PHARMACOLOGY NR 508 FINAL
Chapter 16. Drugs Affecting the Cardiovascular and Renal Systems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is
determined to be needed. Prior to prescribing this drug, the NP should assess for:
1. Hypokalemia
2. Impotence
3. Decreased renal function
4. Inability to concentrate
2. Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic
patients because they:
1. Improve insulin sensitivity
2. Improve renal hemodynamics
3. Reduce the production of angiotensin II
4. All of the above
3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is
angioedema. Which of the following statements is true about this adverse response?
1. Swelling of the tongue or hoarseness are the most common symptoms.
2. It appears to be related to the decrease in aldosterone production.
3. Presence of a dry, hacky cough indicates a high risk for this adverse response.
4. Because it takes time to build up a blood level, it occurs after being on the drug for
about 1 week.
4. Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the
following statements are true about both its usefulness in the disorder and the reason for its use?
1. Stable angina because it decreases the thickening of vascular walls due to
decreased modified release.
2. Heart failure because it reduces remodeling of injured myocardial tissues.
3. Both 1 and 2 are true and the reasons are correct.
4. Both 1 and 2 are true but the reasons are wrong.
5. Neither 1 nor 2 are true.
5. Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-
converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:
1. Is stronger than the ACE inhibitor
2. Does not produce a dry, hacky cough
3. Has no effect on the renal system
4. Reduces sodium and water retention
6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-
counter drugs without first consulting the provider because:
,1. Cimetidine is metabolized by the CYP 3A4 isoenzymes
2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
3. Both 1 and 2
, 4. Neither 1 nor 2
7. Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II
receptor blockers should include:
1. White blood cell counts with the drug dosage increased for elevations above
10,000 feet
2. Liver function tests with the drug dosage stopped for alanine aminotransferase
values twice that of normal
3. Serum creatinine levels with the drug dosage reduced for values greater than 2.5
mg/dL
4. Serum glucose levels with the drug dosage increased for levels greater than 120
mg/dL
8. Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps
control blood pressure because it:
1. Decreases the amount of calcium inside the cell
2. Reduces stroke volume
3. Increases the activity of the Na+/K+/ATPase pump indirectly
4. Decreases heart rate
9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel
blocker?
1. Bradycardia
2. Hepatic impairment
3. Increased contractility
4. Edema of the hands and feet
10. Patient teaching related to amlodipine includes:
1. Increase calcium intake to prevent osteoporosis from a calcium blockade.
2. Do not crush the tablet; it must be given in liquid form if the patient has trouble
swallowing it.
3. Avoid grapefruit juice as it affects the metabolism of this drug.
4. Rise slowly from a supine position to reduce orthostatic hypotension.
11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
1. Started at about half the usual dosage
2. Not increased over the usual dosage for an adult
3. Given once daily because of memory issues in the older adult
4. Withheld if she experiences gastroesophageal reflux
12. Larry has heart failure, which is being treated with digoxin because it exhibits:
1. Negative inotropism
2. Positive chronotropism
3. Both 1 and 2
4. Neither 1 nor 2
13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for
this combination includes:
1. Hemoglobin
, 2. Serum potassium
3. Blood urea nitrogen
4. Serum glucose
14. Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it
must be correct.
1. Older adults because of reduced renal function
2. Administration of aldosterone antagonist diuretics because of decreased potassium
levels
3. Taking an antacid for gastroesophageal reflux disease because it increases the
absorption of digoxin
4. Doses between 0.25 and 0.5 mg/day
15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:
1. Within 6 hours of the last dose
2. Because a reference point is needed in adjusting a dose
3. After three half-lives from the starting of the drug
4. When a patient has stable renal function
16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for
dyspnea, jugular venous distention, and peripheral edema because they may indicate:
1. Widening of the area of infarction
2. Onset of congestive heart failure
3. An electrolyte imbalance involving potassium
4. Renal dysfunction
17. Which of the following is true about procainamide and its dosing schedule?
1. It produces bradycardia and should be used cautiously in patients with cardiac
conditions that a slower heart rate might worsen.
2. Gastrointestinal adverse effects are common so the drug should be taken with food.
3. Adherence can be improved by using a sustained release formulation that can be
given once daily.
4. Doses of this drug should be taken evenly spaced around the clock to keep an even
blood level.
18. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching
should include all of the following EXCEPT:
1. Notify your health-care provider immediately if you have visual change.
2. Monitor your own blood pressure and pulse daily.
3. Take a hot shower or bath if you feel dizzy.
4. Use a sunscreen on exposed body surfaces.
19. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not
have thyroid disease and wants to know why the test is ordered. Which is a correct response?
1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and
can cause hypothyroidism.
2. Amiodarone damages the thyroid gland and can result in inflammation of that
gland, causing hyperthyroidism.
Chapter 16. Drugs Affecting the Cardiovascular and Renal Systems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is
determined to be needed. Prior to prescribing this drug, the NP should assess for:
1. Hypokalemia
2. Impotence
3. Decreased renal function
4. Inability to concentrate
2. Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic
patients because they:
1. Improve insulin sensitivity
2. Improve renal hemodynamics
3. Reduce the production of angiotensin II
4. All of the above
3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is
angioedema. Which of the following statements is true about this adverse response?
1. Swelling of the tongue or hoarseness are the most common symptoms.
2. It appears to be related to the decrease in aldosterone production.
3. Presence of a dry, hacky cough indicates a high risk for this adverse response.
4. Because it takes time to build up a blood level, it occurs after being on the drug for
about 1 week.
4. Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the
following statements are true about both its usefulness in the disorder and the reason for its use?
1. Stable angina because it decreases the thickening of vascular walls due to
decreased modified release.
2. Heart failure because it reduces remodeling of injured myocardial tissues.
3. Both 1 and 2 are true and the reasons are correct.
4. Both 1 and 2 are true but the reasons are wrong.
5. Neither 1 nor 2 are true.
5. Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-
converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:
1. Is stronger than the ACE inhibitor
2. Does not produce a dry, hacky cough
3. Has no effect on the renal system
4. Reduces sodium and water retention
6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-
counter drugs without first consulting the provider because:
,1. Cimetidine is metabolized by the CYP 3A4 isoenzymes
2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
3. Both 1 and 2
, 4. Neither 1 nor 2
7. Laboratory monitoring for patients on angiotensin-converting enzyme inhibitors or angiotensin II
receptor blockers should include:
1. White blood cell counts with the drug dosage increased for elevations above
10,000 feet
2. Liver function tests with the drug dosage stopped for alanine aminotransferase
values twice that of normal
3. Serum creatinine levels with the drug dosage reduced for values greater than 2.5
mg/dL
4. Serum glucose levels with the drug dosage increased for levels greater than 120
mg/dL
8. Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps
control blood pressure because it:
1. Decreases the amount of calcium inside the cell
2. Reduces stroke volume
3. Increases the activity of the Na+/K+/ATPase pump indirectly
4. Decreases heart rate
9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel
blocker?
1. Bradycardia
2. Hepatic impairment
3. Increased contractility
4. Edema of the hands and feet
10. Patient teaching related to amlodipine includes:
1. Increase calcium intake to prevent osteoporosis from a calcium blockade.
2. Do not crush the tablet; it must be given in liquid form if the patient has trouble
swallowing it.
3. Avoid grapefruit juice as it affects the metabolism of this drug.
4. Rise slowly from a supine position to reduce orthostatic hypotension.
11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:
1. Started at about half the usual dosage
2. Not increased over the usual dosage for an adult
3. Given once daily because of memory issues in the older adult
4. Withheld if she experiences gastroesophageal reflux
12. Larry has heart failure, which is being treated with digoxin because it exhibits:
1. Negative inotropism
2. Positive chronotropism
3. Both 1 and 2
4. Neither 1 nor 2
13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for
this combination includes:
1. Hemoglobin
, 2. Serum potassium
3. Blood urea nitrogen
4. Serum glucose
14. Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it
must be correct.
1. Older adults because of reduced renal function
2. Administration of aldosterone antagonist diuretics because of decreased potassium
levels
3. Taking an antacid for gastroesophageal reflux disease because it increases the
absorption of digoxin
4. Doses between 0.25 and 0.5 mg/day
15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:
1. Within 6 hours of the last dose
2. Because a reference point is needed in adjusting a dose
3. After three half-lives from the starting of the drug
4. When a patient has stable renal function
16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for
dyspnea, jugular venous distention, and peripheral edema because they may indicate:
1. Widening of the area of infarction
2. Onset of congestive heart failure
3. An electrolyte imbalance involving potassium
4. Renal dysfunction
17. Which of the following is true about procainamide and its dosing schedule?
1. It produces bradycardia and should be used cautiously in patients with cardiac
conditions that a slower heart rate might worsen.
2. Gastrointestinal adverse effects are common so the drug should be taken with food.
3. Adherence can be improved by using a sustained release formulation that can be
given once daily.
4. Doses of this drug should be taken evenly spaced around the clock to keep an even
blood level.
18. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching
should include all of the following EXCEPT:
1. Notify your health-care provider immediately if you have visual change.
2. Monitor your own blood pressure and pulse daily.
3. Take a hot shower or bath if you feel dizzy.
4. Use a sunscreen on exposed body surfaces.
19. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not
have thyroid disease and wants to know why the test is ordered. Which is a correct response?
1. Amiodarone inhibits an enzyme that is important in making thyroid hormone and
can cause hypothyroidism.
2. Amiodarone damages the thyroid gland and can result in inflammation of that
gland, causing hyperthyroidism.
