Question 1

A patient who takes nitroglycerin for stable angina pectoris develops hypertension.The primary care NP should contact the patient's cardiologist to discuss adding:

Accepted Answer

Nifedipine and related drugs are potent vasodilators,which makes them more effective for hypertension than verapamil and diltiazem.Amlodipine is not a first-line drug.

Question 2

A patient who has angina is taking nitroglycerin and long-acting nifedipine.The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits.The patient reports lightheadedness associated with standing up.The NP should consult with the patient's cardiologist about changing the medication to:

Accepted Answer

Verapamil and diltiazem are less likely to cause hypotension than nifedipine and related drugs,such as isradipine and amlodipine.

Question 3

A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and verapamil.The patient asks the primary care nurse practitioner (NP)why it is necessary to take verapamil.The NP should tell the patient that verapamil:

Accepted Answer

Verapamil decreases the force of smooth muscle contraction in the smooth muscle of the coronary and peripheral vessels; this results in coronary artery dilation,which lowers coronary resistance and improves blood flow through collateral vessels as well as oxygen delivery to ischemic areas of the heart.Calcium channel blockers do not increase the rate or force of contraction of the heart.

Question 4

An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic.The primary care NP should consider prescribing a(n):

Accepted Answer

African-American patients are considered good candidates for calcium channel blockers to treat hypertension.Treatment with calcium channel blockers as monotherapy in African-American patients has proved to be more effective than some other classes of antihypertensive agents.

Question 5

A patient who has stable angina is taking nitroglycerin and a b-blocker.The patient tells the primary care NP that the cardiologist is considering adding a calcium channel blocker.The NP should anticipate that the cardiologist will prescribe:

Accepted Answer

Nitrates and β-blockers are first-line therapy for stable angina.Calcium channel blockers should be reserved for patients who cannot take these agents or patients whose symptoms are not controlled with these agents.Verapamil is one of the calcium channel blockers that should be used.The other calcium channel blockers are not recommended for this purpose.

Question 6

A patient who takes a calcium channel blocker is in the clinic for an annual physical examination.The cardiovascular examination is normal.As part of routine monitoring for this patient,the primary care NP should evaluate:

Accepted Answer

Patients who take calcium channel blockers should have periodic renal and LFTs.

Question 7

A patient who is taking nifedipine develops mild edema of both feet.The primary care NP should contact the patient's cardiologist to discuss:

Accepted Answer

Mild to moderate peripheral edema occurs in the lower extremities in about 10% of patients; this is caused by arterial dilation,not by left ventricular dysfunction.Amlodipine is less likely to have this effect.Renal function tests are not indicated.Increasing the nifedipine dose would worsen the symptoms.

Quiz 21: Calcium Channel Blockers

A patient who takes nitroglycerin for stable angina pectoris develops hypertension.The primary care NP should contact the patient's cardiologist to discuss adding:

A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and verapamil.The patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil.The NP should tell the patient that verapamil:

An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic.The primary care NP should consider prescribing a(n) :

A patient who has stable angina is taking nitroglycerin and a b-blocker.The patient tells the primary care NP that the cardiologist is considering adding a calcium channel blocker.The NP should anticipate that the cardiologist will prescribe:

A patient who takes a calcium channel blocker is in the clinic for an annual physical examination.The cardiovascular examination is normal.As part of routine monitoring for this patient,the primary care NP should evaluate:

A patient who is taking nifedipine develops mild edema of both feet.The primary care NP should contact the patient's cardiologist to discuss: