Ray has been diagnosed with hypertension and it is determined that an angiotensin-convert-
ing enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP)
should assess for: - ANSWER Decreased renal function
Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hyperten-
sion in diabetic patients because they: - ANSWER All of the above:
Improve insulin sensitivity
Improve renal hemodynamics
Reduce the production of angiotensin II
A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of
the following statements is true about this adverse response? - ANSWER Swelling of the
tongue and hoarseness are the most common symptoms.
ACE inhibitors are useful in a variety of disorders. Which of the following statements is true
about both their usefulness in a particular disorder and the reason for their use? - AN-
SWER Both 1 and 2 are true:
1. They are useful to prevent stable angina because they decrease the thickening of vascular
walls due to decreased modified release.
2. They are useful to prevent heart failure because they reduce remodeling of injured myo-
cardial tissues.
Despite good blood pressure control, an NP might change a patient's drug from an ACE in-
hibitor to an angiotensin II receptor blocker (ARB) because the ARB: - ANSWER Does not
produce a dry, hacking cough
1
,While taking an ARB, patients need to avoid certain over-the-counter drugs without irst con-
sulting the provider because: - ANSWER Both 1 and 2:
1. Cimetidine is metabolized by the CYP3A4 isoenzymes
2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
Laboratory monitoring for patients on ACE inhibitors or ARBs should include: - ANSWER
Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug
helps control blood pressure because it: - ANSWER Decreases the amount of calcium in-
side the cell
Which of the following adverse effects may occur due to a dihydropyridine-type calcium
channel blocker? - ANSWER Edema of the hands and feet
Patient teaching related to amlodipine includes: - ANSWER Avoid grapefruit juice as it af-
fects the metabolism of this drug.
Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her
should be: - ANSWER Started at about half the usual dosage
Larry has heart failure, which is being treated with digoxin because it exhibits: - ANSWER
Negative inotropism
Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitor-
ing for this combination includes: - ANSWER Serum potassium
Which of the following create a higher risk for digoxin toxicity? Both the cause and the rea-
son for it must be correct. - ANSWER Administration to older adults because of reduced
renal function
2
,Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: - AN-
SWER Because a reference point is needed to adjust dosage
Which of the following is true about procainamide and its dosing schedule? - ANSWER
Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for
dyspnea, jugular venous distention, and peripheral edema because they may indicate: - AN-
SWER Onset of congestive heart failure
Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient
teaching should include all of the following EXCEPT: - ANSWER Take a hot shower or bath
if you feel dizzy.
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 has been ordered. Which is a
correct response? - ANSWER Amiodarone inhibits an enzyme that is important in making
thyroid hormone and can cause hypothyroidism.
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is admin-
istered twice daily, but the schedule is 7 a.m. and 2 p.m. because: - ANSWER Nitrate tol-
erance can develop.
Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He
complains of headaches after using his nitrate. An appropriate reply might be: - ANSWER
In teaching about the use of sublingual nitroglycerine, the patient should be instructed: -
ANSWER To place one tablet under the tongue if chest pain occurs and allow it to dis-
solve
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is
prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald
3
, should be told to: - ANSWER Report muscle weakness or tenderness and dark urine to his
provider immediately.
Which of the following diagnostic results would NOT indicate a problem related to a reduc-
tase inhibitor? - ANSWER Increased white blood cell count
Because of the pattern of cholesterol synthesis, reductase inhibitors are given - ANSWER
In the evening in a single daily dose
Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient's
hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the follow-
ing drugs with research efficacy should be substituted? - ANSWER 1 or 2:
1. Statins
2. Fibrates
Niaspan is less likely to cause which side effect that is common to niacin? - ANSWER Cu-
taneous flushing
Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil
to treat her hypertriglyceridemia. A history of which of the following might contraindicate
the use of this drug? - ANSWER Gallbladder disease
Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric
acid derivative such as gemfibrozil with which of the following is not recommended? The
drug and the reason must both be correct for the answer to be correct. - ANSWER Reduc-
tase inhibitors, due to an increased risk for rhabdomyolysis
Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidem-
ics, this drug: - ANSWER Exchanges chloride ions for negatively charged acids in the
bowel
4
ing enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP)
should assess for: - ANSWER Decreased renal function
Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hyperten-
sion in diabetic patients because they: - ANSWER All of the above:
Improve insulin sensitivity
Improve renal hemodynamics
Reduce the production of angiotensin II
A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of
the following statements is true about this adverse response? - ANSWER Swelling of the
tongue and hoarseness are the most common symptoms.
ACE inhibitors are useful in a variety of disorders. Which of the following statements is true
about both their usefulness in a particular disorder and the reason for their use? - AN-
SWER Both 1 and 2 are true:
1. They are useful to prevent stable angina because they decrease the thickening of vascular
walls due to decreased modified release.
2. They are useful to prevent heart failure because they reduce remodeling of injured myo-
cardial tissues.
Despite good blood pressure control, an NP might change a patient's drug from an ACE in-
hibitor to an angiotensin II receptor blocker (ARB) because the ARB: - ANSWER Does not
produce a dry, hacking cough
1
,While taking an ARB, patients need to avoid certain over-the-counter drugs without irst con-
sulting the provider because: - ANSWER Both 1 and 2:
1. Cimetidine is metabolized by the CYP3A4 isoenzymes
2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
Laboratory monitoring for patients on ACE inhibitors or ARBs should include: - ANSWER
Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug
helps control blood pressure because it: - ANSWER Decreases the amount of calcium in-
side the cell
Which of the following adverse effects may occur due to a dihydropyridine-type calcium
channel blocker? - ANSWER Edema of the hands and feet
Patient teaching related to amlodipine includes: - ANSWER Avoid grapefruit juice as it af-
fects the metabolism of this drug.
Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her
should be: - ANSWER Started at about half the usual dosage
Larry has heart failure, which is being treated with digoxin because it exhibits: - ANSWER
Negative inotropism
Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitor-
ing for this combination includes: - ANSWER Serum potassium
Which of the following create a higher risk for digoxin toxicity? Both the cause and the rea-
son for it must be correct. - ANSWER Administration to older adults because of reduced
renal function
2
,Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: - AN-
SWER Because a reference point is needed to adjust dosage
Which of the following is true about procainamide and its dosing schedule? - ANSWER
Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for
dyspnea, jugular venous distention, and peripheral edema because they may indicate: - AN-
SWER Onset of congestive heart failure
Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient
teaching should include all of the following EXCEPT: - ANSWER Take a hot shower or bath
if you feel dizzy.
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 has been ordered. Which is a
correct response? - ANSWER Amiodarone inhibits an enzyme that is important in making
thyroid hormone and can cause hypothyroidism.
Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is admin-
istered twice daily, but the schedule is 7 a.m. and 2 p.m. because: - ANSWER Nitrate tol-
erance can develop.
Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He
complains of headaches after using his nitrate. An appropriate reply might be: - ANSWER
In teaching about the use of sublingual nitroglycerine, the patient should be instructed: -
ANSWER To place one tablet under the tongue if chest pain occurs and allow it to dis-
solve
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is
prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald
3
, should be told to: - ANSWER Report muscle weakness or tenderness and dark urine to his
provider immediately.
Which of the following diagnostic results would NOT indicate a problem related to a reduc-
tase inhibitor? - ANSWER Increased white blood cell count
Because of the pattern of cholesterol synthesis, reductase inhibitors are given - ANSWER
In the evening in a single daily dose
Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient's
hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the follow-
ing drugs with research efficacy should be substituted? - ANSWER 1 or 2:
1. Statins
2. Fibrates
Niaspan is less likely to cause which side effect that is common to niacin? - ANSWER Cu-
taneous flushing
Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil
to treat her hypertriglyceridemia. A history of which of the following might contraindicate
the use of this drug? - ANSWER Gallbladder disease
Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric
acid derivative such as gemfibrozil with which of the following is not recommended? The
drug and the reason must both be correct for the answer to be correct. - ANSWER Reduc-
tase inhibitors, due to an increased risk for rhabdomyolysis
Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidem-
ics, this drug: - ANSWER Exchanges chloride ions for negatively charged acids in the
bowel
4
