THE HEART AND CIRCULATORY SYSTEM PART 1

1. Which drug is used to help establish the diagnosis of pheochromocytoma?
   a. prazosin (Minipress®)
   b. phentolamine (Rogitine®)
   c. carvedilol
   d. tamsulosin (Flomax®)

b. phentolamine (Rogitine®)

2. A patient is going home with a new prescription for the -blocker atenolol (Tenormin®). What important information should the nurse tell the patient about this drug?
   a. Never abruptly stop taking this medication.
   b. The medication should be stopped once symptoms subside.
   c. Change positions slowly to prevent or reduce postural hypotension.
   d. Report any weight gain of more than 0.5 kg in a week or any problem with fluid
   buildup.

a. Never abruptly stop taking this medication.

3. A patient has been on a dopamine drip, and the nurse notices that the infusion has extravasated into the tissue of the forearm. After stopping the infusion, the nurse immediately injects phentolamine into the interstitial catheter. What is the effect of this action?
   a. It causes vasoconstriction and rapid uptake of the extravasated dopamine.
   b. It causes arterial vasoconstriction and reduced pain and swelling at the site.
   c. It increases peripheral vascular resistance and reduces arterial pressure at the site.
   d. It increases blood flow to the ischemic site by vasodilation and prevents
   permanent tissue damage.

d. It increases blood flow to the ischemic site by vasodilation and prevents
permanent tissue damage.

4. A 58-year-old male has had a myocardial infarction (MI). He has begun rehabilitation and is ready for discharge. When he is given a prescription for metoprolol (Lopressor®), he becomes upset and says, “I don’t have high blood pressure! Why did my doctor give me this medicine?” What is the nurse’s best explanation to the patient?
   a. This medication prevents emboli that may lead to another MI.
   b. -Blockers are routinely prescribed for all post-MI patients.
   c. It is being prescribed to prevent hypertension that often occurs post MI.
   d. Studies have shown that this medication greatly increases survival in post-MI
   patients.

d. Studies have shown that this medication greatly increases survival in post-MI
patients.

5. A patient has received a prescription for prazosin (Minipress) to reduce urinary obstruction due to benign prostatic hyperplasia (BPH). What important information about this medication should the nurse give this patient?
   a. Fluids should be restricted while on this medication.
   b. Take the medication with breakfast to promote the maximum effects of the drug.
   c. Until a tolerance is built up, lightheadedness may occur when standing up after sitting or lying down.
   d. Blood pressure should be monitored because the medication may cause hypertension due to vasoconstriction.

c. Until a tolerance is built up, lightheadedness may occur when standing up after sitting or lying down.

6. A female patient has been admitted to the emergency department after an accidental overdose of an -blocker. Her daughter states that her mother called to tell her that she had taken two double doses that morning because the headache “just would not go away.” The patient is now dizzy, nauseated, and very weak. What should the nurse do immediately?
   a. Administer activated charcoal
   b. Force intravenous and oral fluids
   c. Empty the stomach by gastric lavage
   d. Administer a cathartic such as sorbitol

c. Empty the stomach by gastric lavage

7. Which -blocker is indicated for the treatment of heart failure?
   a. atenolol (Tenormin)
   b. carvedilol
   c. acebutolol (Sectral®)
   d. esmolol (Brevibloc®)

b. carvedilol

8. The nurse is teaching a patient about self-monitoring while taking a -blocker at home. The nurse should teach the patient to measure apical pulse daily for 1 minute. What does the nurse instruct the patient to do if the pulse rate decreases to less than 60 beats per minute?
   a. Contact the physician for instructions.
   b. Reduce the dose of the -blocker by half.
   c. Continue the medication, because this is an expected effect.
   d. Skip the medication dose that day and check the pulse again the next day.

a. Contact the physician for instructions.

1. The physician has ordered doxazosin mesylate (Cardura®) for a female patient. What important information should the nurse give this patient?
   a. She should weigh herself daily and report any weight loss to the physician.
   b. She must increase her potassium intake by eating more bananas and apricots.
   c. The impaired taste associated with the medication usually goes away in 2 to 3
   weeks.
   d. She should take her first dose while lying down, because prazosin has a first-dose
   effect.

d. She should take her first dose while lying down, because prazosin has a first-dose
effect.

2. Which is the best angiotensin-converting enzyme (ACE) inhibitor for a patient who has liver dysfunction in addition to an acute myocardial infarction?
   a. quinapril (Accupril®) because it is a prodrug
   b. captopril (Capoten®) because it is not a prodrug
   c. lisinopril (Prinivil®) because it can be dosed only once a day
   d. enalapril (Vasotec®) because it is also available in a parenteral form

b. captopril (Capoten®) because it is not a prodrug

3. Why does a physician examine the fundus of a patient’s eyes during antihypertensive therapy?
   a. To monitor for drug toxicity
   b. To assess for increased intraocular pressure
   c. To assess for visual changes that may occur with drug therapy
   d. To evaluate the long-term effectiveness of the treatment

d. To evaluate the long-term effectiveness of the treatment

4. Which parameters determine the regulation of arterial blood pressure?
   a. Cardiac output and vascular resistance
   b. Heart rate and peripheral resistance
   c. Blood volume and renal blood flow
   d. Myocardial contractility and arteriolar constriction

a. Cardiac output and vascular resistance

5. Which adverse effect commonly occurs in male patients who are taking antihypertensive medications?
   a. Erectile dysfunction
   b. Bradycardia
   c. Increased libido
   d. Increased weight

a. Erectile dysfunction

6. Antihypertensive drug therapy has been prescribed for a Black male patient newly diagnosed with stage 1 hypertension. What is most likely included in his medication therapy?
   a. Vasodilators alone
   b. ACE inhibitors alone
   c. Calcium channel blockers with thiazide diuretic
   d. -Blockers with thiazide diuretic

c. Calcium channel blockers with thiazide diuretic

7. Which is a potential nursing diagnosis for a patient taking antihypertensive medications?
   a. Diarrhea
   b. Sexual dysfunction
   c. Stress urinary incontinence
   d. Impaired memory

b. Sexual dysfunction

8. A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be
   needed. What is the best answer to the patient’s question?
   a. 1 month
   b. 1 year
   c. Until symptoms disappear
   d. Lifelong

d. Lifelong

9. A persistent cough is an adverse effect of which class of antihypertensive drugs?
   cou
   a
   a. -Blockers
   b. ACE inhibitors
   c. Angiotensin receptor blockers
   d. Calcium channel blockers
   ACEn =

ACE inhibitors cause a characteristic dry, hacking, nonproductive chronic cough that reverses when therapy is stopped.

10. A patient diagnosed with prehypertension has which blood pressure reading?
    a. Systolic blood pressure of less than 120 mm Hg and diastolic blood pressure less

    than 80 mm Hg

    b. Systolic blood pressure between 120 and 139 mm Hg and diastolic blood pressure

    between 80 and 89 mm Hg

    c. Systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure

    between 90 and 99 mm Hg

    d. Systolic blood pressure between 160 and 179 mm Hg and diastolic blood pressure

    100 and 109 mm Hg

b. Systolic blood pressure between 120 and 139 mm Hg and diastolic blood pressure between 80 and 89 mm Hg

11. A patient has hypertension, together with type I diabetes mellitus and proteinuria. Which drug is considered to have renal-protective effects for these medical diagnoses?
    a. Which drug is considered to have renal-protective effects for these medical diagnoses?
    a. -Blockers
    b. ACE inhibitors
    c. Diuretics
    d. Calcium channel blockers

b. ACE inhibitors

12. Why do patients on -adrenergic agonists require close assessment of pulse, blood pressure, and weight?
    a. Because of strong vasoconstricting properties
    b. Because of hypertensive effects
    c. Because of strong vasodilating properties
    d. Because of the risk of fluid overload

c. Because of strong vasodilating properties

1. Cholestyramine (Novo-Cholamine®) and colestipol (Colestid®) are most effective in the treatment of which type of hyperlipoproteinemia?
   a. Type V
   b. Mixed
   c. All types
   d. Type II

d. Type II

2. A patient is receiving an antilipemic drug. The nurse should tell the patient to do what in regard to this medication?
   a. Begin a vigorous aerobic exercise program.
   b. Eat extra servings of raw vegetables and fruit.
   c. If a once-a-day dosage regimen is used, take the medication in the morning.
   d. To maximize drug absorption, take the medication 1 hour before meals or 2 hours after meals.

b. Eat extra servings of raw vegetables and fruit.

3. What should be a patient be told to do to minimize the undesirable adverse effects of nicotinic acid?
   a. Take the drug on an empty stomach.
   b. Start off with a high initial dosage.
   c. Take small doses of Aspirin with the drug.
   d. Take the drug with large amounts of fibre.

c. Take small doses of Aspirin with the drug.

4. A patient reports that the cholestyramine resin powder (Olestyr®) that was started yesterday clumps and sticks to the glass when being mixed. What is the nurse’s best suggestion to the patient for mixing this medication for administration?
   a. Use a carbonated soft drink to dissolve the powder faster.
   b. Add the powder to any liquid and stir vigorously to dissolve it quickly.
   c. Mix the powder with food or with 120 to 180 mL of fluid.
   d. Sprinkle the powder into a spoon and take it dry, followed with a glass of water.

c. Mix the powder with food or with 120 to 180 mL of fluid.

5. A patient is taking gemfibrozil to lower her cholesterol level.
   Which adverse effect of this medication should the nurse tell the patient about?
   a. Constipation
   b. Diarrhea
   c. Joint pain
   d. Dry mouth

b. Diarrhea

6. Patients who are receiving antilipemic drugs need to be closely monitored for the development of which adverse effect?
   a. Photosensitivity
   b. Pulmonary problems
   c. Vitamin C deficiency
   d. Liver dysfunction

d. Liver dysfunction

7. Which patient is a likely candidate for drug therapy for cholesterol reduction?
   a. A female patient with a waist circumference greater than 95 cm and a triglyceride
   level greater than or equal to 1.7 mmol/L
   b. A male patient with a high-density lipoprotein cholesterol (HDL-C) level greater
   than 1 mmol/L and blood pressure (BP) greater than 130/85 mm Hg
   c. A female patient with an HDL-C level greater than 1.3 mmol/L and BP greater
   than 130/85 mm Hg
   d. A male patient with a waist circumference greater than 102 cm and a triglyceride
   level of 1.7 mmol/L or higher

d. A male patient with a waist circumference greater than 102 cm and a triglyceride
level of 1.7 mmol/L or higher

8. Which lipoproteins are indicative of a high risk for developing an atherosclerotic plaque formation?
   a. Chylomicrons
   b. Low-density lipoproteins (LDLs)
   c. High-density lipoproteins (HDLs)
   d. Very-low-density lipoproteins

b. Low-density lipoproteins (LDLs)

9. A patient who has recently started therapy with a statin drug asks the nurse how long it will take for an effect on his serum cholesterol to be seen. Which is the nurse’s best response to the patient’s question?
   a. “Blood levels return to normal within a week of beginning therapy.”
   b. “It takes several weeks to see a change in cholesterol levels.”
   c. “It takes at least 6 months to see a change in cholesterol levels.”
   d. “You will need to take this medication for almost a year to see significant
   results.”

b. “It takes several weeks to see a change in cholesterol levels.”

10. The nurse should monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs?
    a. Bile acid sequestrants
    b. Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors
    c. Fibric acid derivatives
    d. Niacin

b. Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors

11. A patient is beginning antilipemic therapy with an HMG–CoA reductase inhibitor. What food should the nurse tell the patient about when discussing possible drug–food interactions?
    a. Oatmeal
    b. Grapefruit juice
    c. Licorice
    d. Dairy products

Taking HMG–CoA reductase inhibitors with grapefruit juice may cause complications.

12. Ezetimibe (Ezetrol®), a newer antilipemic drug, works by doing what?
    a. Preventing the resorption of bile acids from the small intestines
    b. Inhibiting HMG–CoA reductase
    c. Activating lipase, which breaks down cholesterol
    d. Inhibiting cholesterol absorption in the small intestine

d. Inhibiting cholesterol absorption in the small intestine

12. Ezetimibe (Ezetrol®), a newer antilipemic drug, works by doing what?
    a. Preventing the resorption of bile acids from the small intestines
    b. Inhibiting HMG–CoA reductase
    c. Activating lipase, which breaks down cholesterol
    d. Inhibiting cholesterol absorption in the small intestine

d. Inhibiting cholesterol absorption in the small intestine

13. A patient is taking a statin drug. What important action should the nurse tell this patient to take?
    a. Have a hearing assessment done.
    b. Report unexpected muscular pain.
    c. See a physiotherapist.
    d. Take the medication with breakfast.

b. Report unexpected muscular pain.

1. Which are considered positive risk factors for coronary artery disease? (Select all that apply.)
   a. Male aged 40 years or older

   b. Female aged 40 years or older

   c. Family history that includes a sister who died of a myocardial infarction at age 58

   d. Family history that includes a brother who died of a myocardial infarction at age

   40

   e. Current cigarette smoker

   f. Slight build

   g. Hypertension

   h. History of gallbladder disease

ADEG

1. Which is a true statement about carbonic anhydrase inhibitors (CAIs)?
   a. CAIs induce metabolic alkalosis.
   b. CAIs can elevate the blood glucose level in diabetic patients.
   c. CAIs are contraindicated in the presence of glaucoma.
   d. CAIs are effective as prolonged therapy for seizures.

b. CAIs can elevate the blood glucose level in diabetic patients.

2. Patients who are placed on spironolactone (Aldactone®) should be assessed continuously for which condition? a. Hypokalemia
   b. Hyperkalemia
   c. Hyponatremia
   d. Hypercalcemia

Hyperkalemia may occur with administration of potassium-sparing diuretics.

3. The physician has ordered mannitol (Osmitrol®) for a patient. How should this drug be administered?
   a. Intravenously, through a filter

   b. By rapid intravenous (IV) bolus

   c. 20 to 80 mg orally (PO) daily, in a single morning dose

   d. By oral or IV route, depending on the severity of the patient’s condition

a. Intravenously, through a filter

4. A patient with a new prescription for furosemide (Lasix®) is being discharged. What should the nurse say to this patient concerning this new prescription?
   a. “Keep a weekly journal or log of your weight.”
   b. “Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and
   dates.”
   c. “If you experience weight gain, such as 2.3 kg or more a week, be sure to tell
   your physician during your next routine visit.”
   d. “Be sure to change your body position slowly and rise slowly after sitting or
   lying. Making slow movements will prevent dizziness and possible fainting
   because of blood pressure changes.”

d. “Be sure to change your body position slowly and rise slowly after sitting or
lying. Making slow movements will prevent dizziness and possible fainting
because of blood pressure changes.”

5. Which statement is true of loop diuretics?
   a. They are also called aldosterone-inhibiting diuretics.
   b. They are very potent, providing a diuretic effect that lasts at least 6 hours.
   c. Because their onset of action is rapid, they are particularly useful when rapid
   diuresis is desired.
   d. They have the disadvantage of ceasing to be effective when creatinine clearance
   decreases below 25 mL per minute.

c. Because their onset of action is rapid, they are particularly useful when rapid
diuresis is desired.

6. The nurse is teaching a patient about using hydrochlorothiazide. The nurse should ensure the patient knows to be cautious when taking which medication with hydrochlorothiazide?
   a. digitalis
   b. Antacids
   c. Potassium supplements
   d. Over-the-counter Aspirin preparations

a. digitalis

7. The manifestations of potassium deficiency include which condition? a. Dyspnea
   b. Diarrhea
   c. Weakness
   d. Hypertension

Weakness is a manifestation of hypokalemia (low potassium levels).

8. A patient is being discharged home on a single daily dose of a diuretic. So that there will be no unnecessary disruptions to the patient’s daily routine, the health care provider instructs the patient to take the dose at what time?
   a. In the morning

   b. At noon

   c. With supper

   d. At bedtime

a. In the morning

9. When a patient is receiving diuretic therapy, what best reflects the patient’s fluid volume status?
   a. Moisture of mucous membranes
   b. Serum potassium and sodium levels
   c. Intake, output, and daily weight
   d. Abdominal girth and calf circumference

c. Intake, output, and daily weight

10. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is to be used initially?
    a. Loop diuretics
    b. Osmotic diuretics
    c. Thiazide diuretics
    d. Vasodilators

c. Thiazide diuretics

11. A patient in the neurological Critical Care Unit is being treated for cerebral edema. Which drug is the patient likely to be given to reduce intracranial pressure?
    a. Which drug is the patient likely to be given to reduce intracranial pressure?
    a. A loop diuretic
    b. An osmotic diuretic
    c. A thiazide diuretic
    d. A vasodilator

b. An osmotic diuretic

1. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency. Which symptoms are indicative of potassium deficiency? (Select all that apply.)
   a. Dyspnea

   b. Constipation

   c. Anorexia

   d. Tinnitus

   e. Muscle weakness

   f. Palpitations

   g. Mental confusion

   h. Lethargy

CEGH