pharmacology MCQ -1

                                CARDIOVASCULAR  -  DRUGS

1. Which of the following clients is at greatest risk for digital toxicity?

A. A 25-year-old client with congenital heart disease
B. A 50-year-old client with CHF
C. A 60-year-old client after myocardial infarction
D. An 80-year-old client with CHF

2. Which of the following is a contraindication for digoxin administration?

A. Blood pressure of 140/90
B. Heart rate above 80
C. Heart rate below 60
D. Respiratory rate above 20

3. The action of medication is inotropic when it:

A. Decreased afterload
B. Increases heart rate
C. Increases the force of contraction
D. Is used to treat CHF

4. Which is the MOST appropriate action for the nurse to take before administering digoxin?

A. Monitor potassium level
B. Assess blood pressure
C. Evaluate urinary output
D. Avoid giving with thiazide diuretic

5. The therapeutic drug level for digoxin is:

A. 0.1-2.0 ng/mg
B. 1.0-2.0 ng/mg
C. 0.1-0.5 ng/mg
D. 0.5-2.0 ng/mg

6. Blurred vision or halos are signs of:

A. Subtherapeutic digoxin levels
B. Digoxin toxicity
C. Nothing related to digoxin
D. Corneal side effects of digoxin

7. Amrinone (Inocor) is used for short term therapy for CHF and acts by which of the following mechanisms?

A. Increasing stroke volume and heart rate
B. Slowing ventricular rate and increasing cardiac output
C. Vasodilating and increasing peripheral vascular resistance
D. Increasing cardiac output and enhancing renal perfusion

8. Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the following nursing actions is necessary?

A. Record sodium level.
B. Administer loading dose over 15 minutes.
C. Assess CV status.
D. Review medication regimen to identify if client is on IV furosemide (Lasix).

9. Johanna has ventricular ectopy, which of the following drugs is the first line used to treat her condition?

A. quinidine (Cardioquin)
B. digoxin (Lanoxin)
C. procainamide ( Pronestyl)
D. lidocaine (Xylocaine)

10. Class IA antiarrhythmic agents have little effect on:

A. AV node
B. SA node
C. Purkinje fibers
D. Bundle of His

11. Which of the following drugs can cause severe hematologic disorders?

A. digoxin (Lanoxin)
B. quinidine (Cardioquin)
C. disopyramide (Norpace)
D. procainamide (Pronestyl)

12. Which of the following ECG findings alerts the nurse that the client needs an antiarrhythmic?

A. Normal sinus rhythm
B. Sinus bradycardia
C. Sinus arrhythmia
D. Frequent ventricular ectopy

13. When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate?

A. ECG
B. Pulse rate
C. Respiratory rate
D. Blood pressure

14. Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias?

A. Serum chemistries
B. Complete blood counts
C. Drug levels
D. None of the above

15. Which of the following drugs should be used only in situations in which the client can be very closely monitored, such as a critical care unit?

A. bretylium (Bretylol)
B. digoxin (Lanoxin)
C. quinidine (Cardioquin)
D. inderal (Propranolol)

16. The most toxic antiarrhythmic agent is:

A. digoxin (Lanoxin)
B. lidocaine (Xylocaine)
C. amiodarone (Cordarone)
D. quinidine (Cardioquin)

17. Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following actions?

A. Increased speed of conduction and gluconeogenesis
B. Bronchodilation and increased heart rate, contractility, and conduction
C. Increased vasodilation and enhanced myocardial contractility
D. Bronchoconstriction and increased heart rate

18. Following norepinephrine  administration, it is essential to the nurse to assess:

A. electrolyte status
B. color and temperature of toes and fingers
C. capillary refill
D. ventricular arrhythmias

19. Norepinephrine   is contraindicated in which of the following conditions?

A. Hypovolemic shock
B. Neurogenic shock
C. Blood pressures above 80-100 mmHg (systolic)
D. Decreased renal perfusion

20. When administering dopamine , it is most important for the nurse to know that:

A. the drug’s action varies according to the dose.
B. the drug may be used instead of fluid replacement.
C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline.
D. the lowest dose to produce the desired effect should be used.

21. Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the following conditions except:

A. septic shock
B. congestive heart failure
C. arrhythmias
D. pulmonary congestion

22. Conduction defects will most likely be an adverse associated with the use of:

A. verapamil
B. nifedipine
C. diltiazem
D. Amlodipine

23. Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator effect?

A. diltiazem
B. nifedipine
C. amlodipine
D. verapamil

24. Which of the following adverse reactions is found more often in volume-depleted elderly clients?

A. Bradycardia
B. Conduction defects
C. Ankle edema
D. Hypotension

25. Which of the following calcium channel blockers is used to counteract or prevent cerebral vasospasm?

A. verapamil
B. amlodipine
C. nifedipine
D. felodipine

26. Which of the following effects of calcium channel blockers causes a reduction in blood pressure?

A. Increased cardiac output
B. Decreased peripheral vascular resistance
C. Decreased renal blood flow
D. Calcium influx into cardiac muscles

27. Ramesh  is taking ß blockers, all of the following should be included in his assessment except:

A. Pulmonary function tests
B. Baseline ECG
C. Glucose level
D. Blood pressure

28. Routine laboratory monitoring in clients taking ß blockers should include:

A. Sodium
B. Glucose
C. Thyrotropin
D. Creatine phosphokinase

29. Competitive antagonism of which of the following occurs at ß receptor sites?

A. Catecholamines
B. Adrenergic sites
C. Acetylcholine
D. Norepinephrine

30. ß blockers should be avoided in which of the following conditions?

A. Bronchoconstriction
B. Hypertension
C. Angina
D. Myocardial infarction

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Answers and Rationale

1. Answer: D. An 80-year-old client with CHF

Extremely old clients are at greater risk for digitalis toxicity. Remember when it comes to adversity, the very old and very young are always at highest risk.

2. Answer: C. Heart rate below 60

The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.

3. Answer: C. Increases the force of contraction

Inotropic drugs increase the force of contraction. Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an indication for use not an action of inotropic drug.

4. Answer: A. Monitor potassium level

Monitoring potassium is especially important because hypokalemia potentiates digoxin toxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.

5. Answer: D. 0.5-2.0 ng/mg

This is the correct therapeutic range for digoxin. Every nurse should know this information.

6. Answer: B. Digoxin toxicity

Halos is a hallmark sign of digoxin toxicity. A, C and D are incorrect because subtherapeutic digoxin levels have no such effects.

7. Answer: A. Increasing stroke volume and heart rate

The action of amrinone (Inocor) is to increase stroke volume, ejection fraction, and heart rate. Lanoxin, not amrinone, slows ventricular rate and increases cardiac output. The vasodilator effect of amrinone decreases peripheral vascular resistance. Any increase in cardiac output will enhance renal perfusion; this is not just specific to amrinone.

8. Answer: D. Review medication regimen to identify if client is on IV furosemide (Lasix).

Milrinone (Primacor) is incompatible with IV furosemide (Lasix), and many clients with CHF are taking furosemide. Assessing potassium, not sodium, is essential. Choice B is not done before administration but during administration. Assessment of CV status is not specific for milrinone and is indicated for any drug that affects the circulatory system.

9. Answer: D. lidocaine (Xylocaine)

Lidocaine is the only choice used to treat ventricular ectopy. A and C are class IA antiarrhythmics. Digoxin is a cardiac glycoside.

10. Answer: B. SA node

Class IA antiarrhythmics have little effect on the SA node.

11. Answer: D. procainamide (Pronestyl)

Pronestyl is known for this serious side effect. Associate Pronestyl with plasma — P and P. This drug is known for its hematologic side effects.

12. Answer: D. Frequent ventricular ectopy

Ventricular ectopy can be a life-threatening arrhythmia; therefore, the client needs an arrhythmic. Other choices are not arrhythmias that need to be treated.

13. Answer: A. ECG

The ECG is the most important parameter to assess. B, C, and D need to be monitored, but the ECG is the most important.

14. Answer: C. Drug levels

Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect.

15. Answer: A. bretylium (Bretylol)

Among the choices, this is the only agent that must be monitored this closely. B, C, and D are given to outpatients as oral preparations.

16. Answer: C. amiodarone (Cordarone)

This is the most toxic drug and should be used only if other less toxic agents have been tried. Digoxin, on the other hand, is cardiotonic, not antiarrhythmic agent. B and D are not known for their toxicity.

17. Answer: B. Bronchodilation and increased heart rate, contractility, and conduction

Bronchodilation results from stimulated beta receptors, and cardiac effects result from the stimulation of ß₁ receptors. Choice A does not address respiratory effects of medication. Choice C is incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not bronchoconstriction, results from ß₂ activity.

18. Answer: B. color and temperature of toes and fingers

Because decreased perfusion is a side effect of norepinephrine (Levophed), the nurse must check circulation frequently. Capillary refill is not a reliable indication of perfusion in a shock state. Choices A and D are not specific for norepinephrine.

19. Answer: A. Hypovolemic shock

Norepinephrine (Levophed) is contraindicated in hypovolemia. Neurogenic shock is an indication for norepinephrine use. Norepinephrine is given to maintain a systolic blood pressure of 80-100 mmHG. Decreased renal perfusion is an adverse reaction.

20. Answer: C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline.

The nurse is responsible for knowing compatible solutions before administering dopamine (Intropin). It is important to know that drug action varies by dose, but the physician is responsible for determining the dose. Dopamine should not be used instead of fluid replacement. Choice D is incorrect because, although it is true, it is not the nurse’s primary concern. It is a collaborative action in which the physician is involved in determining the rate.

21. Answer: C. arrhythmias

Dobutamine (Dobutrex) is not used to treat arrhythmias. Choices A, B, and D are conditions are conditions that respond to dobutamine.

22. Answer: A. verapamil

Verapamil (Calan) has the strongest chronotropic effect and will cause a delay in conduction at the SA and AV nodes.

23. Answer: B. nifedipine

Nifedipine has the strongest peripheral smooth muscle dilator effect of all the calcium channel blockers. Other choices have less of a vasodilator effect.

24. Answer: D. Hypotension

Hypotension is more likely to occur in the elderly. Choices A, B, and C may occur but are not necessarily increased in frequency in elderly clients.

25. Answer: B. amlodipine

ammodipine is given in the neurologic client to prevent cerebral vasospasm. Choices A, C, and D are given in cardiac disease and in the management of hypertension only.

26. Answer: B. Decreased peripheral vascular resistance

One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.

27. Answer: A. Pulmonary function tests

Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers.

28. Answer: B. Glucose

ß blockers influence glucose metabolism. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed.

29. Answer: A. Catecholamines

Catecholamine receptor sites are blocked by the action of ß-blocking agents. Adrenergic sites may be blocked, but the more appropriate response is catecholamine receptors. Acetylcholine is not affected by ß blockers. Noradrenaline is a catecholamine.

30. Answer: A. Bronchoconstriction

ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.