Marshalltown Community College - NURSING PNN101

Chapter 08: Drugs Affecting theRenal/Urinary and Cardiovascular Problems Visovsky: Introduction to Clinical Pharmacology, 9th Edition

MULTIPLE CHOICE

1)Which body system works with the renal/urinary system to maintain fluid balance and remove waste products from the body?

1. 1. Biliary system
   2. Cardiovascular system
   3. Central nervous system
   4. Gastrointestinal system

2. Which category of diuretic drugs exerts its mechanism of action in the collecting duct?
   1. Loop diuretics
   2. Thiazide diuretics
   3. Potassium-sparing diuretics
   4. Thiazide-like sulfonamide diuretics

3. How do thiazide and thiazide-like diuretic drugs reduce high blood pressure?
   1. Reducing blood volume and relaxing vascular smooth muscle
   2. Increasing potassium excretion and slowing heart contractions
   3. Releasing sodium from cellular storage sites and preventing heart block
   4. Reducing the thirst response and increasing the amount of urine the bladder can hold

4. Which precaution is most important for the LPN/VN to teach a patient newly prescribed to take 10 mg of amiloride (Midamor) orally daily?
   1. “Avoid the use of salt substitutes.”
   2. “Avoid aspirin and aspirin-containing products.”
   3. “Eat plenty of bananas and oranges to prevent complications.”
   4. “Report a decrease in hearing to your healthcare provider immediately.

5. Which health problem is a potential side effect or adverse reaction of any class of diuretic drug?
   1. Dehydration
   2. Heart failure
   3. Blurred vision
   4. Urinary tract infection

6. Which statement made by a patient taking a loop diuretic indicates the need for more teaching?
   1. “Since I work nights, I take my drug when I first wake up rather than in the morning.”
   2. “If my hearing decreases, I will notify my healthcare provider.”
   3. “I make sure to space my fluid intake evenly throughout the day.”
   4. “When I travel by car, I always skip my diuretic that day.”

7. Why is it important to warn a patient prescribed to take finasteride (Proscar) for benign prostatic hyperplasia to wear a condom when having sex with a pregnant woman or one who could become pregnant?
   1. The drug contains a hormone that can greatly increase the risk for having twins when absorbed by a pregnant woman.
   2. The drug can be absorbed by the pregnant woman and cause birth defects in the

fetus.

1. 3. The drug reduces local immunity and increases the risk for transmitting HIV.
   4. The drug increases the risk for vaginal infections in pregnant women.

8. How does phenazopyridine help reduce the symptoms of a bladder infection (cystitis)?
   1. Increasing the strength of the bladder contraction
   2. Changing the color and the smell of the urine
   3. Killing off the bacteria causing the infection
   4. Reducing the irritation of the bladder

9. You are teaching a patient about drug therapy for hyperlipidemia. Which statement made by the patient indicates that more teaching is needed?
   1. “I am so thankful that my high cholesterol has been cured by this drug.”
   2. “I always try to drink just about the same amount of fluid that I urinate each day.”

1. 3. “I have been taking this drug just before I go to bed so that it has the greatest effect.”
   4. “I will keep regular appointments with my healthcare provider to assess for any

organ complications.”

10. Why are “statins” avoided during pregnancy and breast-feeding?
    1. These drugs cause hypotension in the fetus and infant.
    2. These drugs are associated with development of autism.
    3. They lower cholesterol levels in the fetus and infant.
    4. They can lead to miscarriage and early pregnancy loss.

11. A patient who has been taking atorvastatin for 6 months reports that he has stopped exercising because his muscles and joints are always so sore. What is the nurse’s best action?
    1. Document the report as the only action.
    2. Assess the patient’s range of joint motion.
    3. Hold the drug and notify the healthcare provider immediately.
    4. Suggest that the patient continue to exercise but take aspirin an hour before starting.

12. Which precaution is most important to teach patients who are taking any “statin” drug?
    1. “Eat plenty of bananas and oranges to prevent low blood potassium levels.”

1. 2. “Avoid using aspirin or any aspirin-containing products and drugs.”
   3. “Be sure to take this drug right before you eat a high fat meal.”
   4. “Avoid drinking alcohol and taking acetaminophen.”

13. How do bile acid sequestrants work to lower blood lipids?
    1. Increasing the intestinal excretion of dietary fat
    2. Preventing the liver from making excess lipids
    3. Moving blood fats into blood vessel linings
    4. Increasing kidney excretion of blood lipids

14. What are the most common side effects of any drug used to manage hypertension?
    1. Headache and an increased risk for nose bleeds
    2. Low blood pressure and an increased risk for falls
    3. Water retention and an increased risk for low sodium levels
    4. Low potassium levels and in increased risk for hearing loss

15. Which category of drugs for hypertension has the potential to make heart failure worse?
    1. Angiotensin receptor blockers
    2. Beta blockers
    3. Calcium channel blockers

1. 4. High ceiling “loop” diuretics

16. A patient who has been taking lisinopril for 2 years calls the clinic to report that her tongue and lips are swelling, making it hard for her to talk and swallow. What is your priority action?
    1. Take a complete history of all her allergies over the phone.
    2. Suggest that she take 25 mg of diphenhydramine as soon as possible.
    3. Tell her to go to the nearest emergency department or call 911 right now.
    4. Tell her that you will notify her healthcare provider for more instructions.

17. Which statement made by a patient who is prescribed to take clonidine twice daily indicates the need for more teaching?
    1. “When I get out of bed, I will take my time changing positions.”
    2. “If I forget my drug doses one day, I will take double doses the next day.”
    3. “If I get a cold, I will check with my healthcare provider before taking a cold drug.”
    4. “To determine how well my drugs are working, I will take my blood pressure every

day.”

18. A patient newly prescribed to take propranolol for hypertension has all of the following health problems. For which one will you check with the healthcare provider before giving?
    1. Asthma
    2. Cataracts
    3. Atrial fibrillation

1. 4. Benign prostatic hyperplasia

19. When checking a patient’s blood pressure before giving a drug specifically prescribed for hypertension, the reading is 84/50 mm Hg. What is your best action?
    1. Change the patient’s position and reassess the blood pressure in 15 min.
    2. Document the finding as the only action and give the drug as usual.
    3. Assess the patient’s ankles for peripheral pulses and edema.
    4. Hold the dose and notify the healthcare provider.

20. A nursing home patient who currently takes furosemide is now prescribed to receive the first dose of losartan. You are aware that both drugs are used to manage hypertension. What is your best action?
    1. Give both drugs as prescribed.
    2. Give the drugs at least 6 h apart.
    3. Notify the healthcare provider that this patient already takes a drug for hypertension.
    4. Assess the patient’s blood pressure to determine whether his or her hypertension is

classified as normal, prehypertension, stage I, or stage II.

21. By which mechanism or mechanisms do the nitrates help angina and heart failure?
    1. Increasing preload and increasing afterload
    2. Increasing preload and decreasing afterload
    3. Decreasing preload and increasing afterload

1. 4. Decreasing preload and decreasing afterload

22. You are assessing the knowledge of a patient who has been using nitroglycerine for about a year as needed for angina. Which statement indicates the need for more teaching?
    1. “I always get my prescription refilled every 3 months even when there are tablets left in the bottle.”
    2. “I know that my nitroglycerine is working when it tingles under my tongue and my

chest pain goes away.”

1. 3. “I always carry at least three tablets with me in a baggie my purse in case I have chest pains while I am out.”
   4. “I only drink one cup of coffee (decaffeinated) each day because caffeine can

interfere with the effectiveness of the nitroglycerine.”

23. Which factor or symptom is used to determine the most effective drug class to manage a patient’s cardiac dysrhythmia?
    1. The cause of the dysrhythmia
    2. The age of the patient
    3. Whether the patient has a pacemaker
    4. Which other drugs the patient takes daily

24. What is the most important action to take or assessment to make before giving any drug for dysrhythmia to a patient?
    1. Taking the blood pressure in both arms

1. 2. Listening to the apical pulse for a full minute
   3. Assessing the legs and feet for peripheral edema
   4. Checking the results of the most recent ECG

25. What specific effect on the heart does a drug with a positive inotropic action have?
    1. Increased heart rate
    2. Decreased heart rate
    3. Increased pumping action
    4. Decreased pumping action

26. What is the most common adult dosage of digoxin?
    1. 125 mg
    2. 12.5 mg
    3. 1.25 mg

d. 0.125 mg

MULTIPLE RESPONSE

1. A 70-year-old has been prescribed a “loop” diuretic to manage hypertension. Which side effects are most important to assess for in this patient? (Select all that apply.)
   1. High blood glucose levels
   2. Low blood glucose levels
   3. High blood potassium levels
   4. Low blood potassium levels

1. 5. High blood sodium levels
   6. Low blood sodium levels

2. A woman taking tolterodine for overactive bladder tells you that she now has all the following changes noted below. Which ones will you report to the healthcare provider? (Select all that apply.)
   1. Blurred vision
   2. Chest pain
   3. Drowsiness
   4. Dry mouth
   5. Irregular heart rate
   6. Swollen ankles

3. Which symptoms are indicators of digoxin toxicity? (Select all that apply.)
   1. Bitter taste
   2. Blurred vision
   3. Nausea and vomiting
   4. Palpitations
   5. Tingling of the fingers and toes
   6. Urinary retention

4. Which precautions are most important to teach the caregiver of a home care patient who is prescribed nitroglycerine patches? (Select all that apply.)
   1. Remove old patches before applying new ones.
   2. Before applying a new patch, dab a little on your tongue to check for a tingling sensation that indicates the drug is active.

1. 3. If a rash develops under a patch, discontinue the drug.
   4. Rotate the placement of the patch to new areas.
   5. Use sterile technique when applying patches.
   6. Do not apply patches to areas where the skin is open or irritated.
   7. Keep the patches in the refrigerator until they are used.
   8. Return old patches back to the pharmacy for refilling.

COMPLETION

Drug Calculation Problems

1. The patient is prescribed to receive 40 mg of furosemide by IV push at a rate of 10 mg per minute. The vial of furosemide on hand has a concentration of 20 mg/mL.

A. How many mL will you give for the correct dose?

2. The patient is prescribed to receive 40 mg of furosemide by IV push at a rate of 10 mg per minute. The vial of furosemide on hand has a concentration of 20 mg/mL.

How many mL will you give per minute?

3. The patient is prescribed to receive 40 mg of furosemide by IV push at a rate of 10 mg per minute. The vial of furosemide on hand has a concentration of 20 mg/mL.