AGNP BOARD EXAM CARDIOVASCULAR PRESRIBING (113 Questions with Answers and Explanations)
AGNP BOARD EXAM CARDIOVASCULAR PRESRIBING (113 Questions with
... [Show More] Answers and Explanations)
Question:
Signs and symptoms of digitalis toxicity include:
constipation and muscle spasms.
bradycardia and tinnitus.
headache and dizziness.
blurred vision and persistent diarrhea. Correct
Explanation:
Signs and symptoms of digitalis toxicity include: confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, fast heart beat, and visual changes (blurred vision, blind spots, green-yellow color disturbances, halo effect). Regardless of route of administration, digoxin levels should be checked at 12-24 hours after the last dose. However, depending on the clinical situation, wait at least 6-8 hours after the last dose to check levels.
Question:
A side effect of beta-blockers that is more common in children than adults is:
decreased appetite.
muscle weakness.
vivid dreams.
a cough that produces mucus. Correct
Explanation:
Side effects of beta-blockers that are more common in children than adults may include a mucus-producing cough, difficulty breathing, or tightness in the chest. Beta-blockers are not recommended as initial therapy in children due to potential adverse outcomes including increased bronchial obstruction and airway reactivity in children with asthma.
Question:
Spironolactone (Aldactone) is highly protein bound and has a duration of:
6 hours.
12 hours.
24 hours.
48 hours. Correct
Explanation:
Spironolactone (Aldactone) is greater than 90% protein bound, has a half-life elimination of 1.4 hours and a duration of 48-72 hours. It is classified as an aldosterone receptor antagonist. This class blocks the effects of aldosterone, which increases sodium reabsorption by the kidneys.
Question:
Nonselective beta-blockers block the stimulation of:
beta-1 receptors in the heart.
beta-2 receptors in the lungs.
both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct
neither beta-1 receptors in the heart nor beta-2 receptors in the lungs.
Explanation:
Nonselective beta-blockers (i.e., propranolol [Inderal]) block the stimulation of both beta-1 receptors in the heart and beta-2 receptors in the lungs. Selective beta-blockers (i.e. metoprolol [Lopressor]) specifically block beta-1 receptors, but may also block beta-2 receptors at higher doses. Because they also block beta-2 receptors in the lungs, nonselective beta-blockers are contraindicated in patients with asthma or chronic obstructive pulmonary disease.
Question:
Dabigatran (Pradaxa), an anticoagulant, is also classified as a:
direct factor Xa inhibitor.
direct thrombin inhibitor. Correct
indirect thrombin inhibitor.
factor V inhibitor.
Explanation:
Dabigatran (Pradaxa) is a direct thrombin inhibitor (DTI). Medications in this class inactivate circulating and clotting thrombin (factor IIa). They prevent thrombin (central to the generation of a thrombus) from attaching fibrinogen to fibrin. DTIs bind directly to thrombin and do not require a cofactor such as antithrombin to exert their effect. They can inhibit both soluble thrombin and fibrin-bound thrombin. Key advantages of using DTIs instead of heparin is that they: produce a more predictable anticoagulant effect due to their lack of binding to other plasma proteins; exert an antiplatelet effect; and do not cause immune-mediated thrombocytopenia.
Question:
The brand name for candesartan cilexetil is:
Atacand. Correct
Avandia.
Benicar.
Cozaar.
Explanation:
The brand name for candesartan cilexetil is Atacand. The generic name for Avandia is rosiglitazone; Benicar is olmesartan medoxomil (an ARB); Cozaar is losartan. Candesartan, olmesartan and losartan are classified as angiotensin receptor blockers (ARBs) and are used in the treatment of hypertension. Notice that they all end in "sartan." Rosiglitazone is a thiazolidinedione and is used in the treatment of diabetes.
Question:
Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a:
bile acid sequestrant.
nicotinic acid.
fibric acid. Correct
statin.
Explanation:
Gemfibrozil (Lopid) is a fibric acid. It is indicated in the treatment of hypertriglyceridemia and mixed dyslipidemia. Fibric acid derivatives, also known as fibrates, are the recommended treatment for very high triglyceride levels (>500 mg/dL). Fibrates lower serum triglyceride levels by reducing the liver's production of VLDL (triglyceride-carrying particle circulating in the blood) and by speeding up the removal of triglycerides from the blood. Gemfibrozil should not be used concurrently with statins.
Question:
In patients with normal renal function, the diuretic that has the greater antihypertensive effect is:
osmotic diuretics.
thiazide diuretics. Correct
loop diuretics.
potassium-sparing diuretics.
Explanation:
Among patients with normal renal function, thiazide diuretics, particularly chlorthalidone (Thalitone), have a greater antihypertensive effect than the loop diuretics. This may be related to the longer duration of action of thiazides compared to most loop diuretics. Diuretics lower blood pressure, at least initially, by inducing sodium and fluid loss. Other thiazide diuretics include hydrochlorothiazide (Microzide) and methyclothiazide.
Question:
An adverse effect of statin therapy for the treatment of hyperlipidemia is:
hypertension.
myalgia. Correct
hypoglycemia.
edema.
Explanation:
Statins may cause myalgia. The pain may be experienced as a soreness, fatigue or weakness in the muscles. The pain can be a mild discomfort, or it can be severe enough to make daily activities difficult. Other common side effects include diarrhea, arthralgia and nasopharyngitis.
Question:
Nitroglycerin sublingual (Nitrostat) tablets should be stored:
in a dark bottle, with the patient carrying all tablets at all times.
in a dark container in the refrigerator, with only a small quantity kept with the patient. Correct
in a tightly capped medicine bottle at room temperature.
in a tightly sealed bag or container in a purse or wallet.
Explanation:
Nitroglycerin sublingual (Nitrostat) tablets are both heat- and light-sensitive. They should be stored in a tightly capped dark bottle in the refrigerator. Only a small supply should be carried by the patient. Nitroglycerin tablets in an opened bottle should be discarded after 12 months.
Question:
Patients taking warfarin (Coumadin) therapy should:
increase intake of vitamin K-enriched foods.
avoid intake of vitamin K-enriched foods.
maintain a consistent intake of vitamin K-enriched foods. Correct
decrease intake of vitamin K-enriched foods.
Explanation:
Patients who are anticoagulated with warfarin (Coumadin) generally are sensitive to fluctuations in vitamin K intake. Adequate INR control requires a consistent intake of vitamin K. The goal of monitoring vitamin K intake is to maintain a moderate, constant level of intake rather than to eliminate vitamin K from the diet. Reducing vitamin K intake can cause the INR to increase, and increasing vitamin K can cause the INR to decrease, making it more difficult to control.
Question:
Non-dihydropyridine calcium channel blockers (i.e. verapamil) may be safely used in patients with:
heart failure.
bradycardia.
second-degree AV block.
chronic stable angina. Correct
Explanation:
Non-dihydropyridine CCBs (non-DHP CCB; i.e. verapamil [Calan] and diltiazem [Cardizem]) have negative chronotropic and inotropic effects. Therefore, they slow down heart rate and decrease force of ventricular contractions. Non-DHP CCBs are contraindicated in patients with heart failure who have reduced ejection fraction, sick sinus syndrome, and second- or third-degree atrioventricular block. Since non-DHP CCBs increase myocardial blood flow by dilating coronary arteries, they are beneficial in patients with chronic stable angina. Additionally, they can be given for rate control (tachycardia) or for the control of angina (chronic, stable) when left ventricular systolic function is normal. In general, the long-acting form of Non-DHP CCBs are recommended over the short-acting forms.
Question:
The generic name for Lopressor is:
atenolol.
metoprolol tartrate. Correct
carvedilol.
bisoprolol.
Explanation:
The generic name of Lopressor is metoprolol tartrate. The brand name for atenolol is Tenormin; carvedilol is Coreg; and bisoprolol is Zebeta. All of these drugs are classified as beta-blockers and end in "lol".
Question:
A patient is taking isosorbide dinitrate (Isordil) at 8 am, 2 pm and 9 pm and reports that the medication is no longer effective. The nurse practitioner knows that:
this is the correct time interval and the dose should be increased.
the dosing interval should be changed to allow a 14-hour nitrate-free interval. Correct
the dosing interval should be every 12 hours.
the patient should be switched to transdermal delivery for better efficacy.
Explanation:
Patients on continuous nitrates such as isosorbide (Isordil) may develop tolerance. A nitrate-free period of 12-14 hours per day should be considered to improve efficacy and prevent tolerance. The same holds true whether the nitrates are administered orally or transdermally.
Question:
Of the angiotensin receptor blockers (ARBs) used in the treatment of hypertension, the one with the longest biological half-life at 24 hours is:
irbesartan (Avapro).
losartan (Cozaar).
olmesartan (Benicar).
telmisartan (Micardis). Correct
Explanation:
Telmisartan (Micardis) has a biological half-life of 24 hours. Irbesartan (Avapro) has a half-life of 11-15 hours; olmesartan (Benicar) 13 hours; and losartan (Cozaar) 6-9 hours. These are all classified as angiotensin receptor blockers (ARBs) used in the treatment of hypertension.
Question:
A patient who has warfarin (Coumadin) toxicity should be treated with:
charcoal.
platelets.
vitamin K. Correct
prothrombin.
Explanation:
The antidote for a warfarin (Coumadin) overdose is vitamin K. Warfarin acts by inhibiting the synthesis of vitamin K-dependent clotting factors, including Factors II, VII, IX, and X, and the anticoagulant proteins C and S. The onset of anticoagulant action for oral warfarin (Coumadin) is 24-72 hours. The half-life elimination of warfarin (Coumadin) is 20-60 hours.
Question:
Clopidogrel (Plavix), an anticoagulant, may be coadministered with:
aspirin (Ecotrin). Correct
fluoxetine (Prozac).
omeprazole (Prilosec).
ibuprofen (Motrin).
Explanation:
Clopidogrel (Plavix) can be coadministered with antiplatelet medications (i.e., aspirin). Clopidogrel is often combined with aspirin to treat myocardial infarctions or unstable angina, and to prevent blood clots. Selective serotonin reuptake inhibitors (SSRIs; fluoxetine [Prozac]) and serotonin norepinephrine reuptake inhibitors (SNRIs; duloxetine [Cymbalta]) affect platelet activation. The concomitant administration of SSRIs and SNRIs with clopidogrel may increase the risk of bleeding. Coadministration of clopidogrel and NSAIDs (i.e., ibuprofen [Motrin]) increases a patient's risk for gastrointestinal bleeding. Avoid concomitant use of clopidogrel with omeprazole (Prilosec) or esomeprazole (Nexium). In clinical studies, omeprazole was shown to significantly reduce the antiplatelet activity of clopidogrel bisulfate when given concomitantly or 12 hours apart.
Question:
Which of the following drugs blocks the action of aldosterone in order to produce diuresis?
Furosemide (Lasix)
Hydrochlorothiazide (Microzide)
Spironolactone (Aldactone) Correct
Bumetanide (Bumex)
Explanation:
Spironolactone (Aldactone) is a potassium-sparing diuretic. Potassium-sparing diuretics enhance the action of thiazide and loop diuretics and counteract potassium loss by these agents. They block the action of aldosterone and cause the kidney to release fluid to produce diuresis while retaining potassium.
Question:
The lipid-lowering agent that has been proven most effective in raising high-density lipoprotein levels is:
the statin class.
the bile acid sequestrant class.
nicotinic acid. Correct
fibric acid.
Explanation:
Nicotinic acid (Niacin) has the highest potential for raising high-density lipoproteins (15-30%). Unfortunately, no improvement in cardiovascular outcomes has been documented when niacin is used with or without a statin. Consequently, the FDA has removed this as an indication on the product label. Other lipid-lowering agents may raise high-density lipoprotein at rates of: statins 5-15%; bile acid sequestrants 3-5%; fibric acids 10-20%.
Question:
A patient taking spironolactone (Aldactone) has a serum potassium of 5.8 meq/L. The nurse practitioner should:
discontinue spironolactone (Aldactone) immediately.
discontinue the spironolactone (Aldactone) and administer kayexalate.
hold spironolactone (Aldactone) until hyperkalemia is resolved. Correct
discontinue spironolactone (Aldactone) and begin a thiazide diuretic.
Explanation:
While on spironolactone (Aldactone), potassium levels should be monitored. If serum potassium increases to greater than 5.5 mEq/L or renal function worsens, further doses of Aldactone should be held until potassium is less than 5 mEq/L. Once hyperkalemia/renal insufficiency has resolved and is steady for at least 72 hours, consider restarting Aldactone at a reduced dose.
Question:
The mechanism of action of angiotensin-converting enzyme (ACE) inhibitors in lowering blood pressure is to:
block the formation of angiotensinogen in the liver.
convert angiotensin I to angiotensin II in the myocardium.
inhibit the enzyme that converts angiotensin I to angiotensin II in the serum. Correct
inhibit the conversion of angiotensin enzyme production by the kidneys.
Explanation:
Angiotensin-converting enzyme inhibitors (ACE inhibitors) slow (inhibit) the activity of the angiotensin-converting enzyme, which decreases the production of angiotensin II. Angiotensin I is formed from angiotensinogen, a protein produced by the liver and released into the blood. Angiotensin II, a vasoconstrictor, is formed from angiotensin I by angiotensin-converting enzyme (ACE). By blocking the production of angiotensin II, blood vessels dilate, and blood pressure is reduced.
Question:
The diuretic that blocks the reabsorption of sodium and water in the loop of Henle to produce diuresis is:
furosemide (Lasix). Correct
hydrochlorothiazide (Microzide).
spironolactone (Aldactone).
triamterene (Dyrenium).
Explanation:
The diuretic that blocks the reabsorption of sodium and water in the loop of Henle to produce diuresis is known as a loop diuretic. Furosemide (Lasix) is a loop diuretic. Hydrochlorothiazide (Microzide) inhibits sodium and water reabsorption, but this does not occur in the loop of Henle. Spironolactone (Aldactone) and triamterene (Dyrenium) are potassium-sparing diuretics. They antagonize aldosterone-specific mineralocorticoid receptors, primarily in the distal convoluted tubule. They decrease sodium and water reabsorption and increase potassium retention.
Question:
A 2-year-old child has a history of heart failure. To increase the force of ventricular contraction and decrease heart rate, the most appropriate drug choice is:
captopril (Capoten).
enalapril (Vasotec).
diltiazem (Cardizem).
digoxin (Lanoxin). Correct [Show Less]