Cardiovascular System Past Paper PDF

Performance Exit Topic 7 Cardiovascular System: Anti- anginals, Diuretics, Anti- hypertensives Due Jun 23, 2024 by 11:59 pm Final Score 16% 8 out of 50 questions answered corr...

Performance Exit Topic 7 Cardiovascular System: Anti- anginals, Diuretics, Anti- hypertensives Due Jun 23, 2024 by 11:59 pm Final Score 16% 8 out of 50 questions answered correctly Completed on Jun 23, 2024 9:10 pm Incorrect (42)  Report content error Which symptom will a nurse monitor in a patient with suspected digoxin toxicity? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Anorexia Vomiting Dry cough Visual disturbances Cardiac dysrhythmias Rationale The symptoms of digoxin toxicity are anorexia, nausea, vomiting, cardiac dysrhythmias, and loss of appetite. The patient may also have visual disturbances such as halo vision. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. p. 490 Report content error Which information would a nurse include in discharge teaching to a patient prescribed digoxin and hydrochlorothiazide for the management of heart failure? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Obtain pulse before taking digoxin dose. Do not take over-the-counter medications without talking with a health care provider. Include foods high in potassium in the diet. Report signs of toxicity such as blurred vision. Hold drug for heart rate less than 60 beats per minute. Rationale The nurse would instruct the patient to include foods high in potassium in the diet, because the combination of the thiazide diuretic and digoxin can cause hypokalemia. The nurse would instruct the patient to take his or her pulse before taking the dose and hold the drug and call the health care provider for a heart rate less than 60 beats per minute. It is also important to teach patients the signs of toxicity for them to be reported to the health care provider. Most over-the-counter medications can be taken, but the patient needs approval before starting them. pp. 490-491  Report content error Which adverse effect would the nurse educate a patient about who has been prescribed diltiazem? Hyperkalemia Blurred vision Fluid retention Erectile dysfunction Rationale The nurse would instruct that diltiazem can cause fluid retention that manifests as peripheral edema. Hyperkalemia occurs with propranolol. Digoxin toxicity can cause blurred vision. Erectile dysfunction can happen with verapamil. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. pp. 495-496 Report content error The nurse reviews the history of a patient with angina who The nurse reviews the history of a patient with angina who is prescribed propranolol. Which action will be the nurse's priority when noting that the patient has a history of asthma? Seek a bronchodilator prescription. Administer the drug as prescribed. Administer half the prescribed dose of the drug. Ask the health care provider to switch to another drug. Rationale Propranolol is a nonselective beta blocker, meaning that it blocks beta1 and beta2 receptors. Blocking beta2 receptors may cause bronchospasm, which is especially detrimental in patients with a history of asthma. The nurse would ask the health care provider to switch to another drug, specifically a cardioselective beta blocker. Adding a bronchodilator prescription would not be appropriate. Administering the drug would place the patient at risk for bronchospasm. The nurse cannot alter the dose of the drug without a prescription from the health care provider. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 494 Report content error Which intervention would the nurse implement immediately for a patient newly prescribed digoxin who is concurrently prescribed furosemide? Assess the prothrombin time (PT) and partial thromboplastin time (PTT). Monitor the potassium level. Obtain a baseline hearing assessment. Instruct the patient on a low-sodium, low-fat diet. Rationale Furosemide, a loop diuretic, can result in hypokalemia; therefore potassium levels should be monitored. Hypokalemia can increase the incidence of digoxin toxicity. Digoxin does not affect PT and PTT levels. Digoxin may affect sight, not hearing. Although the patient would need to follow a low-sodium, low-fat diet to treat heart failure, this is not the priority action for a patient who is prescribed both digoxin and furosemide. p. 499  Report content error Which instruction will be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? 'Apply the patch to a nonhairy, nonfatty area of the chest, arm, or thigh.' 'If you get a headache, remove the patch for 4 hours and then reapply.' 'If you experience chest pain, apply a second patch right next to the first patch.' 'Apply the patch to the same site each day to maintain consistent drug absorption.' Rationale A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. It is most commonly applied to the chest wall but may also be applied to the arm or thigh. Headache is a brief side effect of the therapy, but it soon diminishes. The patch should not be removed if headache occurs, because this is an anticipated side effect of therapy. A second patch should not be applied if chest pain occurs. Sublingual nitroglycerin is typically administered for acute angina episodes. The application sites should be rotated to prevent skin irritation. p. 497  Report content error Which mechanism of action describes how digoxin immune Fab works? Binding to digoxin Decreasing elimination of digoxin Inducing a heart block Speeding up digoxin's metabolism Rationale Digoxin immune Fab works by binding to the digoxin molecules that are then excreted in the urine. Elimination of digoxin is not decreased. Digoxin toxicity can cause a heart block. Metabolism of digoxin is not affected. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking by looking for key words; (2) Read each answer thoroughly, and see if it completely covers the material the question asks; and (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 490  Report content error Which outcome is expected with calcium channel blockers (CCBs)? To treat acute myocardial infarction (MI) To reduce exercise-induced elevations in heart rate To prolong the QT interval on the electrocardiogram (ECG) To decrease the afterload and reduce the workload of the heart Rationale The CCBs decrease the afterload and reduce the workload of the heart by preventing muscle contraction and promoting muscle relaxation. CCBs are contraindicated in patients with acute MI. The beta blockers are more effective in reducing exercise-induced heart rate elevations, because they decrease blood pressure and heart rate promptly. Ranolazine, not calcium channel blockers, is used to prolong the QT interval on the ECG. p. 492 Report content error Which formulation of nitroglycerin is likely to have a large first-pass effect? Oral Sublingual Transdermal Intravenous Rationale Oral nitroglycerin goes to the liver and is metabolized before it can become active in the body. As a result, a large amount of nitroglycerin is removed from the circulation. This is known as a large first-pass effect. Sublingual nitroglycerin has an onset of action of 2 to 3 minutes and is absorbed quickly, because the area under the tongue is highly vascular. Transdermal nitroglycerin has an onset of action of 30 to 60 minutes. It is used for long-term management of angina pectoris, because it allows for the continuous slow delivery of nitroglycerin. Intravenous nitroglycerin is quickly absorbed in the blood, because it has an onset of action of 1 to 2 minutes. p. 494 Report content error Which drug class is used as the first line of therapy for reducing fluid volume in patients with heart failure (HF)? Nitrates Diuretics Beta blockers Calcium channel blockers Rationale Diuretics promote the formation of urine by the kidneys and, thereby, help reduce the fluid volume of the body. Therefore diuretics are used as the first-line drugs in patients with HF. Nitrates act by dilating the blood vessels, facilitating blood flow. These drugs are effective in the treatment of myocardial ischemia. Beta blockers decrease the effects of the sympathetic nervous system, thereby reducing the heart rate and blood pressure. Beta blockers find their use in the treatment of angina pectoris. Calcium channel blockers inhibit the activation of calcium channels, thereby inhibiting calcium release. Calcium causes contraction of the myocardium and increases the workload on the heart. Calcium channel blockers decrease the workload of the heart and are used in the treatment of angina pectoris. p. 491 Report content error Which action by a nurse would be taken if the nurse Which action by a nurse would be taken if the nurse observes the patient’s serum digoxin level to be 0.9 ng/mL? Administer potassium. Hold future digoxin doses. Call the health care provider. Administer the prescribed dose of digoxin. Rationale Therapeutic serum digoxin levels are 0.8 to 2 ng/mL. The patient should receive the next dose to continue within the therapeutic drug range. Potassium should never be given without documented potassium deficiency. The level is therapeutic, therefore the health care provider does not need to be notified. Because the dose is in the therapeutic range, it is not necessary to hold future doses. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question. p. 491 Report content error Which instruction does a nurse give a patient about storing sublingual nitroglycerin tablets while traveling? 'You can protect it from heat by placing the bottle in an ice chest.' 'It is best to keep it in its original container away from heat and light.' 'You can put a few tablets in a sealed bag and carry it in your pocket.' 'Lock it in the glove compartment of your car to protect it from heat and light.' Rationale Sublingual nitroglycerin tablets can decompose if exposed to heat and light. Therefore the tablets should be kept in their original container, which is amber in color, to protect the tablets from light. They should also be kept out of the heat. The tablets would not be kept in an ice chest; they should simply be maintained at room temperature. The tablets should not be placed into a sealed bag, because they may be exposed to light. The tablets should not be stored in the car because of exposure to temperature extremes. p. 493 Report content error Which assessment would a nurse make before Which assessment would a nurse make before administering digoxin? Apical pulse Homans sign Breath sounds Pain scale Rationale It is crucial to measure the patient's apical pulse rate (auscultate the apical heart rate, found at the apical impulse located at the fifth left midclavicular intercostal space) for 1 full minute before administering digoxin. It should be greater than 60 beats per minute. The Homans sign is checked to deduce clots and would not be assessed before administration of digoxin. Breath sounds of a patient are used to monitor respiratory conditions like chronic obstructive pulmonary disease (COPD), not before administration of digoxin. Digoxin is not used in the treatment of pain; therefore assessing a pain scale is not necessary. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding. p. 491 Report content error Which instruction does a nurse provide a patient who reports headaches associated with administration of sublingual nitroglycerin? 'Stop taking the tablets immediately.' 'These headaches may be treated with acetaminophen.' 'You should take a lower dose of the drug.' 'You should immediately undergo diagnostic testing.' Rationale Headaches are one of the most common side effects of nitroglycerin. They occur when first taking nitroglycerin and last up to 30 minutes. Headaches from nitroglycerin may be managed with acetaminophen. The nurse would not tell the patient to stop taking the tablets or to lower the dose because it will impact efficacy. It is not necessary to get diagnostic testing, because headaches are a brief and expected side effect associated with nitroglycerin. p. 497 Report content error Which instruction does a nurse provide a patient who is prescribed nitroglycerin patches in order to prevent the development of tolerance to nitrates? 'Apply the nitroglycerin patch every other day.' 'Use the nitroglycerin patch for acute episodes of angina only.' 'Use sublingual nitroglycerin if your systolic blood pressure is 140 mm Hg.' 'Apply the nitroglycerin patch each day, and remove it for 8 - 12 hours at night.' Rationale Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. Therefore the nurse would advise the patient to apply the nitroglycerin patch daily, removing it for this time frame. Applying the patch every other day will not have the therapeutic effects. Sublingual nitroglycerin, not transdermal nitroglycerin, is more effective for chest pain. Sublingual nitroglycerin is administered for treating acute episodes of angina, and not elevated blood pressure readings. p. 494 Report content error Which rationale explains why a nurse would ask a patient newly prescribed digoxin to stop taking licorice supplementation? Licorice may increase the risk for hyperkalemia. Licorice may reduce the effects of digoxin. Licorice may increase the risk for hypomagnesemia. Licorice enhances the effect of digoxin. Rationale Licorice is an herbal drug. Licorice and digoxin produce a drug-herb interaction. Licorice may increase the risk for cardiac toxicity because of potassium loss, which increases the effects of digoxin. As a result, the patient may experience digoxin toxicity. Licorice causes hypokalemia, not hyperkalemia. It can increase, not decrease the effects of digoxin. It does not cause hypomagnesemia. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct; therefore base your selection on identified priorities for action. p. 490 Report content error Which class of drugs is used in the treatment of angina pectoris? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Diuretics Beta blockers Antihistamines Nitrates and nitrites Calcium channel blockers (CCBs) Rationale Beta blockers, nitrates/nitrites, and calcium channel blockers are all used in the management of angina pectoris. Beta blockers reduce heart rate, contractility, and oxygen demand. Nitrates and nitrites cause venous dilation and relax coronary arteries. Calcium channel blockers relax coronary arteries and dilate the arterioles. Diuretics are not prescribed for the treatment of angina pectoris but to increase the patient's fluid output. Antihistamines are used to reduce the physiologic and pharmacologic effects of histamine. p. 492 Report content error Which statement by a nurse about the use of medicinal nitrates indicates effective understanding? They slow conduction.  They dilate all blood vessels. Medicinal nitrates have no adverse effects. Medicinal nitrates are used for atrial fibrillation. Rationale Medicinal nitrates cause generalized vascular and coronary vasodilation, which increases blood flow through the coronary arteries to the myocardial cells. They do not slow conduction. They are associated with adverse effects like tachycardia and postural hypotension. They are not used to treat atrial fibrillation. p. 492 Report content error Which statement by the nurse about beta blockers is accurate? 'They work by increasing myocardial contractility.' 'Beta blockers increase the patient's urine output.' 'They work by increasing dilation of the peripheral vessels.' 'Beta blockers decrease sympathetic stimulation of the heart.' Rationale Beta blockers decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine and norepinephrine, thereby decreasing the heart rate and blood pressure. They do not increase myocardial contractility, increase the patient’s urine output, or increase dilation of the peripheral vessels. p. 494 Report content error Which statement made by a patient demonstrates a need for further instruction regarding the use of sublingual nitroglycerin? 'I should keep my nitroglycerin in a cool, dry place that is protected from light.' 'I should change positions slowly to avoid getting dizzy.' 'I can take up to five tablets at 3-minute intervals for chest pain if necessary.' 'If I get a headache, I should keep taking nitroglycerin and use acetaminophen for pain relief.' Rationale Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. Thus taking five tablets every 3 minutes is incorrect. Nitroglycerin should be kept in a cool, dry place away from light, as the sublingual tablets decompose when exposed to light and heat. Nitroglycerin lowers blood pressure; and, as such, patients should be advised to change positions slowly to avoid dizziness. Headaches are common with nitroglycerin and can be managed with acetaminophen. p. 493 Report content error The nurse is reviewing a patient’s health record before administering the patient’s scheduled dose of digoxin. Based on the findings in the patient’s chart, which action would the nurse take? Select all that apply. One, some, or all responses may be correct. Assessment Data Laboratory Results Oriented X 4 Glucose 82 Reports headache and double vision mg/dL Apical heart rate 47 beats/minute and Sodium 142 irregular mEq/L Blood pressure 108/62 mm Hg Potassium 2.9 Respiratory rate 13 breaths/minute mEq/L  Respiratory rate 13 breaths/minute mEq/L Temperature 98.2°F Chloride 98 Oxygen saturation 97% room air mEq/L Vomited X 2 this morning BUN 15 mg/dL Loose stool X 1 today Creatinine 0.8 Bowel sounds hyperactive mg/dL Peripheral pulses 1+ bilaterally Some correct answers were not selected Obtain the patient’s serum digoxin level. Assess the patient for peripheral edema. Hold the scheduled digoxin dose. Administer supplemental oxygen. Contact the health care provider (HCP). Initiate continuous telemetry monitoring. Rationale The patient is experiencing signs of digoxin toxicity (nausea, vomiting, diarrhea, and an irregular heart rate). Therefore the nurse would contact the HCP, then obtain a serum digoxin level. The nurse would hold the scheduled dose until the digoxin level is obtained. Given the patient’s possible digoxin toxicity and irregular heart rate, the nurse would also initiate continuous telemetry monitoring. Peripheral edema is a side effect of calcium channel blockers, not digoxin. Supplemental oxygen would be administered if the oxygen saturation drops. This is unrelated to digoxin. p. 491 Report content error The nurse is providing education to a patient who will begin digoxin. Which food would the nurse instruct the patient to consume to increase serum potassium levels? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Broccoli Eggplant Potatoes Cauliflower Orange juice Rationale Digoxin can cause hypokalemia. Therefore the nurse would educate the patient on how to increase potassium intake. Foods that are high in potassium include potatoes and orange juice. Broccoli, eggplant, and cauliflower are very low in potassium. p. 491  Report content error Which drug is a calcium channel blocker? Diltiazem Metoprolol Propranolol Nitroglycerin Rationale Diltiazem is a calcium channel blocker. Metoprolol and propranolol are beta blockers. Nitroglycerin is a nitrate. pp. 495,500 Report content error Which result(s) would the nurse expect to be decreased if the nurse is reviewing the laboratory results of a patient taking hydrochlorothiazide? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Chloride Calcium Potassium Magnesium Glucose Rationale The nurse would expect chloride, potassium, and magnesium to be decreased in this patient. Hydrochlorothiazide lowers chloride, potassium, and magnesium levels. It increases calcium and glucose levels. pp. 510,511 Report content error Which finding in the patient’s medication profile indicates a need to contact the health care provider (HCP) if the nurse is preparing to administer spironolactone to a patient with cirrhosis? Lisinopril Diltiazem  Metoprolol Hydralazine Rationale Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, can cause hyperkalemiaif given with spironolactone. Thereforeif the nurse found lisinopril in the patient’s medication profile,the nurse would contact the HCP before giving the diuretic to the patient. Spironolactone is safe to give with diltiazem, metoprolol, and hydralazine. p. 515 Report content error Which intervention(s) would the nurse include in the plan of care for a patient taking spironolactone? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Assess renal function. Weigh patient every day. Obtain serum electrolytes. Monitor urinary output. Offer high-potassium foods. Rationale Spironolactone is a potassium-sparing diuretic used to remove excess fluid in patients with heart failure and cirrhosis. The patient needs to have good renal function for the drug to be effective, so the nurse would assess the blood urea nitrogen and creatinine. The nurse would weigh the patient every day and monitor urinary output to determine fluid loss. The nurse would assess serum electrolytes to look for excesses and deficits. The nurse would offer low-potassium foods because this diuretic holds on to potassium. p. 516 Report content error Which action would the nurse perform first after reviewing the patient’s health record and before administering 40 mg of furosemide via an IV push to a patient with heart failure?  Hold the medication. Take the blood pressure. Obtain the patient’s weight. Obtain an electrocardiogram (ECG) reading. Rationale A side effect of loop diuretics, such as furosemide, is hypokalemia. The patient has a serum potassium level of 2.9 mEq/L, which can lead to life-threatening dysrhythmias. Therefore the nurse’s first action would be to hold the medication. After this, the nurse would notify the health care provider (HCP) to obtain further orders. The nurse would obtain the heart rate and listen to the cardiac rhythm for abnormalities. The blood pressure would be a parameter to assess if the medication would be given. The nurse would not obtain the patient’s weight at this time. The HCP would likely ask for a 12-lead ECG. p. 512  Report content error Which nursing intervention is a priority for a patient receiving furosemide who is observed to have muscle weakness, leg cramps, and heart palpitations? Administer calcium supplements. Assess the serum potassium level. Reduce salt in the patient’s food. Give a lower dose of hydrochlorothiazide. Rationale Furosemide can cause hypokalemic symptoms, which are characterized by muscle weakness, leg cramps, and cardiac dysrhythmias. The nurse would assess the patient’s serum potassium level to determine the course of action. Giving calcium supplements alone would not reduce the symptoms caused by potassium deficiency. Decreasing the salt intake would further reduce the patient’s blood pressure and cause sodium deficiency. Reducing the dose of the drug should not occur without further discussion with, and intervention by, the health care provider. p. 514  Report content error Which category of diuretics may cause hypotension, hyperglycemia, hearing impairment, and gout? Loop diuretics Thiazide diuretics Osmotic diuretics Potassium-sparing diuretics Rationale Loop diuretics may cause physiologic or laboratory changes such as hypotension, hyperglycemia, hearing impairment, and gout. Thiazide diuretics may cause agranulocytosis, potassium loss, and aplastic anemia. Osmotic diuretics may cause fluid and electrolyte imbalances; pulmonary edema from a rapid shift of fluids; and vomiting. Potassium- sparing diuretics may cause severe hyperkalemia, asthenia, and paresthesia. p. 513 Report content error Which range is considered normal for a potassium level?  24 to 28 mEq/L 1.5 to 2.5 mEq/L 3.5 to 5 mEq/L 96 to 106 mEq/L Rationale The normal potassium range is 3.5 to 5 mEq/L. Any value lower than this standard parameter indicates hypokalemia. Any value higher than this indicates hyperkalemia. The normal bicarbonate range is 24 to 28 mEq/L. The normal magnesium range is 1.5 to 2.5 mEq/L. The normal chloride range is 96 to 106 mEq/L. p. 510 Report content error Which two functions are associated with diuretics? Reducing edema and blood pressure Reducing weight and edema Reducing blood volume and edema Reducing calcium and blood pressure Rationale The two functions of diuretics are to reduce edema and to reduce blood pressure. Although diuretics can rid the body of excess fluid and thereby cause weight loss, they are not intended for this purpose. Similarly, although diuretics may have an effect on blood volume byincreasing urinary output, they are not intended for this purpose. Diuretics promote sodium and potassium loss, not calcium loss. Test-Taking Tip: If you can eliminate any responses as incorrect based on your knowledge, you will not be guessing randomly but will be exercising “informed guessing.” p. 507 Report content error A patient who is retaining excess fluid wants to try hydrochlorothiazide. Which parameter in the patient’s health record would lead to this drug being cautioned? Gout Decreased mobility Potassium level of 4.4 mEq/L Blood pressure reading of 142/90 mm Hg Rationale Hydrochlorothiazide raises the uric acid levels. This can be problematic for a patient with a history of gout, as this would further elevate uric acid levels. A patient with decreased mobility may need to plan to use the bathroom frequently to prevent incontinence, buthydrochlorothiazide would not be contraindicated. The patient has a normal potassium level, so this is not an issue. The patient’s blood pressure is elevated but will decrease with diuretic therapy. pp. 509-510 Report content error Which description is accurate regarding the action of angiotensin-converting enzyme inhibitors (ACEIs)? Block alpha-adrenergic receptors to cause vasodilation Act by relaxing the smooth muscles of blood vessels, mainly arteries Inhibit formation of angiotensin II and block the release of aldosterone Block the calcium channel in the vascular smooth muscles, promoting vasodilation Rationale ACEIs inhibit the formation of angiotensin II and block the release of aldosterone, thereby decreasing blood pressure. Alpha-adrenergic blockers inhibit alpha-adrenergic receptors to cause vasodilation and reduce blood pressure. Direct-acting arteriolar vasodilators relax the smooth muscles of the blood vessels (mainly the arteries), causing vasodilation and decreasing blood pressure. Calcium channel blockers block the calcium channel in the vascular smooth muscles, promoting vasodilation and reducing blood pressure. p. 526 Report content error Which statement by the patient indicates a need for further instruction if the nurse is teaching the patient about newly prescribed captopril? “I should take my medication about half an hour before a meal.” “I will avoid stopping this medication suddenly.” “Irritating cough and swollen lips are to be expected.” “I will stop using salt substitutes while taking this medication.” Rationale Captopril is an angiotensin-converting enzyme inhibitor (ACEI) prescribed for hypertension. When teaching patients about possible adverse effects, the nurse should provide information on angioedema, in which the lips, tongue, face, and airway swell, blocking the airway. Angioedema is a life-threatening event, and any indications of angioedema development, such as swollen lips, are not expected; the patient should be instructed to go to the closest emergency room for treatment if these occur. Thus the patient’s statement about an irritating cough and swollen lips being expected indicates a need for further education. Food can reduce the absorption of captopril by 35%, so captopril should ideally be taken 20 minutes to an hour before a meal. Patients should avoid abruptly stopping captopril, as this can lead to rebound hypertension. Use of salt substitutes should be stopped because salt substitutes may cause a sharp rise in serum potassium. p. 527 Report content error Which nonpharmacologic method(s) can be used to decrease blood pressure? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Stress reduction Exercise Salt restriction Smoking cessation Reduced alcohol ingestion Rationale Stress reduction techniques, exercise, salt restriction, reduction in alcohol ingestion, and smoking cessation are useful nonpharmacologic methods for reducing blood pressure. p. 519 Report content error Which drug(s) blocks (block) angiotensin II from the angiotensin I receptors? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Losartan potassium Valsartan Moexipril Captopril Irbesartan Diltiazem HCl Rationale Losartan potassium, valsartan, and irbesartan are angiotensin II receptor blockersthat block angiotensin II from the angiotensin I receptors. These drugs cause vasodilation and reduce peripheral resistance. Moexipril and captopril are angiotensin-converting enzyme inhibitors that inhibit the angiotensin-converting enzyme in the formation of angiotensin II. Diltiazem HCl is a calcium channel blocker that blocks the calcium channels in vascular smooth muscle to cause vasodilation. p. 527 Report content error Which drug(s) would the nurse expect the primary health care provider to prescribe for an African American patient diagnosed with low-renin hypertension? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Beta blockers Alpha1 blockers Calcium channel blockers (CCBs) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Rationale Alpha1 blockers and CCBs are effective in controlling hypertension in African American patients with low-renin hypertension. African American patients are susceptible to low-renin hypertension and therefore do not respond well to beta blockers, ACE inhibitors, and ARBs. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patients, but only one or some of the options may relate directly to the situation or patient. p. 519 Report content error Which drug class is associated with a constant, irritated, and nonproductive cough in some patients? Angiotensin II–receptor blockers Angiotensin-converting enzyme (ACE) inhibitors Beta blockers Calcium channel blockers Rationale A persistent, irritated, nonproductive cough may occur in some patients from ACE inhibitor therapy. It can be relieved upon discontinuation of the drug. Angiotensin II–receptor blockers, beta blockers, and calcium channel blockers are not associated with the development of a cough. Test-Taking Tip: Persistent cough is an adverse effect of ACE inhibitors. Use this information to answer this question accurately. p. 527 Report content error Which patient being treated with a beta blocker for hypertension will receive priority assessment by the nurse? The patient who has been on a beta blocker for 1 day The patient who is on a beta blocker and a thiazide diuretic The patient who has stopped taking a beta blocker due to cost The patient who is taking a beta blocker and furosemide Rationale Abrupt discontinuation of a beta blocker may cause rebound hypertension, angina, dysrhythmias, and myocardial infarction. The patient who has stopped taking a beta blocker due to cost will receive priority assessment by the nurse. The patient who has just been started on an antihypertensive drug and the patients who are on combinations of antihypertensive drugs will not be as high of a priority for assessment because they seem to be complying with treatment. Study Tip: Begin studying by setting goals. Make sure that they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. p. 521 Report content error Which rationale would the nurse provide when teaching a patient about how a calcium channel blocker lowers blood pressure? “This drug will work to cause you to get rid of fluid.” “This drug will help you to get rid of sodium.” “This drug will dilate your blood vessels.” “This drug will help you to lose weight.” Rationale Calcium channel blockers lower blood pressure by blocking calcium channels in vascular smooth muscle to cause vasodilation. Thus the nurse would inform the patient that calcium channel blockers dilate the blood vessels. Calcium channel blockers do not lower blood pressure through diuresis, excretion of sodium, or weight loss. Test-Taking Tip: Keywords or phrases in the stem of the question, such as first, primary, early, or best, are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; every rule has its exceptions, so answer with care. p. 530 Report content error Which side effect(s) would a nurse monitor for after administering lisinopril to a patient? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Anemia Dry cough Hematuria Anuria Hyperkalemia Rationale Lisinopril is used as an angiotensin-converting enzyme inhibitor. A dry cough and hyperkalemia are side effects of lisinopril. Thus the nurse would monitor for a dry cough and hyperkalemia. The drug does not affect hemoglobin concentrations and therefore does not cause anemia. Lisinopril does not cause hematuria or anuria. p. 527 Report content error The nurse is preparing to administer 25 mg of metoprolol orally to a patient with hypertension. Which patient parameter would cause the nurse to hold the dose and contact the health care provider (HCP)? Potassium level of 3.4 mEq/L Heart rate of 45 beats/minute Blood pressure of 118/76 mm Hg Urinary output of 1200 mL/24 hours Rationale An adverse effect of beta blockers, such as metoprolol, is bradycardia. A heart rate of 45 beats/minute indicates that this patient has developed bradycardia. Therefore the nurse would hold the dose and contact the HCP. Diuretics, not beta blockers, affect the potassium level. The patient has a normal blood pressure that would not require the nurse to hold the dose. Beta blockers do not affect urinary output. pp. 521-522 Correct (8) Report content error Which parameter does chronotropic drugs affect? Heart rate Blood pressure Conduction velocity Myocardial contractility Rationale Drugs that affect heart rate are referred to as chronotropic drugs. Drugs that affect blood pressure are referred to as vasopressor drugs. Drugs that affect the rate of conduction of electrical impulses through the myocardium are referred to as dromotropic drugs. Drugs that affect the force of myocardial contraction are referred to as inotropic drugs. p. 488 Report content error Which concomitantly administered drug will cause the nurse to monitor serum potassium levels in a patient who is also receiving digoxin for heart failure? Lisinopril Valsartan Furosemide Spironolactone Rationale Furosemide is a loop diuretic, which acts to prevent the reabsorption of sodium; as a result, the patient excretes sodium, water, and potassium. For this reason, the nurse checks the patient's serum potassium before administering digoxin, because hypokalemia increases the risk for digoxin toxicity and related dysrhythmias. Lisinopril is an angiotensin- converting enzyme inhibitor that also tends to be potassium sparing but is not used for diuresis. Valsartan is an angiotensin II–receptor blocker used to prevent vasoconstriction. Spironolactone is a potassium-sparing diuretic. These drugs do not cause hypokalemia, a concern for digoxin toxicity. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment. p. 490  Report content error Which condition indicates an excessive dose of digoxin? Polyuria Tinnitus Halo vision Photophobia Rationale Digoxin can cause halo vision, a condition in which colored or luminous rings are seen around lights. Other signs and symptoms of digoxin toxicity from an excessive dose include anorexia, diarrhea, nausea and vomiting, bradycardia (pulse rate below 60 beats per minute), premature ventricular contractions, cardiac dysrhythmias, headaches, malaise, blurred vision, confusion, and delirium. Older adults are more prone to toxicity. Polyuria, tinnitus, and photophobia are not signs of an excessive dose of digoxin. p. 490 Report content error Which effect do beta blockers have on classic (stable) angina? angina? No effect Decrease heart rate Reduce vasospasms Relax coronary arteries Rationale Beta blockers decrease the heart rate and contractility of the heart. Beta blockers have no effect on variant anginas. Nitrates and calcium channel blockers reduce vasospasms and relax coronary arteries. p. 492 Report content error Which side effect is common with nitrates, beta blockers, and calcium channel blockers? Heartburn Heart failure Hypotension Hyperkalemia Rationale All drugs in the nitrate, beta blocker, and calcium channel blocker classes can cause hypotension. Nifedipine can cause pyrosis, heartburn, and heart failure. Hyperkalemia occurs with propranolol. pp. 495,496 Report content error Which phrase describes how a diuretic lowers blood pressure? Decreases urine flow Maintains calcium balance Removes excess potassium Blocks sodium and water reabsorption Rationale Diuretics block sodium and water reabsorption from the kidney tubules. This causes diuresis, which increases, not decreases, urine flow. The parathyroid glands control calcium balance. Potassium levels do not affect blood pressure or fluid volume. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for keywords or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 507 Report content error Which information would the nurse share when teaching a patient about the administration of furosemide? Select all that apply. One, some, or all responses may be correct. Use at least SPF 30 sunscreen. Change body positions slowly. Eat bananas daily. Take the dose in the evenings for best effects. Supplement the dose with a licorice supplement. Rationale Loop diuretics such as furosemide can cause photosensitivity; therefore, it is important for the nurse to recommend sunscreen usage, especially with prolonged sun exposure. Due to fluid loss, the nurse would instruct the patient to change positions slowly. Furosemide can cause potassium loss, so the nurse would instruct the patient to eat foods high in potassium, such as bananas. The patient would be instructed to take the dosage in the morning, not the evenings, to prevent nocturia disrupting sleep. Licorice accelerates potassium loss; therefore the nurse would not recommend that a supplement be taken along with furosemide. pp. 512,514 Report content error Which action would the nurse perform first, based on the information below, if a patient presents to the urgent care center reporting leg cramps, nausea, and blurred vision?  Administer oral digoxin. Address the serum potassium level. Give scheduled sliding scale insulin. Obtain orthostatic blood pressures. Rationale When a person combines hydrochlorothiazide with digoxin, this can cause digoxin toxicity if the patient is hypokalemic. The patient reports leg cramps, which is a sign of hypokalemia, and has a potassium level of 2.9 mEq/L, also indicating hypokalemia. Therefore the nurse would address the patient’s serum potassium level first. The patient’s reports of nausea and blurred vision could be signs of digoxin toxicity. It would also be prudent for the nurse to monitor the patient’s digoxin level. The nurse would wait to administer the digoxin until the potassium level is dealt with and until the digoxin level has been determined. The nurse would wait to administer the insulin because the patient’s electrolyte levels and cardiac status need to be addressed first. Orthostatic blood pressures can be obtained later; this is not the first priority. p. 510