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NURS 676 Advanced Pharmacology Midterm
Exam (WCU) VERIFIED QUESTIONS AND
ANSWERS WITH DETAILED RATIONALES
GRADED A+ GUARANTEED PASS
A patient who has been taking propranolol for 6 months reports having nocturnal cough and shortness of breath.
The primary care NP should:
a. obtain serum drug levels to monitor for toxicity of this medication.
b. contact the patient's cardiologist to discuss changing to a selective b-blocker.
c. instruct the patient to increase activity and exercise to counter these side effects.
d. tell the patient to stop taking the medication.
- ANS :b. contact the patient's cardiologist to discuss changing to a selective b-blocker.
Nocturnal cough and shortness of breath may be a side effect of propranolol, which can cause bronchospasm
because it is a nonselective â-blocker. The NP should discuss a selective b-blocker with the patient's cardiologist. â-
Blockers should never be stopped abruptly. Bradycardia and hypotension are signs of toxicity. Increasing activity
would not counter these side effects if bronchospasm is the cause.
A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and
learns that the patient is taking a b-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical
examination, and performs a review of systems. Which finding may warrant discontinuation of the b-blocker in this
patient?
Answers:
a. Wheezing, dyspnea, and cough
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b. Decreased exercise tolerance
c. Increased triglycerides
d. Nausea, vomiting, and anorexia
- ANS :a. Wheezing, dyspnea, and cough
b-Blockers may cause bronchospasm in susceptible patients, and discontinuation of the b-blocker may be required.
b-Blockers may cause an insignificant increase in serum triglycerides. Exercise intolerance, fatigue, and
gastrointestinal side effects are common.
A primary care NP provides teaching for a patient who will begin taking propranolol (Inderal). Which statement by
the patient indicates understanding of the teaching?
Answers:
a. "I should take this medication on an empty stomach."
b. "I should use caution while driving while taking this medication."
c. "I should not take the medication if my pulse is less than 60 beats per minute."
d. "If I have shortness of breath, I should discontinue the medication immediately."
- ANS :b. "I should use caution while driving while taking this medication."
Because the medication can cause fatigue and drowsiness, patients should be advised to use caution when driving.
The medication should be taken with food. Patients should not take a dose if the heart rate is less than 50 beats per
minute. Patients should be advised to report shortness of breath but should not abruptly stop taking the
medication.
A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and
verapamil. The patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil. The NP
should tell the patient that verapamil:
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Answers:
a. increases the rate of contraction of the cardiac muscle.
b. has a positive inotropic effect to increase cardiac output.
c. increases the force of contraction of the cardiac muscle.
d. improves blood flow and oxygen delivery to the heart.
- ANS :d. improves blood flow and oxygen delivery to the heart.
Verapamil decreases the force of smooth muscle contraction in the smooth muscle of the coronary and peripheral
vessels; this results in coronary artery dilation, which lowers coronary resistance and improves blood flow through
collateral vessels as well as oxygen delivery to ischemic areas of the heart. Calcium channel blockers do not
increase the rate or force of contraction of the heart.
A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The primary care NP should
contact the patient's cardiologist to discuss adding:
Answers:
a. verapamil HCl (Calan).
b. diltiazem (Cardizem).
c. nifedipine (Procardia XL).
d. amlodipine (Norvasc)
. - ANS :c. nifedipine (Procardia XL).
Nifedipine and related drugs are potent vasodilators, which makes them more effective for hypertension than
verapamil and diltiazem. Amlodipine is not a first-line drug.
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A patient who has stable angina is taking nitroglycerin and a b-blocker. The patient tells the primary care NP that
the cardiologist is considering adding a calcium channel blocker. The NP should anticipate that the cardiologist will
prescribe:
a. verapamil HCl (Calan).
b. isradipine (DynaCirc).
c. nicardipine (Cardene).
d. nifedipine (Procardia XL).
- ANS :a. verapamil HCl (Calan).
Nitrates and b-blockers are first-line therapy for stable angina. Calcium channel blockers should be reserved for
patients who cannot take these agents or patients whose symptoms are not controlled with these agents.
Verapamil is one of the calcium channel blockers that should be used. The other calcium channel blockers are not
recommended for this purpose.
A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent
blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with
standing up. The NP should consult with the patient's cardiologist about changing the medication to:
a. amlodipine (Norvasc).
b. verapamil HCl (Calan).
c. short-acting nifedipine (Procardia).
d. isradipine (DynaCirc).
- ANS :b. verapamil HCl (Calan).
Verapamil and diltiazem are less likely to cause hypotension than nifedipine and related drugs, such as isradipine
and amlodipine.
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NURS 676 Advanced Pharmacology Midterm
Exam (WCU) VERIFIED QUESTIONS AND
ANSWERS WITH DETAILED RATIONALES
GRADED A+ GUARANTEED PASS
A patient who has been taking propranolol for 6 months reports having nocturnal cough and shortness of breath.
The primary care NP should:
a. obtain serum drug levels to monitor for toxicity of this medication.
b. contact the patient's cardiologist to discuss changing to a selective b-blocker.
c. instruct the patient to increase activity and exercise to counter these side effects.
d. tell the patient to stop taking the medication.
- ANS :b. contact the patient's cardiologist to discuss changing to a selective b-blocker.
Nocturnal cough and shortness of breath may be a side effect of propranolol, which can cause bronchospasm
because it is a nonselective â-blocker. The NP should discuss a selective b-blocker with the patient's cardiologist. â-
Blockers should never be stopped abruptly. Bradycardia and hypotension are signs of toxicity. Increasing activity
would not counter these side effects if bronchospasm is the cause.
A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and
learns that the patient is taking a b-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical
examination, and performs a review of systems. Which finding may warrant discontinuation of the b-blocker in this
patient?
Answers:
a. Wheezing, dyspnea, and cough
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, 2
b. Decreased exercise tolerance
c. Increased triglycerides
d. Nausea, vomiting, and anorexia
- ANS :a. Wheezing, dyspnea, and cough
b-Blockers may cause bronchospasm in susceptible patients, and discontinuation of the b-blocker may be required.
b-Blockers may cause an insignificant increase in serum triglycerides. Exercise intolerance, fatigue, and
gastrointestinal side effects are common.
A primary care NP provides teaching for a patient who will begin taking propranolol (Inderal). Which statement by
the patient indicates understanding of the teaching?
Answers:
a. "I should take this medication on an empty stomach."
b. "I should use caution while driving while taking this medication."
c. "I should not take the medication if my pulse is less than 60 beats per minute."
d. "If I have shortness of breath, I should discontinue the medication immediately."
- ANS :b. "I should use caution while driving while taking this medication."
Because the medication can cause fatigue and drowsiness, patients should be advised to use caution when driving.
The medication should be taken with food. Patients should not take a dose if the heart rate is less than 50 beats per
minute. Patients should be advised to report shortness of breath but should not abruptly stop taking the
medication.
A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and
verapamil. The patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil. The NP
should tell the patient that verapamil:
2|Page
, 3
Answers:
a. increases the rate of contraction of the cardiac muscle.
b. has a positive inotropic effect to increase cardiac output.
c. increases the force of contraction of the cardiac muscle.
d. improves blood flow and oxygen delivery to the heart.
- ANS :d. improves blood flow and oxygen delivery to the heart.
Verapamil decreases the force of smooth muscle contraction in the smooth muscle of the coronary and peripheral
vessels; this results in coronary artery dilation, which lowers coronary resistance and improves blood flow through
collateral vessels as well as oxygen delivery to ischemic areas of the heart. Calcium channel blockers do not
increase the rate or force of contraction of the heart.
A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The primary care NP should
contact the patient's cardiologist to discuss adding:
Answers:
a. verapamil HCl (Calan).
b. diltiazem (Cardizem).
c. nifedipine (Procardia XL).
d. amlodipine (Norvasc)
. - ANS :c. nifedipine (Procardia XL).
Nifedipine and related drugs are potent vasodilators, which makes them more effective for hypertension than
verapamil and diltiazem. Amlodipine is not a first-line drug.
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A patient who has stable angina is taking nitroglycerin and a b-blocker. The patient tells the primary care NP that
the cardiologist is considering adding a calcium channel blocker. The NP should anticipate that the cardiologist will
prescribe:
a. verapamil HCl (Calan).
b. isradipine (DynaCirc).
c. nicardipine (Cardene).
d. nifedipine (Procardia XL).
- ANS :a. verapamil HCl (Calan).
Nitrates and b-blockers are first-line therapy for stable angina. Calcium channel blockers should be reserved for
patients who cannot take these agents or patients whose symptoms are not controlled with these agents.
Verapamil is one of the calcium channel blockers that should be used. The other calcium channel blockers are not
recommended for this purpose.
A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent
blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with
standing up. The NP should consult with the patient's cardiologist about changing the medication to:
a. amlodipine (Norvasc).
b. verapamil HCl (Calan).
c. short-acting nifedipine (Procardia).
d. isradipine (DynaCirc).
- ANS :b. verapamil HCl (Calan).
Verapamil and diltiazem are less likely to cause hypotension than nifedipine and related drugs, such as isradipine
and amlodipine.
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