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Pharmacology Cardiovascular drugs Part I. 1. Which of the following clients is at greatest risk for digital toxicity?. A. A 25-year-old client with congenital heart disease B. A 50-year-old client with CHF C. A 60-year-old client after myocardial infarction D. An 80-year-old client with CHF.
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1. Which of the following clients is at greatest risk for digital toxicity? A. A 25-year-old client with congenital heart diseaseB. A 50-year-old client with CHFC. A 60-year-old client after myocardial infarctionD. An 80-year-old client with CHF 1. Answer: D. An 80-year-old client with CHF Extremely old clients are at greater risk for digitalis toxicity. Remember when it comes to adversity, the very old and very young are always at highest risk.
2. Which of the following is a contraindication for digoxin administration? A. Blood pressure of 140/90B. Heart rate above 80C. Heart rate below 60D. Respiratory rate above 20 2. Answer: C. Heart rate below 60 The apical heart rate must be monitored during therapy with digoxin, and the drug held for pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection.
3. The action of medication is inotropic when it: A. Decreased afterloadB. Increases heart rateC. Increases the force of contractionD. Is used to treat CHF 3. Answer: C. Increases the force of contraction Inotropic drugs increase the force of contraction. Preload, not afterload, is decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an indication for use not an action of inotropic drug.
4. Which is the MOST appropriate action for the nurse to take before administering digoxin? A. Monitor potassium levelB. Assess blood pressureC. Evaluate urinary outputD. Avoid giving with thiazide diuretic 4. Answer: A. Monitor potassium level Monitoring potassium is especially important because hypokalemia potentiates digoxintoxicity. B and C are incorrect because these data reflect overall CV status but are not specific for digoxin. Choice D are drugs usually administered with digoxin.
5. The therapeutic drug level for digoxin is: A. 0.1-2.0 ng/mgB. 1.0-2.0 ng/mgC. 0.1-0.5 ng/mgD. 0.5-2.0 ng/mg 5. Answer: D. 0.5-2.0 ng/mg This is the correct therapeutic range for digoxin. Every nurse should know this information
6. Blurred vision or halos are signs of: A. Subtherapeutic digoxin levelsB. Digoxin toxicityC. Nothing related to digoxinD. Corneal side effects of digoxin 6. Answer: B. Digoxin toxicity Halos is a hallmark sign of digoxin toxicity. A, C and D are incorrect because subtherapeutic digoxin levels have no such effects.
7. Amrinone (Inocor) is used for short term therapy for CHF and acts by which of the following mechanisms? A. Increasing stroke volume and heart rateB. Slowing ventricular rate and increasing cardiac outputC. Vasodilating and increasing peripheral vascular resistanceD. Increasing cardiac output and enhancing renal perfusion 7. Answer: A. Increasing stroke volume and heart rate The action of amrinone (Inocor) is to increase stroke volume, ejection fraction, and heart rate. Lanoxin, not amrinone, slows ventricular rate and increases cardiac output. The vasodilator effect of amrinone decreases peripheral vascular resistance. Any increase in cardiac output will enhance renal perfusion; this is not just specific to amrinone.
8. Before giving milrinone (Primacor) by an IV infusion to a client with symptoms of CHF, which of the following nursing actions is necessary? A. Record sodium level.B. Administer loading dose over 15 minutes.C. Assess CV status.D. Review medication regimen to identify if client is on IV furosemide (Lasix). 8. Answer: D. Review medication regimen to identify if client is on IV furosemide (Lasix). Milrinone (Primacor) is incompatible with IV furosemide (Lasix), and many clients with CHF are taking furosemide. Assessing potassium, not sodium, is essential. Choice B is not done before administration but during administration. Assessment of CV status is not specific for milrinone and is indicated for any drug that affects the circulatory system.
9. Johanna has ventricular ectopy, which of the following drugs is the first line used to treat her condition? A. quinidine (Cardioquin)B. digoxin (Lanoxin)C. procainamide ( Pronestyl)D. lidocaine (Xylocaine) 9. Answer: D. lidocaine (Xylocaine) Lidocaine is the only choice used to treat ventricular ectopy. A and C are class IA antiarrhythmics. Digoxin is a cardiac glycoside.
10. Class IA antiarrhythmic agents have little effect on: A. AV nodeB. SA nodeC. Purkinje fibersD. Bundle of His 10. Answer: B. SA node Class IA antiarrhythmics have little effect on the SA node.
11. Which of the following drugs can cause severe hematologic disorders? A. digoxin (Lanoxin)B. quinidine (Cardioquin)C. disopyramide (Norpace)D. procainamide (Pronestyl 11. Answer: D. procainamide (Pronestyl) Pronestyl is known for this serious side effect. Associate Pronestyl with plasma — P and P. This drug is known for its hematologic side effects.
12. Which of the following ECG findings alerts the nurse that the client needs an antiarrhythmic? A. Normal sinus rhythmB. Sinus bradycardiaC. Sinus arrhythmiaD. Frequent ventricular ectopy 12. Answer: D. Frequent ventricular ectopy Ventricular ectopy can be a life-threatening arrhythmia; therefore, the client needs an arrhythmic. Other choices are not arrhythmias that need to be treated.
13. When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate? A. ECGB. Pulse rateC. Respiratory rateD. Blood pressure 13. Answer: A. ECG The ECG is the most important parameter to assess. B, C, and D need to be monitored, but the ECG is the most important.
14. Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias? A. Serum chemistriesB. Complete blood countsC. Drug levelsD. None of the above 14. Answer: C. Drug levels Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect.
15. Which of the following drugs should be used only in situations in which the client can be very closely monitored, such as a critical care unit? A. bretylium (Bretylol)B. digoxin (Lanoxin)C. quinidine (Cardioquin)D. inderal (Propranolol) 15. Answer: A. bretylium (Bretylol) Among the choices, this is the only agent that must be monitored this closely. B, C, and D are given to outpatients as oral preparations.
16. The most toxic antiarrhythmic agent is: A. digoxin (Lanoxin)B. lidocaine (Xylocaine)C. amiodarone (Cordarone)D. quinidine (Cardioquin) 16. Answer: C. amiodarone (Cordarone) This is the most toxic drug and should be used only if other less toxic agents have been tried. Digoxin, on the other hand, is cardiotonic, not antiarrhythmic agent. B and D are not known for their toxicity.
17. Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following actions? A. Increased speed of conduction and gluconeogenesisB. Bronchodilation and increased heart rate, contractility, and conductionC. Increased vasodilation and enhanced myocardial contractilityD. Bronchoconstriction and increased heart rate 17. Answer: B. Bronchodilation and increased heart rate, contractility, and conduction Bronchodilation results from stimulated beta receptors, and cardiac effects result from the stimulation of ß1 receptors. Choice A does not address respiratory effects of medication. Choice C is incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not bronchoconstriction, results from ß2 activity.
18. Following norepinephrine (Levophed) administration, it is essential to the nurse to assess: A. electrolyte statusB. color and temperature of toes and fingersC. capillary refillD. ventricular arrhythmias 18. Answer: B. color and temperature of toes and fingers Because decreased perfusion is a side effect of norepinephrine (Levophed), the nurse must check circulation frequently. Capillary refill is not a reliable indication of perfusion in a shock state. Choices A and D are not specific for norepinephrine.
19. Norepinephrine (Levophed) is contraindicated in which of the following conditions? A. Hypovolemic shockB. Neurogenic shockC. Blood pressures above 80-100 mmHg (systolic)D. Decreased renal perfusion 19. Answer: A. Hypovolemic shock Norepinephrine (Levophed) is contraindicated in hypovolemia. Neurogenic shock is an indication for norepinephrine use. Norepinephrine is given to maintain a systolic blood pressure of 80-100 mmHG. Decreased renal perfusion is an adverse reaction.
20. When administering dopamine (Intropin), it is most important for the nurse to know that: A. the drug’s action varies according to the dose.B. the drug may be used instead of fluid replacement.C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline.D. the lowest dose to produce the desired effect should be used. 20. Answer: C. the drug cannot be directly mixed in solutions containing bicarbonate or aminophylline. The nurse is responsible for knowing compatible solutions before administering dopamine (Intropin). It is important to know that drug action varies by dose, but the physician is responsible for determining the dose. Dopamine should not be used instead of fluid replacement. Choice D is incorrect because, although it is true, it is not the nurse’s primary concern. It is a collaborative action in which the physician is involved in determining the rate.
21. Dobutamine (Dobutrex) improves cardiac output and is indicated for use in all of the following conditions except: A. septic shockB. congestive heart failureC. arrhythmiasD. pulmonary congestion 21. Answer: C. arrhythmias Dobutamine (Dobutrex) is not used to treat arrhythmias. Choices A, B, and D are conditions are conditions that respond to dobutamine.
22. Conduction defects will most likely be an adverse associated with the use of: A. verapamilB. nifedipineC. diltiazemD. felodipine 22. Answer: A. verapamil Verapamil (Calan) has the strongest chronotropic effect and will cause a delay in conduction at the SA and AV nodes.
23. Which of the following calcium channel blockers has the most potent peripheral smooth muscle dilator effect? A. diltiazemB. nifedipineC. nimodipineD. verapamil 23. Answer: B. nifedipine Nifedipine has the strongest peripheral smooth muscle dilator effect of all the calcium channel blockers. Other choices have less of a vasodilator effect.
24. Which of the following adverse reactions is found more often in volume-depleted elderly clients? A. BradycardiaB. Conduction defectsC. Ankle edemaD. Hypotension 24. Answer: D. Hypotension Hypotension is more likely to occur in the elderly. Choices A, B, and C may occur but are not necessarily increased in frequency in elderly clients.
25. Which of the following calcium channel blockers is used to counteract or prevent cerebral vasospasm? A. verapamilB. nimodipineC. nifedipineD. felodipine 25. Answer: B. nimodipine Nimodipine is given in the neurologic client to prevent cerebral vasospasm. Choices A, C, and D are given in cardiac disease and in the management of hypertension only.
26. Which of the following effects of calcium channel blockers causes a reduction in blood pressure? A. Increased cardiac outputB. Decreased peripheral vascular resistanceC. Decreased renal blood flowD. Calcium influx into cardiac muscles 26. Answer: B. Decreased peripheral vascular resistance One of the effects of calcium channel blockers is to decrease peripheral vascular resistance. A, C, and D describe the opposite effects of calcium channel blockers.
27. Jason James is taking ß blockers, all of the following should be included in his assessment except: A. Pulmonary function testsB. Baseline ECGC. Glucose levelD. Blood pressure 27. Answer: A. Pulmonary function tests Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers.
28. Routine laboratory monitoring in clients taking ß blockers should include: A. SodiumB. GlucoseC. ThyrotropinD. Creatine phosphokinase 28. Answer: B. Glucose ß blockers influence glucose metabolism. Although A, C, and D are nice to have, there is no indication that routine assessment of thyrotropin, sodium, or creatine phosphokinase is needed.
29. Competitive antagonism of which of the following occurs at ß receptor sites? A. CatecholaminesB. Adrenergic sitesC. AcetylcholineD. Norepinephrine 29. Answer: A. Catecholamines Catecholamine receptor sites are blocked by the action of ß-blocking agents. Adrenergic sites may be blocked, but the more appropriate response is catecholamine receptors. Acetylcholine is not affected by ß blockers. Norepinephrine is a catecholamine.
30. ß blockers should be avoided in which of the following conditions? A. BronchoconstrictionB. HypertensionC. AnginaD. Myocardial infarction 30. Answer: A. Bronchoconstriction ß blockers should be avoided in bronchoconstrictive disease. B, C, and D are indications for the use of ß blockers.
