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WorksheetsP3 Mastery Exam (1516)
Total questions: 50
Worksheet time: 17mins
A 68-year-old patient reports chest pain that occurs consistently during his morning walk and is relieved by resting for a few minutes. Which type of angina is this patient most likely experiencing?
Prinzmetal angina
Unstable angina
Acute Myocardial Infarction (MI)
Stable angina
A patient with long-standing stable angina is prescribed a Beta-Adrenergic Blocker. The mechanism of action that makes this drug class effective for angina management is primarily:
Direct relaxation of vascular smooth muscle, decreasing afterload.
Competitive blocking of beta receptors, resulting in decreased cardiac oxygen consumption.
Inhibition of calcium ion movement, causing vasodilation and increased coronary blood flow.
Converting Angiotensin I to Angiotensin II, preventing aldosterone secretion.
A nurse is educating a patient newly prescribed sublingual nitroglycerin (Nitrostat) for acute anginal episodes. What is the priority instruction to provide regarding the emergency protocol if the first dose does not relieve the pain?
Wait 15 minutes, then take a second dose and call the healthcare provider (HCP).
Take a second dose in 5 minutes and call for emergency help if pain persists after the third dose.
Seek emergency care immediately and do not take any further doses.
Take a second dose in 5 minutes, and if the pain persists, take a third dose 5 minutes later, then call the HCP.
A patient is prescribed a transdermal nitroglycerin patch. Which instruction is essential for the nurse to give to ensure safe and effective use?
Apply the patch to the same site each day for consistency.
Remove the old patch and thoroughly wash the area before applying the new one.
Apply the patch only when anticipating an anginal episode.
The patch should be replaced once a week.
A patient with a history of chronic angina is diagnosed with a newly-developed cardiac tachyarrhythmia. Which Calcium Channel Blocker (CCB) might be uniquely beneficial due to its ability to treat both conditions?
A. Amlodipine (Norvasc)
B. Nifedipine (Procardia)
C. Verapamil (Calan)
D. Nicardipine (Cardene)
Which combination of drugs is considered critically dangerous due to the risk of severe hypotension?
Isosorbide dinitrate and Heparin
Atenolol and Clonidine
Nitroglycerin and Sildenafil
Ranolazine and Digoxin
Prinzmetal angina (vasospastic angina) is best managed with which class of anti-anginal drugs, as Beta-blockers are contraindicated?
Nitrates
Piperazine Acetamide Agent (Ranolazine)
Calcium Channel Blockers
Ranolazine (Ranexa) is indicated for chronic angina. A key feature of its mechanism, distinguishing it from other anti-anginals, is that it:
Significantly lowers both heart rate and blood pressure.
Is the only agent with an extended-release formulation.
Decreases myocardial workload without primarily decreasing heart rate or blood pressure.
Is specifically used for Prinzmetal angina.
A nurse is preparing to administer a beta-blocker to a patient. The nurse should be aware that a major danger associated with Beta-blocker administration is their potential to:
Cause peripheral edema and flushing.
Worsen a pre-existing cough.
Mask the signs and symptoms of hypoglycemia in diabetic patients.
Cause a paradoxical increase in heart rate.
A 55-year-old patient taking a nitrate for angina reports a persistent headache. The nurse should provide which education point regarding this common adverse effect?
The headache signifies an allergic reaction and should be reported immediately.
The headache is a normal sign of drug-induced vasodilation and may be managed with a mild analgesic.
The medication dosage is likely too high and needs to be reduced immediately.
This adverse effect typically disappears after 6-8 weeks of therapy.
Which class of anti-anginal drugs is known to prolong the QT interval and is contraindicated in patients with a pre-existing prolonged QT interval?
Nitrates
Calcium Channel Blockers
Beta-Adrenergic Blockers
Ranolazine (Ranexa)
An older adult patient is started on an anti-anginal medication. The nurse should anticipate which age-specific consideration?
Starting with the standard adult dose to ensure efficacy.
Avoiding the drug entirely due to higher risk of adverse effects.
Beginning with lower doses and monitoring closely due to potential renal/hepatic impairment.
Only administering the drug in a hospital setting for initial doses.
A patient is prescribed Lisinopril (Prinivil). The nurse understands that this medication works primarily by:
Blocking Angiotensin II receptors to prevent vasoconstriction.
Inhibiting ACE, preventing the conversion of Angiotensin I to Angiotensin II.
Stimulating alpha-2 adrenergic receptors to promote vasodilation.
Blocking calcium ion influx into the heart and arteries.
A patient taking an Angiotensin-Converting Enzyme (ACE) Inhibitor develops a persistent, dry cough. The nurse should recognize this as:
A dangerous sign of heart failure and notify the HCP immediately.
A normal, common side effect of ACE inhibitors.
An indication that the patient is experiencing an allergic reaction.
A sign of elevated potassium levels.
15. A dangerous and must-know side effect of both ACE Inhibitors and Angiotensin II Receptor Blockers (ARBs) is:
Angioedema
Hypokalemia
Bradycardia
Hyperglycemia
A patient is to start a new Angiotensin II Receptor Blocker (ARB), Losartan (Cozar). What key instruction should the nurse provide regarding pregnancy?
ARBs are safe to continue throughout pregnancy.
ARBs are teratogenic and must be avoided during pregnancy.
ARBs can be taken during the first trimester but should be stopped after the first trimester.
ARBs pose a risk only to the mother, not the fetus.
A patient taking an ACE Inhibitor is being educated on diet modifications. Which instruction is most important due to the drug's effect on aldosterone?
Increase salt intake to counter the drug's hypotensive effect.
Consume more dairy products for calcium.
Avoid potassium-containing foods and salt substitutes.
Increase intake of grapefruit juice to improve absorption.
Clonidine (Catapres), an Alpha-2 Adrenergic Agonist, is prescribed for a patient with hypertension. Which instruction is crucial to prevent a hypertensive crisis?
Take the medication only when blood pressure is elevated.
Double the dose if a dose is missed.
Do not suddenly stop the medication; it must be tapered.
Take the medication with alcohol to enhance CNS depression.
A patient is taking a Beta-Blocker. Which key assessment is most important for the nurse to perform before administering the dose?
Assessing for signs of dry cough.
Monitoring the patient's heart rate for bradycardia.
Checking for facial and neck swelling.
Assessing for signs of constipation.
The nurse is caring for a patient taking a Calcium Channel Blocker (CCB). The patient asks how this medication lowers blood pressure. The nurse explains that CCBs work by:
Stimulating the renin-angiotensin-aldosterone system.
Inhibiting ACE to prevent vasoconstriction.
Blocking calcium ions, causing blood vessels to relax and heart stimulation to decrease.
Selectively blocking beta-1 receptors to slow the heart rate.
A patient taking the Calcium Channel Blocker, Verapamil, complains of constipation. The nurse should recommend which dietary modifications?
Increased red meat and complex carbohydrates.
Increased salt and fluid intake.
Increased fruits, fiber, and fluids.
Decreased consumption of all foods to lessen GI upset.
Which antihypertensive medication class is known to decrease heart rate directly, in contrast to ACE Inhibitors which do not directly affect heart rate?
ACE Inhibitors ("-pril")
Angiotensin II Receptor Blockers (ARBs) ("-sartan")
Alpha-2 Adrenergic Agonists
Both B and C
Which drug class is contraindicated in a patient with a known history of severe heart block?
Nitrates
Angiotensin-Converting Enzyme (ACE) Inhibitors
Beta-Adrenergic Blockers
Dihydropyridine Calcium Channel Blockers
Which condition is a contraindication for the use of Nitrates, as it could worsen the patient's outcome?
Severe anemia
Chronic angina
Effort-associated angina
Hypertension
A patient is taking Metoprolol (Lopressor). To prevent orthostatic hypotension, which crucial patient education point should the nurse reinforce?
Limit fluid intake throughout the day.
Change positions slowly, sitting on the side of the bed for a few minutes before standing.
Increase intake of potassium-rich foods.
Stop the medication immediately if feeling dizzy.
A patient with chronic renal failure has been on Epoetin alfa (Epogen) for six months. The provider notices the patient's hemoglobin is currently 12.8 g/dL. What action is the nurse most likely to take next?
Continue the current dose, as the hemoglobin is within the normal range.
Hold the medication or decrease the dose to prevent the hemoglobin from exceeding the maximum target of 11 g/dL.
Increase the dose, as the target hemoglobin is 15 g/dL.
Check the patient's Iron studies, as the ESA dose is independent of the hemoglobin level.
A patient is starting therapy with Darbepoetin alfa (Aranesp). The patient expresses confusion about why they only need an injection once per week, while a friend takes Epoetin alfa 2-3 times per week. What is the primary pharmacological characteristic of Darbepoetin alfa that allows for its less frequent dosing schedule?
It has a faster onset of action due to IV administration only.
It is a first-generation agent, which is more potent.
It has a longer half-life (21-49 hours), allowing for once-weekly administration.
It is administered via the IV route, which provides 100% bioavailability.
The nurse is reviewing the Black Box Warnings associated with Erythropoiesis-Stimulating Agents (ESAs). In a patient with cancer, ESA therapy carries a warning for which serious adverse outcome?
Increased risk of severe anemia due to a rebound effect.
Risk of developing severe hypertension that is refractory to treatment.
Risk of pure red cell aplasia (PRCA).
Increased risk of death, MI, stroke, and tumor progression.
A patient with AIDS-therapy related anemia is prescribed Methoxy polyethylene glycol-epoetin beta (Mircera). The nurse is calculating the patient's schedule. Based on its half-life (119-124 hours), how often is Mircera typically administered to the patient?
Every 2 weeks.
Once per week.
2-3 times per week.
Once per month.
A patient with anemia due to Chronic Kidney Disease (CKD) is considering starting an ESA. The nurse reviews the patient's chart and identifies an absolute contraindication to initiating therapy. Which patient finding would contraindicate the use of an ESA?
History of Deep Vein Thrombosis (DVT).
Uncontrolled hypertension (BP 180/110 mmHg).
Current Hemoglobin of 10 g/dL.
Concomitant use of Iron supplements.
A patient with a history of asthma is prescribed a non-selective Beta-Blocker. Which adverse effect is the patient at risk of experiencing?
Bradycardia
Bronchospasm/Bronchoconstriction
Gastric pain
Constipation
The nurse notes that a patient is taking Valsartan (Diovan). The nurse recognizes that this drug's class is primarily distinguished from ACE inhibitors by the fact that it:
Is less effective at lowering blood pressure.
Directly blocks Angiotensin II, whereas ACE Inhibitors block the enzyme that forms it.
Is known to cause a dry cough more frequently than ACE Inhibitors.
Is not teratogenic.
Which patient education point is necessary for both ACE Inhibitors and Calcium Channel Blockers?
Immediately report swelling of the face or mouth.
Avoid grapefruit juice.
Change positions slowly and sit on the side of the bed before standing.
Take the medication with food to increase bioavailability.
A patient is prescribed Clonidine (Catapres). The nurse should warn the patient that combining this medication with alcohol may lead to:
Rebound hypertension
Increased risk of Angioedema
Further drowsiness/dizziness and CNS depression.
Tachycardia and fever
Which class of Calcium Channel Blockers (CCBs) has less direct cardiac effects and is generally considered safer in patients with heart failure?
Nondihydropyridine CCBs (e.g., Verapamil, Diltiazem)
Dihydropyridine CCBs (e.g., Amlodipine, Nifedipine)
Both classes have equally direct cardiac effects.
CCBs are never safe for patients with heart failure.
A client with angina is prescribed Diltiazem (a non-dihydropyridine CCB). The primary advantage of Diltiazem over a dihydropyridine like Nifedipine for angina is its ability to:
Cause less orthostatic hypotension.
Be safely co-administered with grapefruit juice.
Reduce heart rate (Negative Chronotropy).
Be used safely in pregnant patients.
A client taking Prazosin (an Alpha-1 Blocker) reports dizziness upon standing. The nurse explains that this side effect is related to the drug's mechanism of action, which is to:
Block the synthesis of Angiotensin II.
Inhibit calcium entry into vascular smooth muscle.
Reduce heart rate and contractility.
A 60-year-old African American client with uncomplicated hypertension is starting drug therapy. Which class of medication is generally considered first-line therapy for this population, often included in combination therapy?
ACE Inhibitors
Thiazide Diuretics
Beta-blockers
Direct Renin Inhibitors
The Renin-Angiotensin-Aldosterone System (RAAS) regulates blood pressure. In this system, the primary function of Aldosterone is to:
Promote potassium excretion and water loss.
Promote vasodilation.
Retain sodium and water, thus increasing blood pressure.
Directly increase the force of cardiac contraction.
A patient receives an intravenous dose of Hydralazine (a potent direct vasodilator) for severe hypertension. The nurse should be vigilant for which common reflex action and side effect, which may require a co-administered beta-blocker?
Reflex tachycardia
Dry cough
Hyperkalemia
Constipation
The main effect of Nitrates in reducing cardiac workload and oxygen demand is achieved through:
Directly blocking calcium channels.
Decreased preload (venous pooling) and decreased afterload (vessel relaxation).
Blocking beta-adrenergic receptors.
Increased secretion of aldosterone.
Which drug interaction requires close monitoring when a Nitrate is combined with it?
Sildenafil
Ergot derivatives
Heparin
Grapefruit juice
The nurse understands that Beta-Blockers achieve a decrease in blood pressure by which mechanism?
Increasing sympathetic nervous system influence.
Decreasing cardiac output and decreasing cardiac oxygen consumption.
Directly inhibiting ACE.
Causing vasodilation through smooth muscle relaxation.
A patient is taking a Beta-Blocker and Clonidine. Which instruction is critical for the patient when discontinuing one or both medications?
Stop the Beta-Blocker first, then taper the Clonidine.
Stop both drugs immediately.
Both drugs must be tapered gradually, as abrupt discontinuation can cause rebound hypertension.
Only the Beta-Blocker needs to be tapered.
Which anti-anginal drug is known to have the additional benefits of blocking endothelial cell proliferation and slowing the progress of atherosclerosis?
Nitrates
Beta-Adrenergic Blockers
Calcium Channel Blockers
Ranolazine
When administering sublingual nitroglycerin, the nurse instructs the patient to avoid swallowing the tablet. This is because:
It causes severe gastric irritation.
The oral mucosa allows for rapid absorption, which would be slower if swallowed.
Swallowing may cause an allergic reaction.
The tablet potency may decrease if it touches saliva.
Which anti-anginal agent can cause contact dermatitis and requires application site rotation?
Oral Isosorbide Mononitrate
Transdermal Nitroglycerin patch
Sublingual Nitroglycerin
Ranolazine
An anti-anginal drug with a mechanism that is "Unknown, but decreases myocardial workload" and also decreases blood glucose in diabetic patients is:
Metoprolol
Nitroglycerin
Verapamil
Ranolazine (Ranexa)
Nifedipine (Procardia) is a Dihydropyridine Calcium Channel Blocker. A key characteristic of this subclass is that it has:
More direct negative inotropic effects.
Lower heart rate effects.
Less direct cardiac effects.
Is indicated only for cardiac tachyarrhythmias.
An older patient is prescribed a beta-blocker. Due to potential mobility and balance issues, the nurse should prioritize which safety measure?
Ensuring the patient is taught to lie/sit down before administration to mitigate hypotension.
Administering the drug only at bedtime.
Increasing the initial dosage to ensure a quick therapeutic effect.
Limiting fluid intake to prevent fluid shifts.
