WorksheetsNSG 308/Pharm Exam 3 Cardiac Quiz 2
Total questions: 80
Worksheet time: 40mins
Which class of HTN medications would be most likely prescribed to a black patient who is genetically predisposed to be resistant to traditional medications such as ACEI/ARB used for monotherapy?
Calcium Channel Blockers
Beta Blockers
ACE Inhibitors
Alpha Blockers
What are the basic considerations when treating hypertension?
- Requires lifetime treatment - 130/80 HTN threshold, 180/120 HTN crisis AT REST - Primary Factors that Affect BP: - Peripheral vascular resistance - Myocardial contractility - Heart rate - Blood volume
- Only requires treatment during symptoms - 150/90 HTN threshold, 200/130 HTN crisis AT REST - Primary Factors that Affect BP: - Renal filtration rate - Liver enzymes - Blood glucose - Platelet count
- Treatment is optional for mild cases - 120/70 HTN threshold, 160/100 HTN crisis AT REST - Primary Factors that Affect BP: - Oxygen saturation - White blood cell count - Cholesterol level - Body temperature
- Only diet modification is necessary - 140/90 HTN threshold, 170/110 HTN crisis AT REST - Primary Factors that Affect BP: - Lung capacity - Insulin sensitivity - Calcium levels - Skin turgor
What is the function of baroreceptors in the vascular system (via SNS)?
They sense pressure within large vessels, aorta/carotid, and relay that information to the vasomotor center in the brain.
They sense pressure within peripheral vessels and relay that information to the vasomotor center in the brain.
They sense pressure within large vessels, aorta/carotid, and relay that information to the temporal cortex in the brain.
They filter waste products from the blood.
The vasomotor center will direct smooth muscles in arteries to either constrict (alpha 1) or relax (alpha 2).
True
False
The baroreceptor reflex frequently _______ attempts to reduce BP with medications.
Supports
Ignores
Violently Enhances
In people with hypertension, the "set point" of baroreceptors is high because high BP is what the baroreceptors think is 'normal.'
True
False
When medications lower BP, baroreceptors may respond by causing vasoconstriction and increasing HR in an attempt to raise BP.
True
False
Renin is released in response to _____ renal blood flow and ______ BP.
high, high
low, high
high, low
low, low
Renin stimulates production of angiotensin I from ______.
angiotensinogen
albumin
angiotensin II
aldosterone
Angiotensin I is converted into angiotensin II by ACE (angiotensin converting enzyme) in the ______.
lungs
liver
kidneys
stomach
Angiotensin II acts as a potent vasoconstrictor and stimulates the release of ______.
aldosterone
insulin
thyroxine
glucagon
Aldosterone promotes sodium and water retention.
True
False
ACE inhibitors work in the body to treat hypertension by:
Blocking the conversion of angiotensin I to angiotensin II
Increasing heart rate
Stimulating aldosterone secretion
Constriction of blood vessels
ACE inhibitors will possibly cause which negative, adverse effect to which electrolyte? Which types of concurrent medications/dietary choices should be avoided with ACEI due to this?
ACE inhibitors may cause hyperkalemia; potassium-sparing diuretics and potassium-rich foods should be avoided.
ACE inhibitors may cause hypokalemia; sodium-rich foods should be avoided.
ACE inhibitors may cause hypernatremia; calcium supplements should be avoided.
ACE inhibitors may cause hypocalcemia; magnesium supplements should be avoided.
Common side effects for ALL ACE inhibitors include which of the following, and what is the FIRST recommended plan of action if intolerable side effects develop?
Cough and angioedema; discontinue ACE inhibitor and switch to an angiotensin receptor blocker
Bradycardia and rash; continue ACE inhibitor at a lower dose
Cough and weight gain; add a beta-blocker
Angioedema and blurred vision; switch to a calcium channel blocker
Calcium Channel Blockers (CCB) work in the body to treat hypertension by:
relaxing blood vessels by inhibiting calcium entry into muscle cells
increasing heart rate and cardiac output
relaxing blood vessels by increasing calcium entry into muscle cells
constricting blood vessels to raise blood pressure
relaxing blood vessels by destroying all calcium ions in the peripheral vasculature
How do each category of CCBs work in the body and which drugs fall into which category? When would each category be used versus the other?
CCBs are divided into dihydropyridines (e.g., amlodipine, nifedipine) which mainly act on vascular smooth muscle, and non-dihydropyridines (e.g., verapamil, diltiazem) which act on the heart; dihydropyridines are used for hypertension, while non-dihydropyridines are used for arrhythmias and hypertension.
CCBs are divided into dihydropyridines (e.g., verapamil, diltiazem) which mainly act on vascular smooth muscle, and non-dihydropyridines which act on the heart (e.g., amlodipine, nifedipine); dihydropyridines are used for hypertension, while non-dihydropyridines are used for arrhythmias and hypertension.
CCBs are divided into dihydropyridines (e.g., amlodipine, nifedipine) which mainly act on vascular smooth muscle, and non-dihydropyridines (e.g., verapamil, diltiazem) which act on the heart; dihydropyridines are used for hypotension, while non-dihydropyridines are used for arrhythmias and hypotension.
CCBs are divided into dihydropyridines (e.g., verapamil, diltiazem) which mainly act on vascular smooth muscle, and non-dihydropyridines which act on the heart (e.g., amlodipine, nifedipine); dihydropyridines are used for hypertension, while non-dihydropyridines are used for heart failure and hypertension.
Which of the following are signs & symptoms of heart failure?
Shortness of breath, fatigue, and swelling in the legs
Pulmonary edema and pleuritis
Sudden weight loss and excessive sweating with lethally high pulse rate
Orthopnea, left sided weakness, swelling in the face and bradycardia
What is the inability of the heart to produce adequate cardiac output (CO) to meet metabolic needs called?
Heart failure (HF)
Hypertension
Arrhythmia
Myocardial infarction
Which of the following is NOT a major underlying cause of heart failure (HF)?
Chronic hypertension
Viral heart disease
Diabetes mellitus
Cardiomyopathy
Fill in the blank: Poor renal perfusion in heart failure can lead to ________ and increased blood pressure (BP).
fluid retention
muscle wasting
fluid excretion
fluid loss
Which statement describes Stage 4 heart failure?
Significant activity limitation due to s/s. Comfortable only at rest
No limitation of physical activity, ordinary activity does not cause symptoms
Slight limitation of physical activity, comfortable at rest
Symptoms at rest, unable to carry on any physical activity without discomfort
In heart failure, insufficient tissue perfusion leads to shortness of breath (SOB) and poor exercise tolerance.
True
False
Which of the following is a LATE sign of heart failure?
High blood pressure (BP)
Low blood pressure (BP)
Increased cardiac output (CO)
Decreased heart rate
What is the first step in the vicious cycle of maladaptive compensatory responses to a failing heart?
Cardiac remodeling leads to reduced cardiac output
Increased renal sodium and water retention
Activation of the sympathetic nervous system
Development of pulmonary edema
Which of the following is NOT a clinical manifestation of heart failure (HF)?
reduced exercise tolerance
fatigue
compensatory HTN
ischemic stroke
compensatory tachycardia
Which compensatory response occurs in heart failure to increase oxygen to body tissue?
Bradycardia
Tachycardia
Hypotension
Hyperthermia
Fill in the blank: Cardiomegaly is a clinical manifestation of increased _______ and reduced ejection fraction (EF) in heart failure.
filling pressures
heart rate
angioedema
cardiac glycosides
Which of the following is a sign of increased blood volume and decreased ventricular ejection in heart failure?
A) Pulmonary or peripheral edema
B) Bradycardia
C) Hypotension
D) Cyanosis
Weight gain and hepatomegaly are clinical manifestations of heart failure due to increased blood volume and decreased ventricular ejection.
True
False
Which side of heart failure is associated with lung involvement?
Left side
Right side
Patients with left-sided heart failure may require more _______ to sleep at night and cannot sleep in supine position.
pillows
blankets
medications
windows
Which of the following is NOT a symptom of left-sided heart failure?
Cough and noisy breathing
Frothy pink sputum
JVD and ascites
Waking up gasping for air
Digoxin is given to patients for which of the following reasons?
To treat heart failure in conjunction with certain types of arrhythmias
To treat heart failure in conjunction with certain types of cardiac glycosides
To treat heart failure in conjunction with certain types of varicose vasculature
To treat heart failure in conjunction with certain types of cardiomyopathy
Digoxin has which of the following effects on the heart?
It increases the force of cardiac contractions.
It decreases heart rate by blocking beta 2 receptors.
It causes significant vasoconstriction of coronary arteries.
It acts as a diuretic to reduce blood volume.
Which of the following lists the signs and symptoms of digoxin toxicity?
Nausea, vomiting, visual disturbances, and arrhythmias
Fever, cough, and sore throat
Joint pain, swelling, and redness
Weight gain, increased appetite, and insomnia
There are special directions for digoxin medication administration.
True
False
Sometimes
Only for children
PRIORITY labs to assess when administering digoxin include:
Potassium, creatinine, and digoxin levels
Hemoglobin, hematocrit, and potassium levels
Creatinine, magnesium, and sodium levels
Liver enzymes, bilirubin, and digoxin levels
Potassium, lithium, albumin levels
The most effective diuretic class at removing excess fluid from the body is:
Loop diuretics
Thiazide diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
What are signs and symptoms of fluid overload?
Pitting edema, pulmonary edema, cyanosis, HTN, HF, weight gain, SOB
Dry skin, hypotension, bradycardia, weight loss, SOB
Jaundice, pruritus, dark urine, clay-colored stools, HTN, SOB
Polyuria, polydipsia, weight loss, blurred vision, HF, HTN
How would a beta blocker work in the body to treat heart failure?
Slow pulse rate, reduce blood pressure, decrease vascular tone, and decrease workload on the heart
Increase heart rate and contractility, raising cardiac output
Stimulate the sympathetic nervous system to increase blood pressure, decrease workload on the heart
Cause vasoconstriction and increase afterload, making the heart work harder
How do ACE inhibitors work in the body to treat heart failure?
Reduces afterload and preload. ACEIs should be prescribed for ALL HF patients. Switch to ARBs if patient develops cough.
Increase heart rate and contractility to improve cardiac output. ACEIs should be prescribed for SOME HF patients. Switch to ARBs if patient develops cough.
Directly stimulate beta-adrenergic receptors to enhance myocardial function. ACEIs should be prescribed for ALL HF patients. Switch to statins if patient develops cough.
Block calcium channels to decrease myocardial oxygen demand. ACEIs should be prescribed for ONLY ADHF patients. Switch to ARMs if patient develops cough.
What is the therapeutic effect of an alpha 1 blocker?
Reduction of arteriolar smooth muscle tone, reduction of venous return to the heart
Increase in heart rate and cardiac output
Stimulation of beta-2 receptors causing bronchodilation
Increase in aldosterone secretion leading to sodium retention
What are some common side effects of alpha 1 blockers?
Cholinergic effects. Orthostatic hypotension most severe with initial doses.
Anticholinergic effects. Hyperglycemia, weight gain, and increased appetite.
Cholinergic effects. Nephrotoxicity, ototoxicity, and red man syndrome.
Anticholinergic effects. Bradycardia, dry cough, and angioedema.
A patient would be prescribed a less selective alpha-1 blocker such as doxazosin instead of a more prostate selective medication such as tamsulosin when:
they have both hypertension and benign prostatic hyperplasia (BPH).
they have only benign prostatic hyperplasia (BPH).
they have only hypertension.
they have a history of prostate cancer.
they have both hypotension and big balls disease (BBD).
A serious side effect of anticoagulants is:
Excess bleeding
Weight gain
Nonselective clot dissolution
Viscous blood
Factors including dietary and drug-drug interactions that affect warfarin levels include:
Vitamin K intake, certain antibiotics, and antifungal medications
Vitamin K intake, lack of exercise and certain barbiturates
Vitamin K intake, sunlight exposure and certain benzodiazepines
Vitamin K intake, calcium supplements and iron-rich foods
Anticoagulants given to patients at increased risk for developing a blood clot to PREVENT this from happening include:
Heparin
Aspirin
Acetaminophen
Ibuprofen
HIT is a condition that can be identified by a nurse if a patient develops which of the following signs after heparin administration, and what should the nurse do if HIT is suspected?
A significant drop in platelet count; notify the healthcare provider and stop heparin
An increase in blood pressure; administer more heparin
A decrease in heart rate; encourage ambulation
A rise in white blood cell count; start antibiotics and stop the heparin immediately
A significant spike in thrombolytics; just go on ahead and get the body bag ready
Which anticoagulants have specific reversal agents/antidotes, and what are they?
Warfarin (Vitamin K/FFP), Dabigatran (Idarucizumab), Apixaban/Rivaroxaban (Andexanet alfa), Heparin (Protamine Sulfate)
Heparin (Protamine), Aspirin (Vitamin K/FFP), Clopidogrel (Idarucizumab)
Warfarin (Protamine Tartrate/FFP), Dabigatran (Vitamin K), Apixaban (Protamine Sulfate)
Rivaroxaban (Vitamin K), Heparin (Idarucizumab), Warfarin (Andexanet alfa/FFP)
Thrombolytics work in the body by:
Dissolving blood clots
Increasing platelet production
Preventing blood clots
Blocking thrombus absorption
Thrombolytics should be administered for which of the following conditions?
Acute myocardial infarction, ischemic stroke, and massive pulmonary embolism
Chronic stable angina, hemorrhagic stroke, peripheral edema
Hypertensive crisis, chronic venous insufficiency, hemorrhagic stroke
Left ventricular heart failure, life threatening hypotension, massive blood loss secondary to trauma
Contraindications that would prevent safe administration of thrombolytics include:
Active internal bleeding
Poorly controlled hypertension
History of seasonal allergies
Impaction
The first factor that should be determined when a patient comes to the ED with stroke-like symptoms to assess for tPA eligibility is:
Time of symptom onset
Patient's blood pressure
History of diabetes insipidus
Concurrent use of bile acid sequestrants
After tPA is administered, bleeding can occur in various locations and may present with which of the following signs and symptoms?
Sudden severe headache, decreased level of consciousness, and hematuria
Increased appetite and weight gain
Improved muscle strength and coordination
Persistent cough and sore throat
The PRIMARY therapeutic effect of aspirin, clopidogrel, and ticagrelor is:
Inhibition of platelet aggregation
Increase in red blood cell production
Anticoagulation
Dissolution of clots
Nitroglycerin would be prescribed for which of the following reasons?
To relieve chest pain
To treat hypertension
To treat heart pants on
To reduce LDL cholesterol levels by 25-60%
To treat heart failure
Common side effects of long acting nitrates include:
Headache
Bradycardia
Constipation
Hypoglycemia
The differences in medication administration according to the different routes include:
Absorption rate, onset of action, and potential side effects
Only the color of the medication
The brand name of the medication
The time of day the medication is given
Alternatives to statins for high cholesterol include niacin. What are the potential side effects of taking niacin?
Flushing and liver toxicity
Cyanosis and kidney failure
Lethal drop in blood pressure when used with sildenafil
MI and hemorrhagic stroke
Spontaneous combustion
Fibrates/Fibric Acid Derivatives are used to:
reduce triglycerides and increase HDL
increase LDL and decrease HDL
decrease HDL and LDL
increase triglycerides
Bile Acid Sequestrants bind to _______ in the intestine.
bile acids
amino acids
fatty acids
glucose
What is an example of a fibrate/fibric acid derivative used as an alternative to statins?
fenofibrate, gemfibrozil
atorvastatin, rosuvastatin
ezetimibe, evolocumab
niacin, vitamin B13
If a patient complains of chest pain outside a healthcare facility, what is the first step in the administration protocol for acute chest pain?
The patient should take a rapid acting nitrate and wait 5 minutes to see if the pain dissipates.
The patient should immediately start chest compressions on themselves.
The patient should take a rapid acting nitrate and wait 5 days to see if the pain dissipates.
The patient should take a long acting nitrate and wait 5 minutes to see if the pain dissipates.
The patient should take a long acting nitrate and wait 5 decades to see if the pain dissipates.
Concurrent use of phosphodiesterase inhibitors such as sildenafil/Viagra or tadalafil with nitroglycerin can lead to ? Choose the correct option.
lethal spike in blood pressure
lethal drop in blood pressure
opioid overdose
lethal spike in heart rate
What is an example of a medication used for bile induced itching and bile malabsorption induced diarrhea?
cholestyramine/Questran
loperamide/Imodium
omeprazole/Prilosec
metformin/Glucophage
Which acid blocks production of cholesterol by the liver, lowers triglycerides, and increases HDL?
Nicotinic Acid
Ascorbic Acid
Folic Acid
Acetic Acid
Name some adverse effects of Nicotinic Acid.
facial flushing, hyperglycemia, liver damage, internal bleeding, stroke, stomach upset
reduced hair growth, loss of vision, weight loss, bad dreams
reduced appetite, sleep apnea, decreased muscle mass, hypoglycemia
pitting edema, kidney damage, stomach upset, tricuspid valve damage
Supplements of Nicotinic Acid are NOT FDA approved.
True
False
What is the mechanism of action of Ezetimibe/Zetia?
Inhibits intestinal absorption of cholesterol
Inhibits HMG-CoA reductase
Increases bile acid excretion
Stimulates lipoprotein lipase
Evolocumab/Repatha is a MAB that lowers LDL and is administered via which route?
SC injection
Oral tablet
IV infusion
Transdermal patch
What time of the day should lipid lowering medications such as simvastatin be administered for maximal effectiveness?
At night
In the morning
At noon
After lunch, before dinner
Key education points for patients taking statin medications include which of the following: dietary restrictions, lab monitoring, and signs and symptoms of serious adverse effects?
Dietary restrictions, lab monitoring, and signs and symptoms of serious adverse effects
Only dietary restrictions are necessary
Lab monitoring is not required for statin therapy
Patients do not need to be educated about adverse effects
Which pregnancy category are statins?
Pregnancy Category X (risks to fetus outweigh benefits to mother)
Pregnancy Category B (no evidence of risk in humans)
Pregnancy Category C (risk cannot be ruled out)
Pregnancy Category D (risks to mother outweigh benefits to fetus)
Pregnancy Category M (will quadruple the amount of neonates the mother will give birth to)
Select the ABSOLUTE thrombolytic contraindication.
known intracranial lesion or neoplasm
severe, uncontrolled HTN
concurrent anticoagulant use
active peptic ulcer
recent CPR that lasted over 10 minutes
When a patient comes to the ED with stroke-like symptoms what is the FIRST factor that should be determined to assess for tPA eligibility?
make sure stroke is ISCHEMIC, NOT HEMORRHAGIC
make sure stroke is HEMORRHAGIC, NOT ISCHEMIC
make sure stroke symptoms occurred AT LEAST 4.5 HOURS AGO
make sure stroke is ACTIVE, NOT PASSIVE
For patients with which condition should the nurse use caution when administering protamine sulfate?
Diabetes Mellitus
Congestive Heart Failure
Prinzmental's Angina
Cardiomyopathy
What type of condition is heparin induced thrombocytopenia?
bacterial condition
viral condition
sexually transmitted condition
autoimmune condition
condition as a result of trauma or injury
T/F. Enoxaparin is an example of a low molecular weight heparin.
True
False
When would the use of IV labetalol be contraindicated for the treatment of acute hypertension?
Decompensated HF, PE, cardiogenic shock, bradycardia, heart block
Decompensated HF, PEDS, cardiogenic shock, tachycardia, heart block
Compensated HF, PE, cardiogenic shivers, bradycardia, rhabdomyolysis
Decompensated HF, PE, septic shock, tachycardia
