Maryville NURS 615- Exam V | Questions with 100% Verified Answers |
Latest Update
Question: What assessments should be made before prescribing any antihypertensive agent?
Answer:
BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes, and potassium levels. Prior
to prescribing any antihypertensives, creatinine and BUN levels should be evaluated. Confirmation of
elevated BP at 3 different times. Children over 3 years old should be assessed at least once at every
visit-preferred method for children is by auscultation, the correct measurement requires using a cuff that
is appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine ratio. Diabetics or
those with renal disease should have the albumin/creatinine ratio annually. The presence of albuminuria,
micro albuminuria even in the setting of normal GFR is associated with increased cardiovascular risk.
Blood sugar, hct, serum calcium, and lipid profile.
Question: Why are ACE inhibitors the drug of choice in diabetic patients with hypertension?
Answer:
ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on the kidneys. Protect the
kidneys, watch for renal function, any creatinine >2.5 requires dose reduction. Prevents diabetic
nephropathy or slow its progression. Reduce albuminuria and BP. ACEIs and ARBs should be used to
treat the HTN. Renal protection, reduces the conversion of AT II and improve the insulin sensitivity.
Question: What is the drug of choice to improve symptoms for patients taking propranolol?
Answer:
Ipratropium
Question: What is the most common adverse effect of an ACE inhibitor?
Answer:
Dry, hacking cough in some patients. Can switch to an angiotensin blocker which won't cause cough.
Reduce dose with either of these if Cr >2.5. Most are associated with hypotension, dizziness, HA,
fatigue, orthostatic hypotension, tachyphylaxis.
Question: What is the action of an ACE inhibitor?
Answer:
Decreases angiotensin II and aldosterone. Vasodilatation on the venous and arterial sides of the heart.
Blocks the RAAS system leads to rennin acts on angiotensinogen to angiotensin I to angiotensin II
through ACE. Angiotensin II stimulates aldosterone causing sodium and water while losing potassium
via the kidney. ACE is also involved in the inactivation of bradykinin a vasodilator. Bradykin is what
causes the cough (irritating the lungs).
Question: What is the action of an Angiotensin Receptor Blocker?
,Answer:
Blocks the angiotensin II receptor to leading to increasing vascular tone and stimulating vascular smooth
muscle contraction. One of the greatest advantages: doesn't produce the dry, hacking cough that ACE-Is
do. Similar to ACE-I except to bradykinin activity (no cough), lowers BP, decreases vascular resistance,
decreases pulmonary cap wedge pressure, decreases HR, increases cardiac index.
Question: What ethnic background should not be prescribed long- acting beta-agonists?
Answer:
African Americans, increased incidence of death in this population
Question: What is tiotropium used to treat?
Answer:
COPD, after patient stops smoking, this medication slow the progression of COPD.
Question: What is the action of a Calcium Channel Blocker?
Answer:
Decrease the amount of calcium inside the cell to control blood pressure. Dihydropyridine CCB: inhibits
transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell
membranes without changing serum calcium concentrations. This results in inhibition of cardiac and
vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries.
Vasodilatation with decreased peripheral resistance and increased heart rate. Nondihydropyridine CCB:
inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth
muscle cells. Resulting in inhibition of cardiac and vascular smooth muscle contraction and thereby
dilating main coronary and systemic arteries. No effect on serum calcium contractions. Substantial
inhibitory effects on cardiac conduction system, acting principally at AV node, with some effects at sinus
node.
Question: What are the adverse effects of a dihydropyridine-type calcium channel blocker?
Answer:
Causes edema of the feet and hands, especially feet. Amlodipine and nifedipine. Type 2
(dihydropyridine=vessel loving) = peripheral edema. Type 1 (non-dihydropyridine=heart
loving)=bradycardia, dizziness, hypotension.
Question: A 70-year-old patient is admitted with peripheral edema. He taking a calcium channel blocker
and metformin. What is the cause of his peripheral edema?
Answer:
is The edema is not related to metformin. Type 1 CCB more commonly exhibit peripheral edema. Pts
report swelling of the hands, feet, ankles, and decreased urine output.
Question: What special populations should not be prescribed pseudoephedrine?
, Answer:
Children under the age of 4, first line treatment for coughs and colds is increased fluids and symptomatic
management. Schedule III- addictive personalities, HTN, CAD. Children under 4= Infants cause sudden
death, not recommended for children under 4. Anytime thinking of cough and cold medications you
should always think of the elderly, very young and HTN.
Question: How is amlodipine metabolized?
Answer:
All CCBs are metabolized by the liver in the CYP 3A4. Avoid, don't administer CCB with grapefruit
juice, it will increase amlodipine level. Has a half life of 30-50 hours (56hr in hepatic impairment),
eliminated via urine.
Question: A patient is prescribed amlodipine. She develops reflex tachycardia. What is the reason for the
development of
Answer:
It increases the myocardial oxygen delivery in patients with angina. Sub-peripheral vasodilatation causes
such a dramatic drop in BP that baroreceptor reflex is triggered.
Question: bradycardia?
Answer:
The baroreceptors are in the aortic arch. The baroreceptor causes sympathetic stimulation of the heart. It
increases pulse, it increases contractile force. Peripheral or facial edema can result. Hypotension is a
common adverse effect of CCB. A beta blocker can be administered to prevent the reflex tachycardia.
When prescribing CCB you always start low and progress slow. Older patients should be started at half
the regular dose. Decrease in SA and AV node conduction velocity occurs.
Question: What drug should be prescribed for a patient with nasal congestion with hypertension?
Answer:
Nasal oxymetazoline or nasal azelastine. Cromolyn sodium, ipratropium bromide, or corticosteroids by
inhalation can be used safely for nasal congestion by patients with HTN.
Question: What patient teaching will you provide when prescribing amiodarone?
Answer:
Take the drug as prescribed. Take the next day's dose if a dose is missed. Change position slowly d/t
hypotension. Avoid taking hot showers or baths, they will cause hypotension. COPD patients. For doses
taken more than once daily, evenly space the doses. An abrupt withdrawal may result in life threatening
arrhythmia, HTN or myocardial ischemia. Keep enough medication on vacations, holidays, and
weekends. If a dose is missed at its usual time, take the next day.
Question: What are the drug interactions with digoxin?
Latest Update
Question: What assessments should be made before prescribing any antihypertensive agent?
Answer:
BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes, and potassium levels. Prior
to prescribing any antihypertensives, creatinine and BUN levels should be evaluated. Confirmation of
elevated BP at 3 different times. Children over 3 years old should be assessed at least once at every
visit-preferred method for children is by auscultation, the correct measurement requires using a cuff that
is appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine ratio. Diabetics or
those with renal disease should have the albumin/creatinine ratio annually. The presence of albuminuria,
micro albuminuria even in the setting of normal GFR is associated with increased cardiovascular risk.
Blood sugar, hct, serum calcium, and lipid profile.
Question: Why are ACE inhibitors the drug of choice in diabetic patients with hypertension?
Answer:
ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on the kidneys. Protect the
kidneys, watch for renal function, any creatinine >2.5 requires dose reduction. Prevents diabetic
nephropathy or slow its progression. Reduce albuminuria and BP. ACEIs and ARBs should be used to
treat the HTN. Renal protection, reduces the conversion of AT II and improve the insulin sensitivity.
Question: What is the drug of choice to improve symptoms for patients taking propranolol?
Answer:
Ipratropium
Question: What is the most common adverse effect of an ACE inhibitor?
Answer:
Dry, hacking cough in some patients. Can switch to an angiotensin blocker which won't cause cough.
Reduce dose with either of these if Cr >2.5. Most are associated with hypotension, dizziness, HA,
fatigue, orthostatic hypotension, tachyphylaxis.
Question: What is the action of an ACE inhibitor?
Answer:
Decreases angiotensin II and aldosterone. Vasodilatation on the venous and arterial sides of the heart.
Blocks the RAAS system leads to rennin acts on angiotensinogen to angiotensin I to angiotensin II
through ACE. Angiotensin II stimulates aldosterone causing sodium and water while losing potassium
via the kidney. ACE is also involved in the inactivation of bradykinin a vasodilator. Bradykin is what
causes the cough (irritating the lungs).
Question: What is the action of an Angiotensin Receptor Blocker?
,Answer:
Blocks the angiotensin II receptor to leading to increasing vascular tone and stimulating vascular smooth
muscle contraction. One of the greatest advantages: doesn't produce the dry, hacking cough that ACE-Is
do. Similar to ACE-I except to bradykinin activity (no cough), lowers BP, decreases vascular resistance,
decreases pulmonary cap wedge pressure, decreases HR, increases cardiac index.
Question: What ethnic background should not be prescribed long- acting beta-agonists?
Answer:
African Americans, increased incidence of death in this population
Question: What is tiotropium used to treat?
Answer:
COPD, after patient stops smoking, this medication slow the progression of COPD.
Question: What is the action of a Calcium Channel Blocker?
Answer:
Decrease the amount of calcium inside the cell to control blood pressure. Dihydropyridine CCB: inhibits
transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell
membranes without changing serum calcium concentrations. This results in inhibition of cardiac and
vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries.
Vasodilatation with decreased peripheral resistance and increased heart rate. Nondihydropyridine CCB:
inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth
muscle cells. Resulting in inhibition of cardiac and vascular smooth muscle contraction and thereby
dilating main coronary and systemic arteries. No effect on serum calcium contractions. Substantial
inhibitory effects on cardiac conduction system, acting principally at AV node, with some effects at sinus
node.
Question: What are the adverse effects of a dihydropyridine-type calcium channel blocker?
Answer:
Causes edema of the feet and hands, especially feet. Amlodipine and nifedipine. Type 2
(dihydropyridine=vessel loving) = peripheral edema. Type 1 (non-dihydropyridine=heart
loving)=bradycardia, dizziness, hypotension.
Question: A 70-year-old patient is admitted with peripheral edema. He taking a calcium channel blocker
and metformin. What is the cause of his peripheral edema?
Answer:
is The edema is not related to metformin. Type 1 CCB more commonly exhibit peripheral edema. Pts
report swelling of the hands, feet, ankles, and decreased urine output.
Question: What special populations should not be prescribed pseudoephedrine?
, Answer:
Children under the age of 4, first line treatment for coughs and colds is increased fluids and symptomatic
management. Schedule III- addictive personalities, HTN, CAD. Children under 4= Infants cause sudden
death, not recommended for children under 4. Anytime thinking of cough and cold medications you
should always think of the elderly, very young and HTN.
Question: How is amlodipine metabolized?
Answer:
All CCBs are metabolized by the liver in the CYP 3A4. Avoid, don't administer CCB with grapefruit
juice, it will increase amlodipine level. Has a half life of 30-50 hours (56hr in hepatic impairment),
eliminated via urine.
Question: A patient is prescribed amlodipine. She develops reflex tachycardia. What is the reason for the
development of
Answer:
It increases the myocardial oxygen delivery in patients with angina. Sub-peripheral vasodilatation causes
such a dramatic drop in BP that baroreceptor reflex is triggered.
Question: bradycardia?
Answer:
The baroreceptors are in the aortic arch. The baroreceptor causes sympathetic stimulation of the heart. It
increases pulse, it increases contractile force. Peripheral or facial edema can result. Hypotension is a
common adverse effect of CCB. A beta blocker can be administered to prevent the reflex tachycardia.
When prescribing CCB you always start low and progress slow. Older patients should be started at half
the regular dose. Decrease in SA and AV node conduction velocity occurs.
Question: What drug should be prescribed for a patient with nasal congestion with hypertension?
Answer:
Nasal oxymetazoline or nasal azelastine. Cromolyn sodium, ipratropium bromide, or corticosteroids by
inhalation can be used safely for nasal congestion by patients with HTN.
Question: What patient teaching will you provide when prescribing amiodarone?
Answer:
Take the drug as prescribed. Take the next day's dose if a dose is missed. Change position slowly d/t
hypotension. Avoid taking hot showers or baths, they will cause hypotension. COPD patients. For doses
taken more than once daily, evenly space the doses. An abrupt withdrawal may result in life threatening
arrhythmia, HTN or myocardial ischemia. Keep enough medication on vacations, holidays, and
weekends. If a dose is missed at its usual time, take the next day.
Question: What are the drug interactions with digoxin?
