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MARYVILLE NURS 615- EXAM V QUESTIONS
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MARYVILLE NURS 615- EXAM V QUESTIONS
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MARYVILLE NURS 615- EXAM V QUESTIONSWhat assessments should be made before prescribing any antihypertensive agent? -
Answers-BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes,
and potassium levels. Prior to prescribing any antihypertensives, creatinine and BUN
levels should be evaluated. Confirmation of elevated BP at 3 different times. Children
over 3 years old should be assessed at least once at every visit-preferred method for
children is by auscultation, the correct measurement requires using a cuff that is
appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine
ratio. Diabetics or those with renal disease should have the albumin/creatinine ratio
annually. The presence of albuminuria, micro albuminuria even in the setting of normal
GFR is associated with increased cardiovascular risk. Blood sugar, hct, serum calcium,
and lipid profile.
Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? -
Answers-ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on
the kidneys. Protect the kidneys, watch for renal function, any creatinine >2.5 requires
dose reduction. Prevents diabetic nephropathy or slow its progression. Reduce
albuminuria and BP. ACEIs and ARBs should be used to treat the HTN. Renal
protection, reduces the conversion of AT II and improve the insulin sensitivity.
What is the drug of choice to improve symptoms for patients taking propranolol? -
Answers-Ipratropium
What is the most common adverse effect of an ACE inhibitor? - Answers-Dry, hacking
cough in some patients. Can switch to an angiotensin blocker which won't cause cough.
Reduce dose with either of these if Cr >2.5. Most are associated with hypotension,
dizziness, HA, fatigue, orthostatic hypotension, tachyphylaxis.
What is the action of an ACE inhibitor? - Answers-Decreases angiotensin II and
aldosterone. Vasodilatation on the venous and arterial sides of the heart. Blocks the
RAAS system leads to rennin acts on angiotensinogen to angiotensin I to angiotensin II
through ACE. Angiotensin II stimulates aldosterone causing sodium and water while
losing potassium via the kidney. ACE is also involved in the inactivation of bradykinin a
vasodilator. Bradykin is what causes the cough (irritating the lungs).
What is the action of an Angiotensin Receptor Blocker? - Answers-Blocks the
angiotensin II receptor to leading to increasing vascular tone and stimulating vascular
smooth muscle contraction. One of the greatest advantages: doesn't produce the dry,
hacking cough that ACE-Is do. Similar to ACE-I except to bradykinin activity (no cough),
lowers BP, decreases vascular resistance, decreases pulmonary cap wedge pressure,
decreases HR, increases cardiac index.
What ethnic background should not be prescribed long-acting beta-agonists? -
Answers-African Americans, increased incidence of death in this population
,What is tiotropium used to treat? - Answers-COPD, after patient stops smoking, this
medication slow the progression of COPD.
What is the action of a Calcium Channel Blocker? - Answers-Decrease the amount of
calcium inside the cell to control blood pressure. Dihydropyridine CCB: inhibits
transmembrane influx of extracellular calcium ions across myocardial and vascular
smooth muscle cell membranes without changing serum calcium concentrations. This
results in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating
main coronary and systemic arteries. Vasodilatation with decreased peripheral
resistance and increased heart rate. Nondihydropyridine CCB: inhibits extracellular
calcium ion influx across membranes of myocardial cells and vascular smooth muscle
cells. Resulting in inhibition of cardiac and vascular smooth muscle contraction and
thereby dilating main coronary and systemic arteries. No effect on serum calcium
contractions. Substantial inhibitory effects on cardiac conduction system, acting
principally at AV node, with some effects at sinus node.
What drug should be prescribed for a patient with nasal congestion with hypertension? -
Answers-Nasal oxymetazoline or nasal azelastine. Cromolyn sodium, ipratropium
bromide, or corticosteroids by inhalation can be used safely for nasal congestion by
patients with HTN.
What patient teaching will you provide when prescribing amiodarone? - Answers-Take
the drug as prescribed. Take the next day's dose if a dose is missed. Change position
slowly d/t hypotension. Avoid taking hot showers or baths, they will cause hypotension.
COPD patients. For doses taken more than once daily, evenly space the doses. An
abrupt withdrawal may result in life threatening arrhythmia, HTN or myocardial
ischemia. Keep enough medication on vacations, holidays, and weekends. If a dose is
missed at its usual time, take the next day.
What are the drug interactions with digoxin? - Answers-Quinidine, amiodarone,
verapamil, diltiazam, and propafenone increase serum cardiac glycoside levels and lead
to toxicity. Drugs that cause bradycardia will increase the risk of bradycardia. Albuterol
and digoxin will decrease digoxin levels. Levels go down especially with increased
albuterol use. Phenobarbital, phenytoin, rifampin = decrease effect of digoxin. Thiazide
and loop diuretics, mezlocillin, piperacillin, ticarcillin, amphotericin B,
glucocorticoids=may cause hypokalemia, increase risk of digoxin toxicity. Calcium
preparations = facilitates toxicity by accelerating overloading of intracellular calcium
stores. Spironolactone=increases digoxin half life. Beta adrenergic blockers, quinidine,
disopyramide + additive bradycardia. Antacids, colestipol, kaolinpectin,
cholestyramine=decreases absorption of CG if given concurrently. Thyroid
hormones=may decrease therapeutic effects and cause arrhythmias. Reductase
inhibitors=increase digoxin levels. Albuterol=decreases digoxin levels.
What is the purpose of a thyroid panel with amiodarone what is nitrate tolerance? -
Answers-Amiodorone can inhibit the thyroid gland, resulting in inflammation of the
, gland, causing hyperthyroidism. It is also a known cause of hypothyroidism, interferes
with thyroid hormone (TH). Can cause hypothyroidism in normal thyroid patients.
What are the adverse effects of statins. - Answers-Rhabdomyolysis is a severe reaction.
#1 weakness and pain (Severe) in the muscles, hepatotoxicity, HA, urine will get dark,
CPK checks for muscle breakdown. Monitor liver function and initially and then every 1-
3 months. S/s unusual or increased muscle weakness, dark urine.
What is nitrate tolerance? - Answers-Administration of nitrates too frequently leads to
nitrate tolerance. Dosing should be 7am and 2 pm (helps prevent intolerance). This is
due attenuation of the vascular effects of nitrates. If the doses are too close together
then the patient will develop nitrate tolerance. In regards to adverse effects, assess the
severity of the HA (is expected). Patient teaching for sublingual use: if swallowed there
will be decrease in effect, under tongue to dissolve. Tachyphylaxis: once start using
nitrates and you continue using the medication you are going to get to a level where
increasing the dose isn't going to necessarily help. It's a ceiling effect. Only after nitrates
have been absent from the body for 10-12 hours does the effectiveness return.
What are the adverse effects of antihistamines? - Answers-Drowsiness, urinary
retention, HTN, dizziness, HA, fatigue, cardio vascular collapse, insomnia, confusion,
dry mouth. In the elderly pt 1st generation antihistamines shouldn't be prescribed. The
risk of urinary retention is extremely large.
What patient education will you provide for a client in which you have prescribed a statin
- Answers-The patient should report any unexplained or unusual muscle pain or
weakness, dark urine (rhabdo). Don't take if you are pregnant or planning to become
pregnant. Administer the medication at night (works best at HS, the bodies cholesterol
time). Best taken at night. Don't take with grapefruit juice because it is an inhibitor of
P450. Call practitioner with weakness or muscle pain because it's a sign of
rhabdomyolysis. Limit fats in the diet, exercise and weight control.
How will you choose a diuretic in the treatment of hypertension? - Answers-Lasix is
really hard on K, need to monitor. Start on HTZ. Initial therapy is with thiazide diuretics
with an (estimated GFR higher than mid 40) this is key, if less choose an alternative.
Furosemide (lasix) and HTZ are not K sparing. CrCl <25, race, amount of dieresis you
are going to go with things like thiazide diuretics, sironolactone. Extensive dieresis you
will use furosemide. Depends on K. If renal disease usually use angiotensin receptor
blockers or ACE-I along with diuretics. Look at the level of kidney function and GFR that
is in the mid 40s range. Want to know that kidneys are functioning, as long as looking in
direction of renal functions. You have a question you have a 57 year old HTN patient
that you want to start furosemide or any diuretic. What is one of the first things you
would check or monitor if you want to lean toward renal function.
What are the central nervous system adverse effects with montelukast (Singular)? -
Answers-It's a leukotriene modifier. Leukotrienes are substances that induce numerous
effects that contribute to the inflammatory process. They include smooth muscle
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