching a patient about the diet for their new warfarin (Coumadin) prescription. What is the most accurate instruction?

You must eat more green leafy vegetables to prevent bleeding.

You must avoid all alcohol, as it will cause your blood to clot.

You should eat the same amount of Vitamin K-containing foods (like spinach) each week.

You must avoid all green leafy vegetables, like spinach and kale.

You should eat the same amount of Vitamin K-containing foods (like spinach) each week.