NUR 2474 Exam 2: Pharmacology for Professional Nursing Exam 2
(Latest 2024 /25)
ACE inhibitors have many advantages over other antihypertensive medications, the most
important of which is their ability to prevent or reverse pathologic changes in the heart
and reduce the risk of cardiac mortality caused by hypertension. They are useful in
patients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL)
cholesterol, but they do not directly affect this comorbidity. They reduce venous return
to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels
A prescriber orders ramipril (Altace) for an obese patient with type 2 diabetes mellitus
who has developed hypertension. The nurse provides teaching before dismissing the
patient home. Which statement by the patient indicates understanding of the teaching?
a. "I am less likely to develop diabetic nephropathy when taking this medication."
b. "I should check my blood sugar more often, because hyperglycemia is a side effect of
this drug."
c. "Taking this medication helps reduce my risk of stroke and heart attack."
d. "This medication will probably prevent the development of diabetic retinopathy." -
c."Taking this medication helps reduce my risk of stroke and heart attack."
Ramipril (Altace) is approved for reducing the risk of stroke and myocardial infarction
(MI) in patients at high risk for a major cardiovascular event because they have
hypertension in conjunction with a history of stroke or MI or because they have diabetes.
ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they
can delay the onset of overt nephropathy in patients who already have less advanced
nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE
inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some patients with type
1 diabetes mellitus.
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the
nurse correctly tell the patient about this symptom?
a. It indicates that a serious side effect has occurred.
b. It is a common side effect that occurs in almost all patients taking the drug.
c. It may be uncomfortable enough that the drug will need to be discontinued.
d. It occurs frequently in patients taking the drug but will subside over time. correct
answer It may be uncomfortable enough that the drug will need to be discontinued.
A cough occurs in about 10% of patients taking ACE inhibitors and is the most common
reason for discontinuing therapy. It does not indicate a serious condition. It occurs in
about 10% of all patients and is more common in women, older adults, and those of Asian
ancestry. It does not subside until the medication is discontinued.
,A nurse is reviewing a patient's medications before administration. Which drug-to-drug
interactions should most concern the nurse in a patient with a history of heart failure and
a potassium level of 5.5 mEq/L?
a.Furosemide (Lasix) and enalapril (Vasotec)
b.Amlodipine (Norvasc) and spironolactone (Aldactone)
c.Eplerenone (Inspra) and spironolactone (Aldactone)
d.Metoprolol (Lopressor) and furosemide (Lasix) correct answer.Eplerenone (Inspra) and
spironolactone (Aldactone)
The greatest risk with eplerenone is hyperkalemia, and combining this drug with a
potassium-sparing diuretic creates a significant risk of hyperkalemia. Furosemide and
enalapril, an ACE inhibitor, would not be contraindicated in this patient. Amlodipine
and spironolactone would not cause hyperkalemia. The combination of metoprolol, a
beta blocker, and furosemide would not be contraindicated in this patient.
A patient who stops taking an ACE inhibitor because of its side effects will begin taking
an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors
will not occur with an ARB medication?
a.Angioedema
b.Cancer c.Cough
d.Renal failure correct answer.Cough
ARBs do not promote the accumulation of bradykinin in the lungs and do not induce
cough. Angioedema may occur with ARBs, but the incidence is lower than with ACE
inhibitors. An increased risk of cancer may be a concern with ARBs but is not a concern
with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with
bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse
tell this patient?
a. The fetus most likely will have serious congenital defects.
b. The fetus must be monitored closely while the patient is taking this drug.
c. The patient's prescriber probably will change her medication to an ARB.
d. The patient should stop taking the medication and contact her provider immediately. -
d.The patient should stop taking the medication and contact her provider immediately.
ACE inhibitors are known to cause serious fetal injury during the second and third
trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the
incidence probably is low. However, women should be counseled to stop taking the drug
if they become pregnant, and they should not take it if they are contemplating becoming
pregnant. Women who take ACE inhibitors in the first trimester should be
,counseled that the risk to the fetus is probably low. Women should stop taking the drug
when pregnant. ARBs carry the same risk as ACE inhibitors.
A nurse is caring for a patient who is receiving verapamil (Calan) for hypertension and
digoxin (Lanoxin) for heart failure. The nurse will observe this patient for:
a.AV blockade.
b.gingival hyperplasia.
c.migraine headaches.
d.reflex tachycardia. - correct answer.AV blockade.
Verapamil and digoxin both suppress impulse conduction through the AV node; when
the two drugs are used concurrently, the risk of AV blockade is increased. Gingival
hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom.
Verapamil can be used to prevent migraine, and its use for this purpose is under
investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes
reflex tachycardia.
A patient begins taking nifedipine (Procardia), along with a beta blocker, to treat
hypertension. The nurse understands that the beta blocker is used to:
a.reduce flushing.
b.minimize gingival hyperplasia.
c.prevent constipation.
d.prevent reflex tachycardia. - correct answer.prevent reflex tachycardia.
Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers
do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta
blockers can reduce the adverse cardiac effects of nifedipine.
A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension
about the drug's side effects. Which statement by the patient indicates understanding of
the teaching?
a. "I may become constipated, so I should increase fluids and fiber."
b. "I may experience a rapid heart rate as a result of taking this drug."
c. "I may have swelling of my hands and feet, but this will subside."
d. "I may need to increase my digoxin dose while taking this drug." - correct answer ."I
may become constipated, so I should increase fluids and fiber."
Constipation is common with verapamil and can be minimized by increasing dietary
fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary
to vasodilation, and patients should notify their prescriber if this occurs, because the
prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar
cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%,
so digoxin doses may need to be reduced.
, A nurse is preparing to assist a nursing student in administering intravenous verapamil
to a patient who also receives a beta blocker. The nurse asks the nursing student to
discuss the plan of care for this patient. Which statement by the student indicates a
need for further teaching?
a. "I will check to see when the last dose of the beta blocker was given."
b. "I will monitor vital signs closely to assess for hypotension."
c. "I will monitor the heart rate frequently to assess for reflex tachycardia."
d. "I will prepare to administer intravenous norepinephrine if necessary." - c
correct answer ."I will monitor the heart rate frequently to assess for reflex
tachycardia."
Reflex tachycardia is not an expected effect; the greater risk is cardiosuppression and
bradycardia. Because beta blockers and verapamil have the same effects on the heart,
there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should
be given several hours apart. Hypotension may occur and should be treated with IV
norepinephrine.
A patient who has been taking verapamil (Calan) for hypertension complains of
constipation. The patient will begin taking amlodipine (Norvasc) to prevent this side
effect. The nurse provides teaching about the difference between the two drugs. Which
statement by the patient indicates that further teaching is needed?
a. "I can expect dizziness and facial flushing with nifedipine."
b. "I should notify the provider if I have swelling of my hands and feet."
c. "I will need to take a beta blocker to prevent reflex tachycardia."
d. "I will need to take this drug once a day." - c correct answer ."I will need to take a
beta blocker to prevent reflex tachycardia."
Amlodipine produces selective blockade of calcium channels in blood vessels with
minimal effects on the heart. Reflex tachycardia is not common, so a beta blocker is not
indicated to prevent this effect. Dizziness and facial flushing may occur. Peripheral
edema may occur and should be reported to the provider. Amlodipine is given once daily.
Which are therapeutic uses for verapamil? (Select all that apply.)
a. Angina of effort
b. Cardiac dysrhythmias
c.Essential hypertension
d.Sick sinus syndrome
e. Suppression of preterm labor - a correct
answer .Angina of effort b.Cardiac dysrhythmias
c. Essential hypertension
(Latest 2024 /25)
ACE inhibitors have many advantages over other antihypertensive medications, the most
important of which is their ability to prevent or reverse pathologic changes in the heart
and reduce the risk of cardiac mortality caused by hypertension. They are useful in
patients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL)
cholesterol, but they do not directly affect this comorbidity. They reduce venous return
to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels
A prescriber orders ramipril (Altace) for an obese patient with type 2 diabetes mellitus
who has developed hypertension. The nurse provides teaching before dismissing the
patient home. Which statement by the patient indicates understanding of the teaching?
a. "I am less likely to develop diabetic nephropathy when taking this medication."
b. "I should check my blood sugar more often, because hyperglycemia is a side effect of
this drug."
c. "Taking this medication helps reduce my risk of stroke and heart attack."
d. "This medication will probably prevent the development of diabetic retinopathy." -
c."Taking this medication helps reduce my risk of stroke and heart attack."
Ramipril (Altace) is approved for reducing the risk of stroke and myocardial infarction
(MI) in patients at high risk for a major cardiovascular event because they have
hypertension in conjunction with a history of stroke or MI or because they have diabetes.
ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they
can delay the onset of overt nephropathy in patients who already have less advanced
nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE
inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some patients with type
1 diabetes mellitus.
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the
nurse correctly tell the patient about this symptom?
a. It indicates that a serious side effect has occurred.
b. It is a common side effect that occurs in almost all patients taking the drug.
c. It may be uncomfortable enough that the drug will need to be discontinued.
d. It occurs frequently in patients taking the drug but will subside over time. correct
answer It may be uncomfortable enough that the drug will need to be discontinued.
A cough occurs in about 10% of patients taking ACE inhibitors and is the most common
reason for discontinuing therapy. It does not indicate a serious condition. It occurs in
about 10% of all patients and is more common in women, older adults, and those of Asian
ancestry. It does not subside until the medication is discontinued.
,A nurse is reviewing a patient's medications before administration. Which drug-to-drug
interactions should most concern the nurse in a patient with a history of heart failure and
a potassium level of 5.5 mEq/L?
a.Furosemide (Lasix) and enalapril (Vasotec)
b.Amlodipine (Norvasc) and spironolactone (Aldactone)
c.Eplerenone (Inspra) and spironolactone (Aldactone)
d.Metoprolol (Lopressor) and furosemide (Lasix) correct answer.Eplerenone (Inspra) and
spironolactone (Aldactone)
The greatest risk with eplerenone is hyperkalemia, and combining this drug with a
potassium-sparing diuretic creates a significant risk of hyperkalemia. Furosemide and
enalapril, an ACE inhibitor, would not be contraindicated in this patient. Amlodipine
and spironolactone would not cause hyperkalemia. The combination of metoprolol, a
beta blocker, and furosemide would not be contraindicated in this patient.
A patient who stops taking an ACE inhibitor because of its side effects will begin taking
an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors
will not occur with an ARB medication?
a.Angioedema
b.Cancer c.Cough
d.Renal failure correct answer.Cough
ARBs do not promote the accumulation of bradykinin in the lungs and do not induce
cough. Angioedema may occur with ARBs, but the incidence is lower than with ACE
inhibitors. An increased risk of cancer may be a concern with ARBs but is not a concern
with ACE inhibitors. As with ACE inhibitors, renal failure can occur in patients with
bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney.
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse
tell this patient?
a. The fetus most likely will have serious congenital defects.
b. The fetus must be monitored closely while the patient is taking this drug.
c. The patient's prescriber probably will change her medication to an ARB.
d. The patient should stop taking the medication and contact her provider immediately. -
d.The patient should stop taking the medication and contact her provider immediately.
ACE inhibitors are known to cause serious fetal injury during the second and third
trimesters of pregnancy. Whether injury occurs earlier in pregnancy is unknown, and the
incidence probably is low. However, women should be counseled to stop taking the drug
if they become pregnant, and they should not take it if they are contemplating becoming
pregnant. Women who take ACE inhibitors in the first trimester should be
,counseled that the risk to the fetus is probably low. Women should stop taking the drug
when pregnant. ARBs carry the same risk as ACE inhibitors.
A nurse is caring for a patient who is receiving verapamil (Calan) for hypertension and
digoxin (Lanoxin) for heart failure. The nurse will observe this patient for:
a.AV blockade.
b.gingival hyperplasia.
c.migraine headaches.
d.reflex tachycardia. - correct answer.AV blockade.
Verapamil and digoxin both suppress impulse conduction through the AV node; when
the two drugs are used concurrently, the risk of AV blockade is increased. Gingival
hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom.
Verapamil can be used to prevent migraine, and its use for this purpose is under
investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes
reflex tachycardia.
A patient begins taking nifedipine (Procardia), along with a beta blocker, to treat
hypertension. The nurse understands that the beta blocker is used to:
a.reduce flushing.
b.minimize gingival hyperplasia.
c.prevent constipation.
d.prevent reflex tachycardia. - correct answer.prevent reflex tachycardia.
Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers
do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta
blockers can reduce the adverse cardiac effects of nifedipine.
A nurse is teaching a patient who will begin taking verapamil (Calan) for hypertension
about the drug's side effects. Which statement by the patient indicates understanding of
the teaching?
a. "I may become constipated, so I should increase fluids and fiber."
b. "I may experience a rapid heart rate as a result of taking this drug."
c. "I may have swelling of my hands and feet, but this will subside."
d. "I may need to increase my digoxin dose while taking this drug." - correct answer ."I
may become constipated, so I should increase fluids and fiber."
Constipation is common with verapamil and can be minimized by increasing dietary
fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary
to vasodilation, and patients should notify their prescriber if this occurs, because the
prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar
cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%,
so digoxin doses may need to be reduced.
, A nurse is preparing to assist a nursing student in administering intravenous verapamil
to a patient who also receives a beta blocker. The nurse asks the nursing student to
discuss the plan of care for this patient. Which statement by the student indicates a
need for further teaching?
a. "I will check to see when the last dose of the beta blocker was given."
b. "I will monitor vital signs closely to assess for hypotension."
c. "I will monitor the heart rate frequently to assess for reflex tachycardia."
d. "I will prepare to administer intravenous norepinephrine if necessary." - c
correct answer ."I will monitor the heart rate frequently to assess for reflex
tachycardia."
Reflex tachycardia is not an expected effect; the greater risk is cardiosuppression and
bradycardia. Because beta blockers and verapamil have the same effects on the heart,
there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should
be given several hours apart. Hypotension may occur and should be treated with IV
norepinephrine.
A patient who has been taking verapamil (Calan) for hypertension complains of
constipation. The patient will begin taking amlodipine (Norvasc) to prevent this side
effect. The nurse provides teaching about the difference between the two drugs. Which
statement by the patient indicates that further teaching is needed?
a. "I can expect dizziness and facial flushing with nifedipine."
b. "I should notify the provider if I have swelling of my hands and feet."
c. "I will need to take a beta blocker to prevent reflex tachycardia."
d. "I will need to take this drug once a day." - c correct answer ."I will need to take a
beta blocker to prevent reflex tachycardia."
Amlodipine produces selective blockade of calcium channels in blood vessels with
minimal effects on the heart. Reflex tachycardia is not common, so a beta blocker is not
indicated to prevent this effect. Dizziness and facial flushing may occur. Peripheral
edema may occur and should be reported to the provider. Amlodipine is given once daily.
Which are therapeutic uses for verapamil? (Select all that apply.)
a. Angina of effort
b. Cardiac dysrhythmias
c.Essential hypertension
d.Sick sinus syndrome
e. Suppression of preterm labor - a correct
answer .Angina of effort b.Cardiac dysrhythmias
c. Essential hypertension
