Exam 2 Pharmacology-Cardiac
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which
assessment finding indicates an adverse effect of this drug?
A. Blood pressure of 90/50 mm Hg
B. Frequent bloody stools
C. QT prolongation on the electrocardiogram
D. Respiratory rate of 11 breaths per minute - ANS-C. Ranolazine can cause an increase in
the QT interval on the electrocardiogram (ECG), mostly with increased doses. Other adverse
effects include elevated blood pressure, headache, nausea, dizziness, and constipation.
\A 20-year-old patient has been prescribed spironolactone (Aldactone) for primary polycystic
ovary syndrome (POS). Developmentally, what would be a priority nursing diagnosis?
a. Activity intolerance related to loss of sodium
b. Altered body image related to hirsutism and deepening of the voice
c. Decisional conflict related to treatment options
d. Fluid volume excess related to excessive salt intake - ANS-B
\A 48 year old black male with a history of type 2 diabetes mellitus comes to the emergency
department with a frontal headache and generalized complaints of "not feeling well." Upon
examination, his BP is 210/120 mm Hg, his pulse is 98, and his respirations are 24 and
labored. When is it important to lower this patient's BP within 1 hour rather than slowly as for
most hypertensive patients?
A. When the nurse is busiest and has multiple patients and this will help to move the patient
to the medical surgical unit faster.
B. When the patient has had chronic hypertension for > 3 months
C. Lowering BP within 1 hour is necessary when associated with organ damage, such as
papilledema, intracranial hemorrhage, myocardial infarction, or heart failure.
D. When the patient's BP drops > 20 mmHg upon standing. - ANS-C. Lowering BP within 1
hour is necessary when associated with organ damage, such as papilledema, intracranial
hemorrhage, myocardial infarction, or heart failure.
\A 78 year old patient is seen in the emergency department in hypertensive crisis. She is 5
feet and 2 inches tall and weighs 125 pounds. Her BP is 230/130 mm Hg and she is very
edematous. She has a history of alcohol abuse. IV nitroprusside sodium at 0.3 mcg/kg/min is
prescribed. The nurse assess the solution to be sure it is not deeply colored blue, green, or
dark red. The nurse knows that a faint brown color to freshly prepared solutions is
acceptable. The drug is administered in a large vein using an infusion pump while protecting
the solution from light with aluminum foil covering. The patient suddenly becomes
diaphoretic and complains of nausea, palpitations, and headache. What should the nurse
do? The nurse should check a radial pulse and a BP. If the BP has dropped more than 30
mm Hg in 2 minutes, continue the infusion and recheck in another 2 minutes.
True
False - ANS-False. Check the BP and notify the prescriber. If the BP has dropped more than
30 mm Hg in 2 minutes, stop the infusion.
,\A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a
priority because of which associated adverse effect?
A. Reflex tachycardia
B. Heart palpitations
C. Cardiac dysrhythmias
D. Orthostatic hypotension - ANS-D. Doxazosin is an alpha1 blocker and can cause
orthostatic hypotension. Common symptoms include dizziness or lightheadedness on
standing, which may impair the patient's balance and increase the risk of a fall.
\A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which
assessment finding indicates that the nitro has been effective?
A) BP 120/80mmHg
B) HR 70bpm
C) ECG without evidence of ST changes
D) Client stating that pain is 0 out 10 - ANS-D. Goal is to relieve chest pain even if BP is
normal.
\A nurse understands how drugs that block the effects of angiotensin II can be beneficial for
heart failure patients. What information would not be correct about ARBs?
a. The drug improves cardiac function primarily by decreasing electrical conduction through
cardiac tissue.
b. The drug can help heart function by increasing excretion of sodium and water by the
kidneys.
c. The drug can decrease the formation of patho- logic changes in cardiac structure.
d. The drug can help heart function by preventing pathologic changes to the structure and
function of blood vessels. - ANS-A
\A patient asks the nurse why nitroglycerin can be administered in so many ways. What is
the basis of the nurse's response?
A. Nitroglycerin does not undergo first-pass effect in the liver.
B. Nitroglycerin has few adverse effects, so vary- ing doses can be administered via different
routes.
C. Nitroglycerin is an inactive compound, so it does not matter which route it is administered
by.
D. Nitroglycerin is lipid-soluble, so it is readily absorbed via different routes. - ANS-D
\A patient has been prescribed an ACE inhibitor and an Aldosterone antagonist daily.
Recently she has been working to avoid salt to reduce her blood pressure further and
decides to use a salt substitute. Which of these ECG findings would suggest hyperkalemia?
A. Absent p wave
B. Prolonged QT interval
C. Prolonged QRS complex
D. Peaked, tall T waves - ANS-D. ECG changes of hyperkalemia, typically seen at a serum
potassium level of 5.5-6.5 mEq/L, include the following: Tall, peaked T waves with a narrow
base, best seen in precordial leads. Shortened QT interval. ST-segment depression.
\A patient has been prescribed extended-release nifedipine (Procardia). Teaching regarding
admin- istration should include which instruction?
a. Administer 1 hour before or 2 hours after meals.
b. Do not crush or chew tablet.
c. Take with grapefruit juice to improve absorp- tion.
d. Take on an empty stomach. - ANS-B
,\A patient has been prescribed furosemide (Lasix). Which symptom is a priority for the nurse
to monitor that suggests possible excessive loss of potassium?
A. Hunger and fatigue
B. 4+ deep tendon reflexes
C. Muscle weakness and cramping
D. Tall, tented T waves on ECG - ANS-C. Muscle weakness and cramping are symptoms
associated with hypokalemia.
\A patient has just been prescribed prazosin (Minipress). Which statement from the patient
would indicate a need for further teaching?
A. I should avoid driving and other hazardous activities for 12-24 hours after I first take this
medication or have a dose increase.
B. I should take the medication first thing in the morning.
C. I should sit on the edge of the bed for a few minutes before standing up when I get up in
the morning.
D. I should be sitting or lying 30-60 minutes after I take the first dose of this medication. -
ANS-B
\A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside
[Nipride] infusion. Which interventions are essential before the nurse administers
nitroprusside [Nipride]? (Select all that apply.)
A. Obtain a baseline weight and weigh daily.
B. Prepare for arterial line insertion.
C. Discontinue the infusion when blood pressure is controlled.
D. Observe for signs of hypertrichosis during the infusion.
E. Cover the solution with an opaque bag. - ANS-A,B,E. A Nipride infusion is ordered in
micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the
appropriate dose. Also, tracking daily weights and comparing them with the baseline values
helps the nurse determine whether the adverse effect of fluid retention has developed. An
arterial line allows for continuous and accurate measurement of blood pressure. Because
light degrades nitroprusside, the infusion solution should be covered. The infusion should not
be discontinued abruptly, because the blood pressure will return to the pretreatment levels
within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.
\A patient in chronic renal failure has been retain- ing fluid despite dialysis. Which diuretic
would the nurse expect to administer?
A. Bumetanide
B. Hydrochlorothiazide (Oretic, HydroDIURIL)
C. Metolazone (Zaroxolyn)
D. Spironolactone (Aldactone) - ANS-A
\A patient is admitted to the hospital with a diagnosis of hypertension. The nurse
understands that which medication works by preventing angiotensin II from binding with its
receptor sites?
A. Quinapril [Accupril]
B. Aliskiren [Tekturna]
C. Eplerenone [Inspra]
D. Candesartan [Atacand] - ANS-C. Patients with bilateral renal artery stenosis are at
increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE)
inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia,
hyperglycemia, or hyperuricemia.
, \A patient is prescribed a nitroglycerin patch that is to be applied at 0900 (9:00 AM) and
removed at 2100 (9:00 PM). When preparing to administer the 0900 patch, the nurse notes
that a nitroglycerin patch is still in place. What should the nurse do?
A. Apply the new patch to a different site, but leave the old patch on until the nursing
supervisor is contacted.
B. Consult with the prescriber regarding application of a new patch.
C. Remove the old patch and apply the new patch to a different site.
D. Remove the old patch and change the timing of the medication so that the patch is
removed at 0900 and applied at 2100. - ANS-B
\A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and
contact the prescriber if which assessment finding is present?
a. BP 150/85 mm Hg
b. Constipation
c. Dizziness with position changes
d. Pulse 50 beats/min - ANS-D. Blockage of cardiac Ca channels can cause bradycardia, AV
block and HF.
\A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and
contact the prescriber if which assessment finding is present?
A. Pulse 50 beats/min
B. BP 150/85 mm Hg
C. Constipation
C. Dizziness with position changes - ANS-A.
\A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension.
Which expected adverse effects should the nurse discuss with the patient? (Select all that
apply.)
A. Nausea
B. Fatigue
C. Dizziness
D. Headache
E. Joint pain - ANS-B,C,D. Some of the common adverse effects of hydralazine include
fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a
common adverse effect of hydralazine.
\A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For
which therapeutic effect will the nurse monitor?
A. Slowing of the heart rate
B. Decrease in blood pressure
C. Symptoms such as dizziness and fainting
D. Pulse oximetry oxygen saturation of 100% - ANS-B. The therapeutic effect of ACE
inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not
affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE
inhibitors do not affect oxygen saturation.
\A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which
finding indicates the patient is experiencing the therapeutic effect of this drug?
A. + 2 edema of the lower extremities
B. Potassium level of 3.5 mEq/L
C. Crackles in the lungs are no longer heard
D. Jugular vein distention - ANS-C. Because ACE inhibitors promote venous dilation, they
provide the therapeutic effect of reducing pulmonary congestion and peripheral edema.
The nurse is monitoring a patient receiving ranolazine [Ranexa] for angina. Which
assessment finding indicates an adverse effect of this drug?
A. Blood pressure of 90/50 mm Hg
B. Frequent bloody stools
C. QT prolongation on the electrocardiogram
D. Respiratory rate of 11 breaths per minute - ANS-C. Ranolazine can cause an increase in
the QT interval on the electrocardiogram (ECG), mostly with increased doses. Other adverse
effects include elevated blood pressure, headache, nausea, dizziness, and constipation.
\A 20-year-old patient has been prescribed spironolactone (Aldactone) for primary polycystic
ovary syndrome (POS). Developmentally, what would be a priority nursing diagnosis?
a. Activity intolerance related to loss of sodium
b. Altered body image related to hirsutism and deepening of the voice
c. Decisional conflict related to treatment options
d. Fluid volume excess related to excessive salt intake - ANS-B
\A 48 year old black male with a history of type 2 diabetes mellitus comes to the emergency
department with a frontal headache and generalized complaints of "not feeling well." Upon
examination, his BP is 210/120 mm Hg, his pulse is 98, and his respirations are 24 and
labored. When is it important to lower this patient's BP within 1 hour rather than slowly as for
most hypertensive patients?
A. When the nurse is busiest and has multiple patients and this will help to move the patient
to the medical surgical unit faster.
B. When the patient has had chronic hypertension for > 3 months
C. Lowering BP within 1 hour is necessary when associated with organ damage, such as
papilledema, intracranial hemorrhage, myocardial infarction, or heart failure.
D. When the patient's BP drops > 20 mmHg upon standing. - ANS-C. Lowering BP within 1
hour is necessary when associated with organ damage, such as papilledema, intracranial
hemorrhage, myocardial infarction, or heart failure.
\A 78 year old patient is seen in the emergency department in hypertensive crisis. She is 5
feet and 2 inches tall and weighs 125 pounds. Her BP is 230/130 mm Hg and she is very
edematous. She has a history of alcohol abuse. IV nitroprusside sodium at 0.3 mcg/kg/min is
prescribed. The nurse assess the solution to be sure it is not deeply colored blue, green, or
dark red. The nurse knows that a faint brown color to freshly prepared solutions is
acceptable. The drug is administered in a large vein using an infusion pump while protecting
the solution from light with aluminum foil covering. The patient suddenly becomes
diaphoretic and complains of nausea, palpitations, and headache. What should the nurse
do? The nurse should check a radial pulse and a BP. If the BP has dropped more than 30
mm Hg in 2 minutes, continue the infusion and recheck in another 2 minutes.
True
False - ANS-False. Check the BP and notify the prescriber. If the BP has dropped more than
30 mm Hg in 2 minutes, stop the infusion.
,\A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a
priority because of which associated adverse effect?
A. Reflex tachycardia
B. Heart palpitations
C. Cardiac dysrhythmias
D. Orthostatic hypotension - ANS-D. Doxazosin is an alpha1 blocker and can cause
orthostatic hypotension. Common symptoms include dizziness or lightheadedness on
standing, which may impair the patient's balance and increase the risk of a fall.
\A nurse is monitoring a client with angina for therapeutic effects of nitroglycerin. Which
assessment finding indicates that the nitro has been effective?
A) BP 120/80mmHg
B) HR 70bpm
C) ECG without evidence of ST changes
D) Client stating that pain is 0 out 10 - ANS-D. Goal is to relieve chest pain even if BP is
normal.
\A nurse understands how drugs that block the effects of angiotensin II can be beneficial for
heart failure patients. What information would not be correct about ARBs?
a. The drug improves cardiac function primarily by decreasing electrical conduction through
cardiac tissue.
b. The drug can help heart function by increasing excretion of sodium and water by the
kidneys.
c. The drug can decrease the formation of patho- logic changes in cardiac structure.
d. The drug can help heart function by preventing pathologic changes to the structure and
function of blood vessels. - ANS-A
\A patient asks the nurse why nitroglycerin can be administered in so many ways. What is
the basis of the nurse's response?
A. Nitroglycerin does not undergo first-pass effect in the liver.
B. Nitroglycerin has few adverse effects, so vary- ing doses can be administered via different
routes.
C. Nitroglycerin is an inactive compound, so it does not matter which route it is administered
by.
D. Nitroglycerin is lipid-soluble, so it is readily absorbed via different routes. - ANS-D
\A patient has been prescribed an ACE inhibitor and an Aldosterone antagonist daily.
Recently she has been working to avoid salt to reduce her blood pressure further and
decides to use a salt substitute. Which of these ECG findings would suggest hyperkalemia?
A. Absent p wave
B. Prolonged QT interval
C. Prolonged QRS complex
D. Peaked, tall T waves - ANS-D. ECG changes of hyperkalemia, typically seen at a serum
potassium level of 5.5-6.5 mEq/L, include the following: Tall, peaked T waves with a narrow
base, best seen in precordial leads. Shortened QT interval. ST-segment depression.
\A patient has been prescribed extended-release nifedipine (Procardia). Teaching regarding
admin- istration should include which instruction?
a. Administer 1 hour before or 2 hours after meals.
b. Do not crush or chew tablet.
c. Take with grapefruit juice to improve absorp- tion.
d. Take on an empty stomach. - ANS-B
,\A patient has been prescribed furosemide (Lasix). Which symptom is a priority for the nurse
to monitor that suggests possible excessive loss of potassium?
A. Hunger and fatigue
B. 4+ deep tendon reflexes
C. Muscle weakness and cramping
D. Tall, tented T waves on ECG - ANS-C. Muscle weakness and cramping are symptoms
associated with hypokalemia.
\A patient has just been prescribed prazosin (Minipress). Which statement from the patient
would indicate a need for further teaching?
A. I should avoid driving and other hazardous activities for 12-24 hours after I first take this
medication or have a dose increase.
B. I should take the medication first thing in the morning.
C. I should sit on the edge of the bed for a few minutes before standing up when I get up in
the morning.
D. I should be sitting or lying 30-60 minutes after I take the first dose of this medication. -
ANS-B
\A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside
[Nipride] infusion. Which interventions are essential before the nurse administers
nitroprusside [Nipride]? (Select all that apply.)
A. Obtain a baseline weight and weigh daily.
B. Prepare for arterial line insertion.
C. Discontinue the infusion when blood pressure is controlled.
D. Observe for signs of hypertrichosis during the infusion.
E. Cover the solution with an opaque bag. - ANS-A,B,E. A Nipride infusion is ordered in
micrograms/kilogram/minute. Knowing the patient's weight is essential for calculating the
appropriate dose. Also, tracking daily weights and comparing them with the baseline values
helps the nurse determine whether the adverse effect of fluid retention has developed. An
arterial line allows for continuous and accurate measurement of blood pressure. Because
light degrades nitroprusside, the infusion solution should be covered. The infusion should not
be discontinued abruptly, because the blood pressure will return to the pretreatment levels
within minutes. Hypertrichosis (excessive hair growth) is a side effect of minoxidil.
\A patient in chronic renal failure has been retain- ing fluid despite dialysis. Which diuretic
would the nurse expect to administer?
A. Bumetanide
B. Hydrochlorothiazide (Oretic, HydroDIURIL)
C. Metolazone (Zaroxolyn)
D. Spironolactone (Aldactone) - ANS-A
\A patient is admitted to the hospital with a diagnosis of hypertension. The nurse
understands that which medication works by preventing angiotensin II from binding with its
receptor sites?
A. Quinapril [Accupril]
B. Aliskiren [Tekturna]
C. Eplerenone [Inspra]
D. Candesartan [Atacand] - ANS-C. Patients with bilateral renal artery stenosis are at
increased risk for renal insufficiency and failure with angiotensin-converting enzyme (ACE)
inhibitors, such as benazepril. ACE inhibitors do not typically cause hypokalemia,
hyperglycemia, or hyperuricemia.
, \A patient is prescribed a nitroglycerin patch that is to be applied at 0900 (9:00 AM) and
removed at 2100 (9:00 PM). When preparing to administer the 0900 patch, the nurse notes
that a nitroglycerin patch is still in place. What should the nurse do?
A. Apply the new patch to a different site, but leave the old patch on until the nursing
supervisor is contacted.
B. Consult with the prescriber regarding application of a new patch.
C. Remove the old patch and apply the new patch to a different site.
D. Remove the old patch and change the timing of the medication so that the patch is
removed at 0900 and applied at 2100. - ANS-B
\A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and
contact the prescriber if which assessment finding is present?
a. BP 150/85 mm Hg
b. Constipation
c. Dizziness with position changes
d. Pulse 50 beats/min - ANS-D. Blockage of cardiac Ca channels can cause bradycardia, AV
block and HF.
\A patient is prescribed diltiazem (Cardizem). It would be a priority to withhold the drug and
contact the prescriber if which assessment finding is present?
A. Pulse 50 beats/min
B. BP 150/85 mm Hg
C. Constipation
C. Dizziness with position changes - ANS-A.
\A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension.
Which expected adverse effects should the nurse discuss with the patient? (Select all that
apply.)
A. Nausea
B. Fatigue
C. Dizziness
D. Headache
E. Joint pain - ANS-B,C,D. Some of the common adverse effects of hydralazine include
fatigue, dizziness, and headache. Nausea is associated with minoxidil. Joint pain is not a
common adverse effect of hydralazine.
\A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For
which therapeutic effect will the nurse monitor?
A. Slowing of the heart rate
B. Decrease in blood pressure
C. Symptoms such as dizziness and fainting
D. Pulse oximetry oxygen saturation of 100% - ANS-B. The therapeutic effect of ACE
inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not
affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE
inhibitors do not affect oxygen saturation.
\A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which
finding indicates the patient is experiencing the therapeutic effect of this drug?
A. + 2 edema of the lower extremities
B. Potassium level of 3.5 mEq/L
C. Crackles in the lungs are no longer heard
D. Jugular vein distention - ANS-C. Because ACE inhibitors promote venous dilation, they
provide the therapeutic effect of reducing pulmonary congestion and peripheral edema.
