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.

pharmacology MCQ - 2

                    Anti-inflammatory and Antineoplastic Drugs

1. As a well-rounded health care provider, you know that corticosteroid therapy is indicated in all of the following conditions except:

A. osteoarthritis
B. rheumatoid arthritis
C. systemic lupus erythematosus
D. acute spinal cord injury

2. Oral steroids are prescribed on a taper in order to:

A. achieve optimal serum levels.
B. ensure drug reliability.
C. ensure compliance.
D. prevent steroid withdrawal syndrome.

3. suresh who has been taking steroids for rheumatoid arthritis over several years presents with a compression vertebral fracture. This fracture is due to:

A. an entirely separate condition.
B. the osteoporotic effect of long-term steroid use.
C. deterioration in rheumatoid arthritis.
D. an excessively high dose of steroids.

4. ramesh is admitted into the emergency department with an acute spinal cord injury. Methylprednisolone is contraindicated for treatment when the injury:

A. is a high cervical lesion.
B. occurred less than 4 hours ago.
C. occurred less than 8 hours ago.
D. occurred more than 8 hours ago.

5. Which of the following statements about intravenous administration of steroids is true?

A. Steroids administered intravenously must be diluted.
B. Steroids administered intravenously can be either in diluted or undiluted form.
C. Steroids should be given IV push only.
D. Intravenous administration of steroids is contraindicated in acutely ill clients.

6. An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following?

A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.
B. Potential for injury related to GI toxicity and decrease in bleeding time.
C. Altered protection related to GI bleeding and increasing platelet aggregation.
D. Risk for injury related to thrombocytosis prolonged prothrombin time.

7. Teaching has been adequate when a client being treated with acetylsalicylic acid states:

A. “I can crush the pills before i swallow them.”
B. “I should take the pills with antacids.”
C. “Taking the pills on an empty stomach will help absorption.”
D. “If the pills smell like vinegar, I should throw them out.”

8. Which of the following groups of clients are most at risk for GI bleeding from the use of NSAIDs?

A. Clients with dysmenorrhea
B. Clients with headaches
C. Clients with arthritis
D. Clients with renal failure

9. To minimize the risk of dyspnea and GI bleeding, OTC ibuprofen is given:

A. IV
B. With orange juice
C. On an empty stomach
D. With meals

10. Which of the following NSAIDs is used to prevent thrombosis?

A. Motrin
B. Toradol
C. Aspirin
D. naproxen

11. Nurse mala may expect to administer azathioprine (Imuran) to a transplant client in which of the following conditions?

A. Prevention of chronic rejection
B. Prevention of acute rejection
C. Management of chronic rejection
D. Treatment of acute rejection

12. Which of the following laboratory tests should be monitored when a client is receiving azathioprine?

A. CBC
B. BUN
C. Electrolytes
D. Sedimentation rate

13. In a transplant client, the action of cyclosporine is to:

A. Defend the body against foreign antigens.
B. Inhibit T cells in response to antigens.
C. Inhibit B cell immunoglobulin.
D. Intensify the production of T lymphocytes

14. Client teaching for mycophenolate mofetil must include instructions to:

A. Take with food.
B. Avoid use of corticosteroid.
C. Monitor for adverse effects.
D. Practice effective contraception.

15. Which of the following client comments demonstrates that teaching has been successful regarding cyclosporine therapy?

A. “I need to mix the medicine in Styrofoam.”
B. “I should take the medication on an empty stomach.”
C. “I need to be consistent about when i take it and also monitor how much fat is in my food.”
D. “If I vomit I should take another dose.”

16. Antirheumatics are used to:

A. Directly affect the inflammatory response
B. Encourage excretion of autoantibodies
C. Retard progression of joint deterioration
D. Mediate the action of NSAIDs

17. Gold compounds are contraindicated in clients with:

A. Liver dysfunction
B. Cardiac disease
C. Preexisting dermatitis
D. Rheumatoid arthritis

18. Which of the following agents can be used in treatment of rheumatoid arthritis  and SLE?

A. auranofin (Ridaura)
B. allopurinol (Zyloprim)
C. sulfasalazine (Azulfidine)
D. chloroquine (Aralen)

19. Frequent eye examinations are recommended in clients receiving:

A. chloroquine
B. colchicine
C. penicillamine
D. gold compounds

20. Nurse jancy is instructing a client receiving probenecid (Benemid), she should cover all of the following information except the need to:

A. Change dietary habits.
B. Increase fluid intake.
C. Have frequent laboratory work done.
D. Recognize side effects.

21. Enrique who is under chemotherapy has the following CBC results: WBC 5000/mm³, RBC platelet 10,000/mm³. Which of the following is he at risk for?

A. Infection
B. Bleeding
C. Angina
D. None of the above

22. kannan who is on chemotherapy has a history of cardiac disease. The client is at risk for cardiac complications because:

A. White blood cells are reduced.
B. Oxygen-carrying capacity may be reduced.
C. Sodium levels may rise meaning fluid overload.
D. Hematocrit is lowered.

23. Which of the following is the priority nursing diagnosis for a client undergoing chemotherapy?

A. Decreased cardiac output
B. Fear
C. Altered nutrition
D. Anxiety

24. Which of the following contributes most to the debilitation of an individual during a course of chemotherapy?

A. Diarrhea
B. Alopecia
C. Constipation
D. Pain

25. Combination chemotherapy is used in the treatment of cancer because:

A. Single-agent therapy produces cell lines that are resistant.
B. Two drugs are more likely to work.
C. Single-agent therapy requires larger doses for long remissions.
D. Two cancers may be present.

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

Answers and Rationale

1. Answer: A. osteoarthritis

Osteoarthritis is not an indication for corticosteroid therapy. It has an inflammatory component, but the disease is not severe enough to suppress the immune system. Lupus, spinal injury, and rheumatoid arthritis are conditions that require suppression of the immune system in order for the client to survive.

2. Answer: D. prevent steroid withdrawal syndrome.

Steroids are tapered off in order to prevent a withdrawal syndrome. Optimal serum levels do not require tapering in order to be maintained. Tapering has nothing to do with drug reliability. Compliance is not dependent on tapering.

3. Answer: B. the osteoporotic effect of long-term steroid use.

In a client on long-term steroids, a compression vertebral fracture can be assumed to be due to the steroids’ bone-softening effect.

4. Answer: D. occurred more than 8 hours ago.

Research has shown that steroids are ineffective when given more than 8 hours after acute spinal injury.

5. Answer: B. Steroids administered intravenously can be either in diluted or undiluted form.

IV steroids can either be diluted or given without dilution.

6. Answer: A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding.

The nursing diagnosis addresses all the interactions that pose a threat to the client taking both these drugs. Choice B is incorrect because bleeding time is prolonged not decreased when both drugs are used. Choice C is incorrect because platelet aggregation is inhibited not increased when both drugs are used. Choice D is incorrect because thrombocytosis does not occur with use of either drugs.

7. Answer: D. “If the pills smell like vinegar, I should throw them out.”

Any aspirin should be discarded if a vinegar odor is noticed. Crushing is not recommended for sustained-release preparations. Antacids impair absorption. Taking the medication on an empty stomach will increase GI irritation.

8. Answer: C. Clients with arthritis

Clients with arthritis are taking the drugs for prolonged periods of time and may take higher doses. Choices A and B are incorrect because the use of NSAIDs with these clients is intermittent. Renal failure is a contraindication for NSAIDs because most of the drug is excreted through the kidneys.

9. Answer: D. With meals

Taking ibuprofen with meals will decrease GI irritation. Ibuprofen is never given IV. Orange juice may promote acidity and increase gastric irritation. Ibuprofen will cause GI upset if given on an empty stomach.

10. Answer: C. Aspirin

Aspirin prevents platelet aggregation and thereby has an anticoagulant effect.

11. Answer: B. Prevention of acute rejection

Azathioprine inhibits humoral and cellular immunity during the early stages of lymphoid differentiation and is useful in preventing the onset of acute rejection.

12. Answer: A. CBC

CBC will identify leukopenia, a common side effect.

13. Answer: B. Inhibit T cells in response to antigens.

The primary action of cyclosporine is to inhibit T-cell generation in response to transplant antigens.

14. Answer: D. Practice effective contraception.

Effective contraception is essential because of the potential for teratogenic effects. It is recommended that the drug be taken on empty stomach. The drug is often given with corticosteroid. All medication should be monitored for side effects.

15. Answer: C. “I need to be consistent about when i take it and also monitor how much fat is in my food.”

Cyclosporines need to be taken consistently in relation to meals, and fat content should not vary to maintain serum levels.

16. Answer: C. Retard progression of joint deterioration

These drugs cannot stop the disease itself but are believed to retard or prevent the process of joint deterioration. For choice A, the inflammatory process is affected indirectly. Autoantibodies are not excreted. Disease modifying antirheumatic drugs are used in combination with NSAIDs but do not mediate their effect.

17. Answer: A. Liver dysfunction

An adverse reaction to gold compounds is liver toxicity; therefore, use care in clients with preexisting liver dysfunction.

18. Answer: D. chloroquine (Aralen)

Chloroquine has had documented success in the treatment of rheumatoid arthritis and SLE. Auranofin and sulfasalazine are used in the treatment of rheumatoid arthritis, but none are used in the treatment of all three syndromes.

19. Answer: A. chloroquine

Corneal deposits are an adverse reaction associated with chloroquine administration, necessitating frequent eye examination.

20. Answer: C. Have frequent laboratory work done.

Side effects of probenecid treatment are relatively benign, and there is no indication that there is a need for frequent laboratory evaluation.

21. Answer: B. Bleeding

A platelet count of 10,000/mm³ means that the client does not have enough platelets to clot the blood; therefore, the possibility of bleeding is high. Choice A is a normal value of WBC. Angina would only be a risk if the client had a lower RBC count.

22. Answer: B. Oxygen-carrying capacity may be reduced.

If hemoglobin and red cell counts drop from myelosuppression, the oxygen-carrying capacity will fall, leaving the person at risk for angina.

23. Answer: A. Decreased cardiac output

Decreased cardiac output is more important than the other choices because it can jeopardize the client’s life.

24. Answer: A. Diarrhea

Diarrhea will cause debilitation as fluid and nutrients are lost at a time when the body most needs to be nourished.

25. Answer: A. Single-agent therapy produces cell lines that are resistant.

Single-agent therapy tends to produce resistant tumor cells, making remission or cure impossible.

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

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

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.