Deck 9: Drugs That Affect the Heart, Blood Vessels, Blood, and Blood Volume36 Review of Hemodynamics

Question 1

The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for treatment of heart failure. The morning assessment identifies an irregular heart rate of 86 beats/minute, a respiratory rate of 22 breaths/minute, and a blood pressure of 130/82 mm Hg. Crackles are heard in both lungs. Which laboratory result will be of greatest concern to the provider?

A) Blood glucose level of 120 mg/dL
B) Oxygen saturation of 90%
C) Potassium level of 3.4 mEq/L
D) Sodium level of 140 mEq/L

Answer 1

Potassium level of 3.4 mEq/L

Question 2

Which effect will the provider expect when prescribing a cardiac glycoside?

A) Decreased cardiac output
B) Decreased force of contraction
C) Decreased heart rate
D) Positive inotropic effects

Answer 2

Decreased heart rate

Question 3

A patient with a recent onset of nephrosclerosis has been taking an angiotensin-converting enzyme (ACE) inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. What action will the provider take to address the patient's blood pressure?

A) Add a calcium channel blocker to this patient's drug regimen.
B) Lower doses of the antihypertensive medications.
C) Order a high-potassium diet.
D) Add spironolactone to the drug regimen.

Answer 3

Add a calcium channel blocker to this patient's drug regimen.

Question 4

A prescriber considers ordering propranolol for a patient with recurrent ventricular tachycardia. What information in the patient's medical history will be of greatest concerned to the prescriber?

A) Asthma
B) Exercise-induced tachyarrhythmias
C) Hypertension
D) Paroxysmal atrial tachycardia associated with emotion

Question 5

A patient who uses transdermal nitroglycerin for angina reports occasional periods of tachycardia. What intervention will the prescriber order?

A) Order digoxin to slow the heart rate.
B) Discontinue the nitroglycerin.
C) Recommend periods of rest when the heart rate increases.
D) Prescribe verapamil as an adjunct to nitroglycerin therapy.

Question 6

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/minute, a blood pressure of 150/90 mm Hg bibasilar crackles, 2+ pitting edema of the ankles, and distention of the jugular veins. What will the provider order in response to this assessment data?

A) Angiotensin-converting enzyme (ACE) inhibitor
B) Digoxin
C) Furosemide
D) Spironolactone

Question 7

A patient who has taken warfarin for a year has now been prescribed carbamazepine. What additional action will the provider take to assure the patient's safety?

A) Decrease the usual dose of carbamazepine.
B) Increase the dose of warfarin.
C) Order more frequent activated partial thromboplastin time (aPTT) monitoring.
D) Order extra dietary vitamin K.

Question 8

A patient taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension tells the provider that she wants to become pregnant. What response will the provider give to the patient?

A) "Controlling your blood pressure will decrease your risk of preeclampsia."
B) "We need to consider changing you to an angiotensin receptor blocker during pregnancy."
C) "It will be safe to continue taking the ACE inhibitor during your pregnancy."
D) "Let's discuss using methyldopa instead of the ACE inhibitor while you are pregnant."

Question 9

A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to treat hypertension in this patient?

A) Angiotensin-converting enzyme (ACE) inhibitors
B) ( $\beta$ )
blockers
C) Direct-acting vasodilators
D) Thiazide diuretics

Question 10

A patient had a blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. This is consistent with a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. What will the patient's provider order to best manage the patient's hypertension?

A) A $\beta$ blocker
B) A loop diuretic and spironolactone
C) A thiazide diuretic
D) An $\alpha$ ₁ blocker

Question 11

A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The patient has a heart rate of 76 beats/minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient's lips and nail beds are pink, and there is no respiratory distress. The provider will prescribe what intervention?

A) An angiotensin-converting enzyme (ACE) inhibitor
B) Intravenous nitroglycerin and a $\beta$ blocker
C) Ranolazine and quinidine STAT
D) Supplemental oxygen and intravenous morphine

Question 12

A patient diagnosed with heart failure (HF) and taking an angiotensin-converting enzyme (ACE) inhibitor, has developed fibrotic changes in the heart and vessels. Which type of medication will the provider order to counter this development?

A) Aldosterone antagonist
B) Angiotensin II receptor blocker (ARB)
C) ( $\beta$ ) blocker
D) Direct renin inhibitor (DRI)

Question 13

Azithromycin is prescribed for a patient who develops an infection. The patient's only other medication is simvastatin. Which patient symptom will create the greatest concern for the provider?

A) Nausea
B) Tiredness
C) Muscle pain
D) Headache

Question 14

A patient presents to the emergency department after accidentally taking too much prescribed warfarin. The patient's heart rate is 78 beats/minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not report any pain. What will the provider order initially to address the patient's current condition?

A) Vitamin K
B) Protamine sulfate
C) An activated partial thromboplastin time (aPTT)
D) A prothrombin time (PT) and an international normalized ratio (INR)

Question 15

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths/minute, intercostal retractions, and frothy, pink sputum. After the patient's provider renders a diagnosis of heart failure, which diuretic will be prescribed to address these assessment findings?

A) Furosemide
B) Hydrochlorothiazide
C) Mannitol
D) Spironolactone

Question 16

Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which adverse reaction?

A) AV blockade
B) Gingival hyperplasia
C) Migraine headaches
D) Reflex tachycardia

Question 17

Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis?

A) Captopril PO
B) Hydralazine PO
C) Minoxidil PO
D) Sodium nitroprusside IV

Question 18

A patient taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia, is now prescribed digoxin 0.125 mg to improve cardiac output. Which action will the provider take to best assure the patient's safety?

A) Add spironolactone.
B) Reduce the dose of digoxin.
C) Discontinue the quinidine.
D) Give potassium supplements.

Question 19

A patient reports a family history of hypertension and cardiovascular disease but has no other risk factors. Current blood pressure is 126/82 mm Hg and the patient has a normal weight and body mass index for height and age. What will be the provider's focus when providing patient education?

A) Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blocker medications
B) The DASH diet, sodium restriction, and exercise
C) Increased calcium and potassium supplements
D) Thiazide diuretics and lifestyle changes

Question 20

A patient with heart failure who takes an angiotensin-converting enzyme (ACE) inhibitor, a thiazide diuretic, and a $\beta$ blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the provider will focus on which evaluation?

A) Complete blood count
B) Ejection fraction
C) Maximal exercise capacity
D) Serum electrolyte levels

Question 21

A patient receiving heparin postoperatively to prevent deep vein thrombosis has a blood pressure of 90/50 mm Hg and a heart rate of 110 beats/minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The provider will order what interventions initially? (Select all that apply.)

A) A repeat aPTT to be drawn immediately
B) Analgesic medication
C) Changing heparin to aspirin
D) Protamine sulfate
E) Discontinue heparin

Question 22

Amiodarone is prescribed for a patient. Which baseline tests will the prescriber order before this medication is started? (Select all that apply.)

A) Chest radiograph
B) Complete blood count with differential
C) Ophthalmologic examination
D) Pulmonary function tests
E) Thyroid function tests

Question 23

A patient is admitted to the hospital with a diagnosis of vitamin B₁₂ deficiency, hypoxia and anemia. In addition to oxygen therapy, what will the provider order to address these problems?

A) IM cyanocobalamin and folic acid
B) IM cyanocobalamin and antibiotics
C) PO cyanocobalamin and folic acid
D) PO cyanocobalamin and blood transfusions

Question 24

Which conditions will the provider consider as a therapeutic use 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

Question 25

A patient has been receiving iron replacement therapy for 2 days after hip replacement surgery. The provider is alerted to the following assessment data: Patient's stools appear black.
Patient is pale and reports feeling tired.
Patient's heart rate is 98 beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50 mm Hg.
What order will the provider take initially to best assure appropriate care for this patient?

A) Packed red blood cells
B) Hemoglobin and hematocrit (H&H)
C) A stool guaiac
D) Hypertonic fluid bolus