pharmacology MCQ - 3

                              Cardiovascular Drugs - 2

 1. As a knowledgeable nurse, you know that the action of nitrates is:

A. Smooth muscle contraction
B. Vasoconstriction
C. Smooth muscle relaxation
D. Increase preload

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

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

4. When nitrates are administered early to the acute MI client, the effect is:

A. Hypotension
B. Bradycardia
C. Reduced mortality
D. Reduced morbidity

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.

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

7. Nurse ananthi 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

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.”

9. Mr. sundaram is a hypertensive client who has been placed on enalapril . He states, “Dr. suresh , 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.”

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

11. Raja  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

12. As a competent nurse, you are aware that vasodilators are used mainly to treat:

A. Diabetes
B. Hypertension
C. Atrial fibrillation
D. 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

14. In a 50-year-old man  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)

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

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

17. Which of the following is a potential side effect of IV furosemide (Lasix)?

A. Drowsiness
B. Diarrhea
C. Cystitis
D. Hearing loss

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

19. All potassium-sparing diuretics:

A. Are required supplements during blood transfusion
B. Enhance aldosterone action
C. Cause hypokalemia
D. Are weak diuretics

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

21. Khan  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

22. For lipid-lowering agents to be successful, drug therapy must lower:

A. HDL
B. LDL
C. Total fat
D. All of the above

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

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

25. Which of the following lipid-lowering agents has the common side effect of constipation?

A. Atorvastatin (Mevacor)
B. colestipol (Colestid)
C. gemfibrozil (Lopid)
D. niacin (Nicotinic acid)

26. Parental 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

27. SubCutenous heparin should be administered in the:

A. Flank
B. Abdominal fat
C. Leg
D. Gluteal area

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

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)

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

---------------------------------------------------------------------------------

Answers and Rationale

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. 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. Answer: C. isosorbide PO (per oral)

Isosorbide is one of the most frequently administered long-acting nitrates. PO nitrates are longer acting than IV or SL agents.

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. 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. 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. 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. 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. 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. 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. 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, 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. Answer: D. All of the above

All are vasodilators used primarily to treat peripheral or cerebral vascular obstructive disease.

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. 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. 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. Answer: D. Hearing loss

Patients receiving large doses of loop diuretics are at risk for developing ototoxicity.

18. Answer: A. Fluid volume excess

Mannitol’s osmotic effect extends to the bloodstream, where increased osmotic pressure draws fluid into the vascular space, thus elevating intravascular volume.

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. Answer: D. A 75-year-old man

Elderly clients are more sensitive to the effects of diuretics.

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. 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. 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. 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. Answer: A. Atorvavastatin

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. Answer: B. Abdominal fat

Heparin should be given in the abdominal area around the umbilicus, deep into the fat.

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. Answer: D. protamine sulfate (Protamine)

Protamine is the drug used to reverse the adverse effects of bleeding that occurs with heparin administration.

30. Answer: C. 8 to 12

Initial extension of PT occurs within 8 to 12 hours after warfarin therapy begins.