Download Pharmacology - Cardiovascular drugs II NCLEX MCQs

Pharmacology Cardiovascular drugs Part II
1. As a knowledgeable nurse, you know that the action of nitrates is:
A. A. Smooth muscle contraction
B. Vasoconstriction
C. Smooth muscle relaxation
D. Increase preload
1. Answer:
C. Smooth muscle relaxation
Nitrates cause smooth muscle relaxation, vasodilation, reduction of preload, and improved
blood flow to the myocardium. Other choices have opposite effect of nitrates.
2. A 50-year-old client is prescribed to take nitrate each day for his condition. As a competent
nurse, you know the result of nitrate administration is:
A. Decreased myocardial oxygen demand
B. Increased myocardial oxygen demand
C. Increased left ventricular end-diastolic volume
D. Increased atrial pressure
2. Answer:
A. Decreased myocardial oxygen demand
Nitrate administration will result in reduced preload and a decrease in myocardial oxygen
demand and left ventricular end-diastolic volume.
3. A student nurse is asked to give an example of a long-acting nitrate. He is correct by saying:
A. nitroglycerin sublingual
B. nitroglycerin IV
C. isosorbide PO
D. nitroglycerin transmucosal
3. Answer: C. isosorbide PO
Isosorbide is one of the most frequently administered long-acting nitrates. PO nitrates are
longer acting than IV or SL agents.
4. When nitrates are administered early to the acute MI client, the effect is:
A. Hypotension
B. Bradycardia
C. Reduced mortality
D. Reduced morbidity
4. Answer: C. Reduced mortality
Research has shown that when nitrates are administered early to the acute MI client, the
effect is reduced mortality, infarct size, infarct extension, and related complications.
Hypotension will result from nitrate administration, but it is not the reason for
prescribing the drug. Tachycardia rather than bradycardia is more likely to occur with
nitrate administration. The morbidity is already present because the client has the pain.
5. When teaching about nitrate administration, the nurse should instruct the client to:
.
A. Change position slowly.
B. Take pulse daily.
C. Reduce salt intake.
D. Chew the sustained-release tablets
5. Answer: A. Change position slowly.
Clients taking nitrates should change position slowly to avoid orthostatic hypotension. It is
not necessary to take the pulse before taking this drug. It is also not necessary to change
the diet while taking this drug. It is contraindicated to chew sustained-release tablets.
6. ACEs participate in the renin-angiotensin-aldosterone system to have which of the following
physiologic effects?
A. Inhibit conversion of angiotensin II to angiotensin I
B. Vasoconstriction and sodium depletion
C. Promote sodium and water retention
D. Stimulate vasodilation and inhibit sodium depletion
6. Answer: C. Promote sodium and water retention
Angiotensin is a potent vasoconstrictor that stimulate the release of aldosterone.
Aldosterone release promotes sodium and water retention. The conversion of
angiotensin I to II is not inhibited. Aldosterone promotes sodium retention not
depletion. Vasoconstriction not vasodilation results.
7. Nurse Margie just administered an ACE inhibitor to her client. Before ambulating the client for
the first time after administration, the nurse should monitor for:
A. Hypokalemia
B. Irregular heartbeat
C. Edema
D. Hypotension
7. Answer: D. Hypotension
ACE inhibitors prevent vasoconstriction and lower blood pressure, placing the client at
greater risk for postural (orthostatic) hypotension. ACE inhibitors reduce potassium
excretion placing the client at risk for hyperkalemia. ACE inhibitors do not affect heart
rate. ACE inhibitor promote sodium excretion thereby decreasing edema.
8. Mira is managing her hypertension with an ACE inhibitor. Which of the following statements
stated by her indicates a need for further instruction?
A. “I should not take my pills with food.”
B. “I need to increase my intake of orange juice, bananas, and green vegetables.”
C. “I will avoid coffee, tea, and colas.”
D. “I will use salt substitutes that are not high in potassium.”
8. Answer: B. “I need to increase my intake of orange juice, bananas, and green
vegetables.”
The client needs to understand the risk of hyperkalemia and foods to eat in moderation.
Taking medications with food will decrease therapeutic effects of ACE inhibitors.
Excessive amounts of caffeine should be avoided. Avoidance of salt substitutes that are
high in potassium decrease the risk of hyperkalemia.
9. Pepito is a hypertensive client who has been placed on captopril (Capoten). He states, “Dr. del Mundo
keeps changing my pills and none are working. I feel like a guinea pig.” Which of the following responses
by the nurse would be most appropriate?
A. “It often takes a while before the right medication is found.”
B. “The doctor is just trying to help you control your blood pressure.”
C. “The action of this drug is to work on both the arteries and to remove excess
fluids.”
D. “This drug is used when other drugs have failed.”
9. Answer: D. “This drug is used when other drugs have failed.”
This response provides accurate information about the medication. Choice A placates the
client and provides no information about the new medication. Choice B is defensive.
Although choice C is true, there is no information provided to motivate the client.
10. The action of an ACE inhibitor interrupts the renin-angiotensin-aldosterone mechanism,
thereby producing which of the following?
A. Reduced renal blood flow
B. Reduced sodium and water excretion
C. Increased peripheral vascular resistance
D. Increased sodium excretion and potassium reabsorption
10. Answer: D. Increased sodium excretion and potassium reabsorption
The inhibition of aldosterone increases sodium excretion and reduces potassium
excretion. ACE inhibitors increases renal blood flow. Excretion of sodium and water is
enhanced by ACE inhibitors. Peripheral vascular resistance is decreased by vasodilation
effect of ACE inhibitors.
11. Raymund is reviewing on cardiovascular drugs for his upcoming exam. For a well-prepared student, he
should know that vasodilators are agents that:
A. Relax smooth muscles
B. Are used to treat hypotension
C. Stimulate the adrenergic receptors of peripheral sympathetic nerves
D. Cause respiratory depression
11. Answer: A. Relax smooth muscles
Vasodilators relax smooth muscle. They are used to treat hypertension, not hypotension.
Stimulating the adrenergic receptors of peripheral sympathetic nerves causes blood
vessels to contract. Choice D is not an action of vasodilators.
12. As a competent nurse, you are aware that vasodilators are used mainly to treat:
A. Diabetes
B. Hypertension
C. Atrial fibrillation
D. Hypotension
12, Answer: B. Hypertension
Vasodilators are used to treat hypertension. They are not used to treat diabetes. Atrial
fibrillation is not treated with vasodilators. Vasodilators are not used to treat
hypotension.
13. The drug/drugs used most commonly to treat peripheral or cerebral vascular obstructive
disease is/are:
A. pentoxifylline (Trental)
B. cyclandelate (Cyclan)
C. isoxsuprine (Vasodilan)
D. All of the above
13. Answer: D. All of the above
All are vasodilators used primarily to treat peripheral or cerebral vascular obstructive
disease.
14. In a 50-year-old widower who had a transient ischemic attack, what is the most common
vasodilator used for his treatment?
A. norepinephrine
B. dopamine (Intropin)
C. papaverine (Pavabid)
D. nitroprusside (Nitropress)
14. Answer: D. nitroprusside (Nitropress)
Nitroprusside (Nitropress) is used in this situation. A and B are sympathomimetics used to
treat hypotension. Papaverine is contraindicated in myocardial depressant states.
15. For a client taking drugs to treat peripheral vascular disease, it is important to provide health
education about:
A. Smoking cessation
B. Developing a proper balance between rest and activity
C. Proper foot care
D. All of the above
15. Answer: D. All of the above
An important component in the treatment of peripheral vascular disease is health
education on preventing further injury to ischemic tissues. Medication therapy is only
one aspect.
16. A clinical instructor asks a nursing student about aldosterone antagonist. The
student is correct by saying that aldosterone antagonists:
A. Create an osmotic gradient
B. Inhibit the exchange of sodium for potassium
C. Cause metabolic acidosis
D. Work poorly in the presence of endogenous aldosterone
16. Answer:
B. Inhibit the exchange of sodium for potassium
Aldosterone antagonists compete with endogenous aldosterone and prevent sodium
reabsorption in exchange for potassium elimination. Aldosterone antagonists work on
inhibiting the action of aldosterone rather than creating an osmotic gradient. Aldosterone
antagonist do not cause metabolic acidosis. Aldosterone antagonists must work in the
presence of endogenous aldosterone.
17. Which of the following is a potential side effect of IV furosemide (Lasix)?
A. Drowsiness
B. Diarrhea
C. Cystitis
D. Hearing loss
17. Answer: D. Hearing loss
Patients receiving large doses of loop diuretics are at risk for developing ototoxicity.
18. A 68-year-old client with a history of mild CHF and glaucoma is receiving IV
mannitol (Osmitrol) to decrease intraocular pressure. The nurse would monitor the
client for signs and symptoms of:
A. Fluid volume excess
B. Fluid volume deficit
C. Hyperkalemia
D. Hypernatremia
18. Answer:
A. Fluid volume excess
Mannitol’s osmotic effect extends to the bloodstream, where increased osmotic pressure draw
fluid into the vascular space, thus elevating intravascular volume.
19. All potassium-sparing diuretics:
A. Are required supplements during blood transfusion
B. Enhance aldosterone action
C. Cause hypokalemia
D. Are weak diuretics
19. Answer: D. Are weak diuretics
Potassium-sparing diuretics are not potent diuretics when used alone. They are used as
adjunctive therapy with other diuretics to minimize potassium loss. Potassium-sparing
diuretics given during blood transfusions tend to cause hyperkalemia because potassium is
present in the transfusion. These drugs block aldosterone’s effects. These drugs cause
hyperkalemia, not hypokalemia.
20. Which of the following clients is most likely to experience adverse effects
from treatment with diuretics?
A. A 21-year-old student
B. A 40-year-old unmarried man
C. A 60-year-old widower
D. A 75-year-old man
20. Answer:
D. A 75-year-old man
Elderly clients are more sensitive to the effects of diuretics.
21. Kylie is reviewing drugs related to cardiovascular therapies. She should be aware that the
desired action of lipid-lowering agents is to:
A. Decrease HDL
B. Increase TC
C. Increase LDL
D. Increase HDL
21. Answer: D. Increase HDL
The desired effect of lipid-lowering agents is to decrease cardiac risk by lowering TC, TG, and
LDL and increasing or maintaining HDL.
22. For lipid-lowering agents to be successful, drug therapy must lower:
A. HDL
B. LDL
C. Total fat
D. All of the above
22. Answer:
B. LDL
An elevated LDL is the most significant risk factor for the development of atherosclerosis;
therefore, for drug therapy to be effective, LDL must be reduced.
23. As a competent nurse, you know that the most significant contraindication for therapy with
lipid-lowering agent is:
A. Renal disease
B. Diabetes
C. Liver disease
D. Cardiac disease
23. Answer:
C. Liver disease
All lipid-lowering agents except the bile acid sequestrants are potentially hepatotoxic, so the
most significant contraindication is liver disease.
24. Which of the following vitamins may not be absorbed properly when giving bile acid
sequestrants?
A. Vitamin B
B. Vitamin C
C. Vitamin B12
D. Vitamin K
24. Answer: D. Vitamin K
Vitamin K absorption may be reduced when giving these drugs. The only fat-soluble vitamin
here is vitamin K, which is synthesized in the liver.
25. Which of the following lipid-lowering agents has the common side effect of constipation?
A. lovastatin (Mevacor)
B. colestipol (Colestid)
C. gemfibrozil (Lopid)
D. niacin (Nicotinic acid)
25. Answer: A. lovastatin (Mevacor)
Mevacor is known to cause constipation.
26. Parenteral anticoagulants work by disrupting:
A. Conversion of prothrombin to thrombin
B. Formation of thromboplastin
C. Vitamin K-dependent clotting factors
D. Conversion of prothrombin to fibrin
26. Answer:
A. Conversion of prothrombin to thrombin
Parenteral anticoagulants such as heparin work by disrupting conversion of prothrombin to
thrombin. Tissue thromboplastin is formed in the extrinsic pathway as tissue is damaged.
Oral anticoagulants work by interfering with vitamin K-dependent clotting factors.
Prothrombin does not convert to fibrin.
27. SC heparin should be administered in the:
A. Flank
B. Abdominal fat
C. Leg
D. Gluteal area
27. Answer:
B. Abdominal fat
Heparin should be given in the abdominal area around the umbilicus, deep into the fat.
28. The half-life of heparin is:
A. 10 minutes
B. 1 to 1.5 hours
C. 8 to 12 hours
D. 1 to 2 days
28. Answer:
B. 1 to 1.5 hours
The half-life of heparin is 60 to 90 minutes. This is important to know when bleeding occurs
during heparin administration.
29. Which drug is used to stop bleeding associated with heparin overdose?
A. urokinase (Abbokinase)
B. aminocaproic acid (Amicar)
C. vitamin K (AquaMEPHYTON)
D. protamine sulfate (Protamine)
29. Answer: D. protamine sulfate (Protamine)
Protamine is the drug used to reverse the adverse effects of bleeding that occurs with heparin
administration.
30. During warfarin (Coumadin) administration, the nurse can expect that the initial extension of
PT occurs within _____ hours after therapy begins.
A. 1 to 2
B. 4 to 6
C. 8 to 12
D. 12 to 24
30. Answer: C. 8 to 12
Initial extension of PT occurs within 8 to 12 hours after warfarin therapy begins.
16. A client
16. A client