MARYVILLE NURS 615 EXAM 5 COMPLETE QUESTIONS &
ANSWERS (100% VERIFIED SOLUTIONS) 2025/2026 UPDATE
What assessments should be made before prescribing any antihypertensive agent? - CORRECT
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.
Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? - CORRECT
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.
What is the drug of choice to improve symptoms for patients taking propranolol? - CORRECT
ANSWER -Ipratropium
What is the most common adverse effect of an ACE inhibitor? - CORRECT 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.
What is the action of an ACE inhibitor? - CORRECT 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).
What is the action of an Angiotensin Receptor Blocker? - CORRECT 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.
What ethnic background should not be prescribed long-acting beta-agonists? - CORRECT
ANSWER -African Americans, increased incidence of death in this population
What is tiotropium used to treat? - CORRECT ANSWER -COPD, after patient stops smoking, this
medication slow the progression of COPD.
What is the action of a Calcium Channel Blocker? - CORRECT 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.
What are the adverse effects of a dihydropyridine-type calcium channel blocker? - CORRECT
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.
,A 70-year-old patient is admitted with peripheral edema. He is taking a calcium channel blocker
and metformin. What is the cause of his peripheral edema? - CORRECT ANSWER -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.
What special populations should not be prescribed pseudoephedrine? - CORRECT 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.
How is amlodipine metabolized? - CORRECT 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.
A patient is prescribed amlodipine. She develops reflex tachycardia. What is the reason for the
development of bradycardia? - CORRECT 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. 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.
What drug should be prescribed for a patient with nasal congestion with hypertension? -
CORRECT 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.
What patient teaching will you provide when prescribing amiodarone? - CORRECT 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.
What are the drug interactions with digoxin? - CORRECT ANSWER -Quinidine, amiodarone,
verapamil, diltiazam, and propafenone increase serum cardiac glycoside levels and lead to
toxicity. Drugs that cause bradycardia will increase the risk of bradycardia. Albuterol and digoxin
will decrease digoxin levels. Levels go down especially with increased albuterol use.
Phenobarbital, phenytoin, rifampin = decrease effect of digoxin. Thiazide and loop diuretics,
mezlocillin, piperacillin, ticarcillin, amphotericin B, glucocorticoids=may cause hypokalemia,
increase risk of digoxin toxicity. Calcium preparations = facilitates toxicity by accelerating
overloading of intracellular calcium stores. Spironolactone=increases digoxin half life. Beta
adrenergic blockers, quinidine, disopyramide + additive bradycardia. Antacids, colestipol,
kaolinpectin, cholestyramine=decreases absorption of CG if given concurrently. Thyroid
hormones=may decrease therapeutic effects and cause arrhythmias. Reductase
inhibitors=increase digoxin levels. Albuterol=decreases digoxin levels.
What is the purpose of a thyroid panel with amiodarone what is nitrate tolerance? - CORRECT
ANSWER -Amiodorone can inhibit the thyroid gland, resulting in inflammation of the gland,
causing hyperthyroidism. It is also a known cause of hypothyroidism, interferes with thyroid
hormone (TH). Can cause hypothyroidism in normal thyroid patients.
What are the adverse effects of statins. - CORRECT ANSWER -Rhabdomyolysis is a severe
reaction. #1 weakness and pain (Severe) in the muscles, hepatotoxicity, HA, urine will get dark,
CPK checks for muscle breakdown. Monitor liver function and initially and then every 1-3
months. S/s unusual or increased muscle weakness, dark urine.
What is nitrate tolerance? - CORRECT ANSWER -Administration of nitrates too frequently leads
to nitrate tolerance. Dosing should be 7am and 2 pm (helps prevent intolerance). This is due
attenuation of the vascular effects of nitrates. If the doses are too close together then the
patient will develop nitrate tolerance. In regards to adverse effects, assess the severity of the HA
(is expected). Patient teaching for sublingual use: if swallowed there will be decrease in effect,
under tongue to dissolve. Tachyphylaxis: once start using nitrates and you continue using the
medication you are going to get to a level where increasing the dose isn't going to necessarily
ANSWERS (100% VERIFIED SOLUTIONS) 2025/2026 UPDATE
What assessments should be made before prescribing any antihypertensive agent? - CORRECT
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.
Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? - CORRECT
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.
What is the drug of choice to improve symptoms for patients taking propranolol? - CORRECT
ANSWER -Ipratropium
What is the most common adverse effect of an ACE inhibitor? - CORRECT 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.
What is the action of an ACE inhibitor? - CORRECT 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).
What is the action of an Angiotensin Receptor Blocker? - CORRECT 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.
What ethnic background should not be prescribed long-acting beta-agonists? - CORRECT
ANSWER -African Americans, increased incidence of death in this population
What is tiotropium used to treat? - CORRECT ANSWER -COPD, after patient stops smoking, this
medication slow the progression of COPD.
What is the action of a Calcium Channel Blocker? - CORRECT 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.
What are the adverse effects of a dihydropyridine-type calcium channel blocker? - CORRECT
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.
,A 70-year-old patient is admitted with peripheral edema. He is taking a calcium channel blocker
and metformin. What is the cause of his peripheral edema? - CORRECT ANSWER -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.
What special populations should not be prescribed pseudoephedrine? - CORRECT 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.
How is amlodipine metabolized? - CORRECT 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.
A patient is prescribed amlodipine. She develops reflex tachycardia. What is the reason for the
development of bradycardia? - CORRECT 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. 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.
What drug should be prescribed for a patient with nasal congestion with hypertension? -
CORRECT 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.
What patient teaching will you provide when prescribing amiodarone? - CORRECT 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.
What are the drug interactions with digoxin? - CORRECT ANSWER -Quinidine, amiodarone,
verapamil, diltiazam, and propafenone increase serum cardiac glycoside levels and lead to
toxicity. Drugs that cause bradycardia will increase the risk of bradycardia. Albuterol and digoxin
will decrease digoxin levels. Levels go down especially with increased albuterol use.
Phenobarbital, phenytoin, rifampin = decrease effect of digoxin. Thiazide and loop diuretics,
mezlocillin, piperacillin, ticarcillin, amphotericin B, glucocorticoids=may cause hypokalemia,
increase risk of digoxin toxicity. Calcium preparations = facilitates toxicity by accelerating
overloading of intracellular calcium stores. Spironolactone=increases digoxin half life. Beta
adrenergic blockers, quinidine, disopyramide + additive bradycardia. Antacids, colestipol,
kaolinpectin, cholestyramine=decreases absorption of CG if given concurrently. Thyroid
hormones=may decrease therapeutic effects and cause arrhythmias. Reductase
inhibitors=increase digoxin levels. Albuterol=decreases digoxin levels.
What is the purpose of a thyroid panel with amiodarone what is nitrate tolerance? - CORRECT
ANSWER -Amiodorone can inhibit the thyroid gland, resulting in inflammation of the gland,
causing hyperthyroidism. It is also a known cause of hypothyroidism, interferes with thyroid
hormone (TH). Can cause hypothyroidism in normal thyroid patients.
What are the adverse effects of statins. - CORRECT ANSWER -Rhabdomyolysis is a severe
reaction. #1 weakness and pain (Severe) in the muscles, hepatotoxicity, HA, urine will get dark,
CPK checks for muscle breakdown. Monitor liver function and initially and then every 1-3
months. S/s unusual or increased muscle weakness, dark urine.
What is nitrate tolerance? - CORRECT ANSWER -Administration of nitrates too frequently leads
to nitrate tolerance. Dosing should be 7am and 2 pm (helps prevent intolerance). This is due
attenuation of the vascular effects of nitrates. If the doses are too close together then the
patient will develop nitrate tolerance. In regards to adverse effects, assess the severity of the HA
(is expected). Patient teaching for sublingual use: if swallowed there will be decrease in effect,
under tongue to dissolve. Tachyphylaxis: once start using nitrates and you continue using the
medication you are going to get to a level where increasing the dose isn't going to necessarily
