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
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
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
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
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
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
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
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).
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)
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
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)
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
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
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
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)
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)
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
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.
