Practice Exam Flashcards
1
Q
A 50 year old female patient with no previous medical history comes to you with complaints of overactive bladders. What treatment recommendations would you begin with?
A) behavior therapy
B) Oxybutynin 5 mg once daily
C) Vesicare 10 mg once daily
D) Enablex 7.5mg once daily
A
A) behavior therapy
Reasoning: page 93/94
2
Q
You begin a patient on an M3 Muscarinic selective blocker for overactive bladder. Which of the following side effects would you NOT tell the patient about?
A) constipation
B) blurred vision
C) dry mouth
D) tachycardia
A
D) tachycardia
Reasoning: page 95
3
Q
When prescribing a Oxybutin for overactive bladder what other type drugs would you tell the patient to avoid?
A) ACEI
B) Antihistamines
C) Aspirin
D) Tylenol
A
B) Antihistamines
Reasoning: page 96
4
Q
All the following are signs of antimuscarinic toxicity EXCEPT:
A) hyperthermia
B) flushed face
C) delirium
D) vomiting
A
D) vomiting
Reasoning: p. 97
5
Q
The following are properties of catecholamine Adrenergic Agonists EXCEPT:
A) they cannot be used orally
B) they cannot cross the blood brain barrier
C) their half life can be up to 24 hours
D) they are short acting
A
C) their half life can be up to 24 hours
Reasoning: p 100
6
Q
What is one if the clinic effects epinephrine has on alpha 1 receptor
A) increased cranial pressure
B) elevation of blood pressure
C) decreased blood pressure
D) decreased edema
A
B) elevation of blood pressure
Reasoning: p. 102
7
Q
What is a therapeutic application of adrenergic agonists on Beta 1 receptors? In other words, which scenario below would you use a adrenergic agonist on Beta 1 receptors?
A) dysrhythmias
B) headache
C) cardiac arrest
D) diarrhea
A
C) cardiac arrest
Reasoning: p 103
8
Q
What is a side effect of Adrenergic Agonists on Beta 2 receptors
A) Hyperglycemia in diabetic patients only
B) Hyperglycemia in any patient
C) preterm labor
D) exacerbation of asthma
A
A) Hyperglycemia in diabetic patients only
Reasoning: p 103
9
Q
Question: Albuterol is preferred in patients over isoproterenol because
A) isoproterenol tasts bad
B) Albuterol is more selective for Beta 2 receptors so it has fewer side effects
C) Albuterol is more available
D) Isoproterenol is more selective for Beta 2 receptors so it is not able to cause bronchodilation
A
B) Albuterol is more selective for Beta 2 receptors so it has fewer side effects
Reasoning: p 103
10
Q
Epinephrine has specificity to all of the following adrenergic receptors EXCEPT:
A) Alpha 1
B) Alpha 2
C) Beta 1
D) Dopamine
A
D) Dopamine
Reasoning: p. 104
11
Q
Mr. Prince was recently diagnosed with heart failure. He arrives to his follow up appointment after starting his new medication regimen. What statement would alarm the APRN?
a. “I have been taking Aleve twice a day for my arthritis in my knee”
b. “I haven’t gotten a good night’s rest because I have been urinating so often”.
c. “I take my blood pressure and heart rate every day after taking my medications and I have noticed my heart rate around 60 bpm”.
d. “I am still short of breath when walking to my mailbox, but it seems it is getting better every day”.
A
a. “I have been taking Aleve twice a day for my arthritis in my knee”
NSAIDS should be avoided in heart failure patients as it has the potential to increase fluid retention.
Increased urine output is normal after starting some new heart failure medications, especially diuretics. Patient should be instructed to take those medications in the morning to avoid nocturia. Side effects of some heart failure medications are lowered heart rate and blood pressure. Patient should be education on side effects and also to start taking blood pressure and heart rate prior to taking medications that would affect his vitals. Continued shortness of breath may indicate the need for adjustments of some medications, which can be addressed at the current appointment.
12
Q
Ms. Smith presents to her primary care physician office with complaints of shortness of breath while ambulating and general fatigue. She has recently had to increase her daily oxygen demand to 2L/NC from her usual 1 L. Upon exam, she has 4+ pitting edema to bilateral lower extremities, BP 156/98, and heart rate 90. What new medication orders would alarm the nurse?
a. Increase Lasix from 20mg to 40mg daily
b. Give loading dose of Digoxin, then start 0.125mg daily.
c. Begin Lisinopril (Zestril) 2.5mg daily.
d. Increase Metoprolol from 12.5mg to 25mg
A
d. Increase Metoprolol from 12.5mg to 25mg
Start of new or change of dose of a beta blocker shouldn’t be given to heart failure patients in exacerbation or showing signs of fluid overload. This may worsen the patient’s current condition. Depending on what stage of heart failure she may be classified, adding ACE-I (Lisinopril) and a cardiac glycoside (Digoxin) is appropriate treatment of heart failure. Increasing Lasix during is exacerbation is appropriate.
13
Q
The major underlying causes of heart failure are
a. diabetes and chronic hypertension
b. chronic hypertension and myocardial infarction
c. myocardial infarction and hyperlipidemia
d. CAD and uncontrolled hypercholesteremia
A
b. chronic hypertension and myocardial infarction
pg. 325/HF Medication Video
Major underlying cause of heart failure are chronic hypertension and myocardial infarction. Other causes include Valvular Heart Disease, CAD, Congenital Heart Disease, dysrhythmias, and aging of the myocardium.
14
Q
A patient is diagnosed with heart failure at his primary care physician’s office. The nurse anticipates which meds to be routinely prescribed for heart failure? Select all.
a. A drug that inhibits the RAAS
b. cardiac glycoside
c. diuretic
d. beta blocker
A
Correct: a, c, d,
pg.327
For routine therapy, heart failure is treatment of drugs that inhibit RAAS, diuretic, and a beta blockers. Cardiac glycoside, such as digoxin, is not considered first line treatment.
15
Q
Mrs. Johnson arrives to clinic with the complaint of a new onset, non-productive cough. She was recently diagnosed with heart failure and started on furosemide (Lasix), Enalapril (Vasotec), and Metoprolol (Toprol). The APRN would make which adjustments to the patient’s medication regimen?
a. Discontinue Lasix and start Spironolactone
b. Add Digoxin loading dose, with 0.125mg daily thereafter
c. Discontinue Enalapril and start Losartan (Cozaar)
d. Increase Lasix dosage, check labs, consider adding potassium supplement
A
c. Discontinue Enalapril and start Losartan (Cozaar)
pg. 32
An adverse effect of ACE-I is intractable cough. ACE-I are preferred drug compared to ARB, but ARBs are considered if patient cannot tolerate ACE-I.
16
Q
The nurse should expect initial and follow up labs after patient starts Spironolactone to monitor for:
a. Hypernatremia
b. Hyperkalemia
c. Hyperglycemia
d. Hyponatremia
A
b. Hyperkalemia
pg. 329
Aldosterone antagonist’s major adverse effect is hyperkalemia with underlying case from renal retention of potassium. Potassium levels and renal function should be measured at baseline and periodically there after.
17
Q
Mr. Jones is on a treatment regimen for heart failure after recently suffering a MI. His regimen includes Quinapril (Accupril), Lasix (furosemide), and KlorCon, and bisoprolol (Zebeta). Mr. Jones symptoms continues to persist despite adequate treatment and multiple dosage changes. The APRN would expect to
a. Discontinue Lasix and add Spironolactone
b. Add Spironolactone and discontinue KlorCon
c. Discontinue Quinapril (Accupril) and add Ramipril (Altace)
d. Add Losartan (Cozaar) after confirming potassium is within normal limits
A
b. Add Spironolactone and discontinue KlorCon
pg. 329- An aldosterone antagonist is recommended for addition to standard heart failure therapy, but only if symptoms persist. The major effect of an aldosterone antagonist if hyperkalemia, so potassium supplements should be discontinued.
pg. 335-336- Adding an aldosterone antagonist (spironolactone or eplerenone) to standard therapy (i.e. diuretic, ACEI or ARB, and a beta blocker) is reasonable in patients with moderately severe symptoms of heart failure after a heart attack. However, aldosterone antagonist must not be used if kidney function is impaired or serum potassium is elevated. Monitor renal function and potassium levels with treatment regimen.
18
Q
Ms. Simpson lives alone in an apartment complex. She complains that lately when she walks to the mailbox, approximately 1 block away, she becomes short of breath and needs to rest to catch her breath upon returning. According the New York Heart Association (NYHA) Heart Failure Classification, Ms. Simpson would be classified as
a. Class I
b. Class II
c. Class III
d. Class IV
A
c. Class III
HF Medication Video
Class III is when patient starts to become symptomatic upon minimal exertion, such as walking two blocks with shortness of breath and fatigue.
19
Q
Mr. Broussard is a 70-year-old male who has been recently diagnosed with heart failure. What statement made by the patient should warrant further education by the APRN?
a. “I will see you soon for my lab recheck”.
b. “I have decreased my smoking to three cigarettes a day and I should be completely off of them by next week”.
c. “I limit my wine intake to four glasses daily”.
d. “I have an appointment soon with my endocrinologist to check my thyroid and adjust my medications”.
A
c. “I limit my wine intake to four glasses daily”.
HF Medication Video
Alcohol should be limited to one drink per day for women and two drinks per day in men.
20
Q
A patient is diagnosed with heart failure classified as Class III in the NYHA Classification. The patient is prescribed Digoxin in addition to standard medication for heart failure. What finding would alarm the APRN? Select all.
A. Digoxin level of 1.2 ng/mL on follow up labs
B. Complaints of GI upset, occasional diarrhea, and mild nausea
C. Patient reports they cannot tell the difference between the red/yellow/green lights when driving.
D. Complaints of muscle cramps at nighttime
A
Correct: ALL, P.332-334
Digoxin treatment for heart failure labs should be kept between 0.5-0.8ng/mL. Symptoms of digoxin toxicity is visual disturbance, GI upset, nausea, and diarrhea. Muscle cramps are a sign of hypokalemia. Loss of potassium increases the risk of digoxin-induced dysrhythmias. Digoxin is excreted primarily by renal excretion.
21
Q
NP students may take what type of drug to alleviate symptoms of test anxiety?
A. B Adrenergic Antagonists
B. A Adrenergic Antagonists
C. Muscarinic Antagonist
D. B Adrenergic Agonist
A
Answer A:
B Adrenergic Antagonists
Pg. 113
Therapeutic uses for B Adrenergic Antagonists are hypertension, angina pectoris, cardiac dysrhythmias, prophylaxis of migraines, treatment of MI, and symptom suppression of situational anxiety. B Adrenergic Antagonists blocks B1 mediated tachycardia.
22
Q
A patient abruptly quits taking their B Blocker medications. He begins to experience chest pain and ventricular dysrhythmias. What might be the cause?
A. Myocardial Infarction
B. Rebound Excitation
C. Heart Failure
D. Cardiac Ischemia
A
Answer B: Rebound Excitation
Pg. 113
Increased cardiac activity is a phenomenon that develops with abrupt cessation of B Blockers. The patient may experience chest pain and/or ventricular dysrhythmias. If this occurs dosing should be temporarily resumed. Patient education should include warning to not abruptly stop B Blocker therapy, and to make sure to have a sufficient amount of medications when traveling. To minimize this phenomenon patient’s dosage should be slowly tapered for 1-2 weeks.
23
Q
What B Blockers is recommended for the treatment of hypertension in pregnant women?
A. Labetalol
B. Nadolol
C. Metoprolol
D. Bisoprolol
A
Answer A: Labetalol
pg. 114-115
Labetalol is a third generation B Blocker. It acts on blood vessels to cause dilation, but may produce nonselective B Blockade. It is one of three medications recommended by the American College of Obstetricians and Gynecologists for the treatment of hypertension in pregnant women. It has low lipid solubility, is metabolized in the liver, and excreted through the urine. Peak time is 2-4 minutes PO and half-life of 6-8 hours
24
Q
A patient is being prescribed propranolol. How would the NP establish an effective dosage for the patient?
A. Draw blood levels to determine therapeutic levels
B. Adjust dosage by monitoring the patient’s response
C. Rely on dosing information
D. Start at a high dose
A
Answer B: Adjust dosage by monitoring the patient’s response
Page 115
Propranolol must be adjusted in response due to patients varying requirements and poor correlation between blood levels and therapeutic response. SNS activity is responsible for the responses to propranolol. Those with high sympathetic activity the dose will need to be high to reduce receptor activation. If sympathetic activity is low, a lower dose is needed.
25
A patient presents to the clinic with uncontrolled hypertension. You are considering starting the patient on a B Blocker. Reviewing the patient’s h/x you see the patient is diabetic and has asthma. What B Blocker would be safe to use?
A. Propranolol
B. Labetalol
C. Metoprolol
D. Nebivolol
Answer C: Metoprolol
Pg. 115
Metoprolol is a selective B Blocker that blocks B1 receptors in the heart when using therapeutic dosing. Higher doses may block B2 receptors as well. Because it is selective to B1 receptors it is preferred to use in patients with diabetes and asthma. It reduces secretion of renin in the kidney and does not block bronchial B2 receptors when taking usual doses. Contraindications include patients with sinus bradycardia and AV block greater than 1st degree. Patients still need to have teaching medication can mask normal signs of hypoglycemia. Black Box ma cause exacerbation of angina and increased risk of MI with abrupt cessation of drug.
26
The NP is considering restarting a patient on sotalol for cardiac dysrhythmia. What precautions need to be taken with this drug?
A. None, the drug is safe
B. Do a baseline ECG, CBC, and creatine clearance
C. The patient’s liver enzymes need to be checked prior to restarting this medication
D. The patient needs to be in a facility that has continuous ECG monitoring and CPR capabilities for a minimum of 3 days. Obtain a creatine clearance before start.
Answer D: The patient needs to be in a facility that has continuous ECG monitoring and CPR capabilities for a minimum of 3 days. Obtain a creatine clearance before start.
pg. 116
Sotalol has a black box warning for starting and restarting this medication. Creatine clearance needs to be checked and the patient needs to be in a facility with continuous monitoring to minimize problems associated with induced arrhythmia. Betapace cannot be substituted for Betapace AF when treating a-fib. This drug is approved for ventricular dysrhythmias and maintenance of sinus rhythm in patients that previously experienced A-fib or A-flutter.
27
What receptor blockade should the NP be aware of when choosing a B Blocker for a patient with diabetes?
A. A1 blockade
B. A2 blockade
C. B1 blockade
D. B2 Blockade
Answer D: B2 Blockade
pg. 119
B2 blockade can prevent glycogenolysis. Patients need to reduce their use of insulin. Cardioselective agents are more preferred. Diabetic patients on B Blockers need to be taught to monitor for other indicators of hypoglycemia such as hunger and poor concentration.
28
The NP is planning to start a patient on methyldopa for hypertension. The NP should order what lab tests before starting the medication?
A. CBC, CMP, Magnesium
B. Liver enzymes, CMP
C. WBC, Electrolytes,
D. CBC, Coombs test, liver enzymes
Answer D: CBC, Coombs test, liver enzymes
pg. 123
Methyldopa inhibits sympathetic outflow from CNS causing A2 activation in the brain It is not an A2 agonist and must be converted to methyl norepinephrine in order to activate A2 receptors. It does not decrease the heart rate or cardiac output. It is safe to administer to pregnant women. Coombs test should be administered before therapy and 6-12 months after initiation of drug therapy. Patients with a positive coombs test need to be monitored for hemolytic anemia. If hemolytic anemia develops the medication should be discontinued immediately
29
A student asks the NP how an indirect-acting antiadrenergic agent works. Which statement best describes how these drugs work?
A. Central acting A2 agonists act within the CNS to reduce outflow impulses along sympathetic neurons acting as an antiadrenergic agent. These drugs decrease activation of A- and B- adrenergic receptors in the periphery.
B. Indirect-acting antiadrenergic agents produce a blockade of adrenergic receptors
C. These agents work by binding directly to the receptor. They promote norepinephrine release, blockade of NE reuptake, or inhibit NE reactivation
D. These agents act directly at cholinergic receptors blocking the actions of acetylcholine.
Answer A: Central acting A2 agonists act within the CNS to reduce outflow impulses along sympathetic neurons acting as an antiadrenergic agent. These drugs decrease activation of A- and B- adrenergic receptors in the periphery.
Pg. 120
Adrenergic antagonists produce blockades of adrenergic receptors. Adrenergic agonist binds to receptors and promote NE release, blockade of NE reuptake or inhibit NE reactivation. Muscarinic Antagonists block actions of acetylcholine and act directly on cholinergic receptors.
30
A 32 year old female presents to the clinic to speak about family planning. When reviewing the patient’s current medications, you notice one medication that is of some concern. What medication would you change?
A. Methyldopa
B. Labetalol
C. Clonidine
D. Nifedipine
Answer C: Clonidine
Pg. 121
Clonidine is not recommended for pregnant women because of possible fetal harm. It is known to be embryotoxic in animals. Other adverse effects include CNS depression patients should be advised to take daily dose at night to minimize daytime sedation. Do not discontinue abruptly. There is a potential for rebound hypertension. This drug also has potential for abuse due to subjective effects of euphoria, sedation, and hallucinations.
31
1. A provider knows that the medication administered when a patient is experiencing toxic effects from a muscarinic agonist is:
a. Neostigmine
b. Bethanechol
c. Atropine
d. Scopolamine
Answer: C-Atropine
pg 85. By blocking access of muscarinic agonist to their receptors, atropine can reverse most signs of toxicity.
32
2. Cholinesterase inhibitors are the primary therapy for patients with Myasthenia Gravis. The NP knows that cholinesterase inhibitors work by:
a. Increasing the reuptake of acetylcholine
b. Preventing acetylcholine inactivation
c. Deactivating muscarinic receptors
d. Releasing epinephrine from the adrenal medulla
Answer: B- Preventing acetylcholine inactivation
pg 89. By preventing acetylcholine inactivation, cholinesterase inhibitors can intensify the effects of acetylcholine released from motor neurons, increasing muscle strength.
33
3. The drug most appropriate for the use in a patient with glaucoma is:
a. Bethanechol
b. Atropine
c. Pilocarpine
d. Pyridostgmine
Answer: C. Pilocarpine
pg. 85.
34
4. Adverse effects seen with cholinergic agonists are directly related to:
a. The activation of the sympathetic nervous system
b. The increase of acetylcholinesterase
c. The overstimulation of cholinergic receptors
d. The activation of Beta 2 receptors
Answer: C. The overstimulation of cholinergic receptors
Pg. 85- see Box 13.1 on Muscarinic/Cholinergic Toxicity
35
5. What symptom would you not expect from a patient experiencing muscarinic toxicity?
a. Urination
b. Bradycardia
c. Diarrhea
d. Mydriasis
Answer: D. Mydriasis
Pg. 85 see box 13.1
36
6. Atropine works by:
a. Deactivating acetylcholine
b. Inhibiting acetylcholinesterase
c. Preventing receptor activation by acetylcholine
d. Blocking all nicotinic receptors
Answer: C pg. 91
37
7. A therapeutic goal of atropine is:
a. Treatment of bradycardia or AV block
b. Treatment of tachydysrhythmia
c. Treatment of elevated IOP
d. Severe constipation
Answer: A. Treatment of bradycardia or AV block
See pg. 93 Summary of Key Prescribing Considerations
38
8. Scopolamine is similar to atropine in all the following EXCEPT:
a. Adverse effect of xerostomia
b. Produces sedation
c. Can be used as preanesthetic sedation
d. Can cause urinary retention
b. Produces sedation
| Answer: Pg. 93
39
9. True/False: The first line treatment for OAB is behavioral therapy?
Answer: True. Pg. 94
40
10. To minimize the side effects of medications used to treat OAB, the provider should prescribe a medication that is:
a. Short-acting
b. Non-selective
c. Acts on the M3 receptor subtype
d. Is a topical gel
Answer: C. Acts on the M3 receptor subtype
Pg. 95.
41
Why are drugs that act via synaptic transmission preferred to drugs that act via axonal conduction?
a. They work faster
b. They are highly selective
c. They have less drug-drug interactions
d. They are cost-effective
Answer (B) They are highly selective
(pg 68): “drugs that alter synaptic transmission can produce effects that are highly selective. This selectivity can occur because synapses, unlike axons, differ from one another”
42
# Choose the option that is NOT one of the effects that drugs can have on transmitter synthesis.
a. Increase transmitter synthesis
b. Decrease transmitter synthesis
c. Dissolve transmitters in the synaptic cleft
d. Cause the synthesis of transmitter molecules that are more effective than the natural transmitter itself (aka super transmitters)
Answer (C) Dissolve transmitters in the synaptic cleft
(pg 69) please read rationale in the heading “transmitter synthesis”
43
Select all that apply. Which are the transmitters that bind with adrenergic receptors
a. Epinephrine
b. Norepinephrine
c. Acetylcholine
d. Dopamine
Answers (A, B, D)
(pg 75): acetylcholine is the neurotransmitter that binds with cholinergic receptors
44
Select all that apply: Which of the following is/are subtypes of cholinergic receptors?
a. Alpha 1
b. Muscarinic
c. Nicotinic
d. Beta 2
Answers (B, C) (pg 76):
alpha and beta are subtypes of adrenergic receptors
45
Which of the following is a function of the parasympathetic nervous system (cholinergic receptors)?
a. Increased heart rate
b. Increased gastric secretion
c. Dilation of pupils
d. Dilation of bronchi
Answer: (B) (pg 72): Increased gastric secretion
read heading “functions of the parasympathetic nervous system” for rationale
46
Which of the following is a function of the sympathetic nervous system (adrenergic receptors)?
a. Pupil constriction
b. Increased secretions
c. Decreased blood pressure
d. Glucose production by the liver
Answer: (D) (pg 72): Decreased blood pressure
read heading “functions of the parasympathetic nervous system” for rationale
47
How can drugs increase the activation of receptors? (select two)
a. Blockade of transmitter reuptake
b. Increased transmitter production
c. Inhibition of transmitter degradation
d. Increased enzyme production
Answers: (A, C)
(pg 69): drugs that act by blockade of transmitter reuptake or inhibition of transmitter degradation will increase transmitter availability, thereby causing receptor activation to increase
48
If a drug directly activates a receptor, it is called a:
a. Substrate
b. Catalyst
c. Agonist
d. Antagonist
Answer: (C) Agonist
| pg 69
49
If a drug prevents a receptor from being activated, it is called a:
a. Antagonist
b. Prodrug
c. Inactive compound
d. Agonist
Answer: (A)Antagonist
| (pg 69)
50
When blood pressure falls, the baroreceptor reflex signals for the body to compensate via what mechanism?
a. Vasoconstrict
b. Vasodilate
c. Release bradykinin
d. Dilate bronchi
Answer: (A) (pg 73): Vasoconstrict
when BP falls, baroreceptors cause vasoconstriction and increase cardiac output. Conversely, when BP rises, baroreceptors cause vasodilation and reduces cardiac output.
51
A patient with HTN is admitted to the hospital. On admission the patient’s HR is 72 bpm and b/p 140/95. After administering a antihypertensive medication the patient’s HR is 85 and b/p 130/80. Which does the nurse expect to occur?
a) a decrease in the HR back to baseline in 1-2 days.
b) an increase in the blood pressure within a few days
c) an increase in potassium retention in 1-2 days
d) a decrease in fluid retention within a week
Answer: a. a decrease in the HR back to baseline in 1-2 days.
When blood pressure drops the baroreceptors in the aortic arch and carotid sinuses sense this and relay information to the vasoconstriction area of the medulla; this causes constriction of the arterioles and veins and increased sympathetic impulses to the heart resulting in increased HR. After 1-2 days the system resets itself to adjust to the new pressure and the heart rate will return to normal. Blood pressure will not reset, no effect on potassium (depends on med) and fluid retention may increase over time but no decrease. From Lehne’s pharmacotherapeutics test bank, 1st edition
52
2. A patient is taking a drug that interferes with venous constriction. The nurse will tell the patient to:
a) Ask for assistance when getting out of bed
b) Expect bradycardia for a few days
c) Notify the provider if headaches
d) Report SOB
Answer: a. Ask for assistance when getting out of bed
A drop in venous pressure, reduces venous return to the heart, and as blood pools in the extremities, orthostatic hypotension can occur. Patients taking drugs that reduce venous constriction should be warned for ask for assistance when getting out of bed. Bradycardia, headache, and SOB are not expected effects in venous constriction. From Lehne’s pharmacotherapeutics test bank, 1st edition
53
3. A patient is taking a beta-1 adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:
a) Cardiac afterload
b) Cardiac preload
c) Myocardial contractility
d) Venous return
Answer: c. Myocardial contractility
Beta 1 receptors increase heart rate, contractility, and velocity of AV conduction. Preload- stretch or volume of heart at diastole. Afterload= SVR. Venous return not affected.
From Lehne’s pharmacotherapeutics test bank, 1st edition
54
4. A patient with HTN is admitted for a procedure. If the patients arterial pressure decreases what else would the nurse expect to see?
a) Decreased HR
b) Increased HR
c) Decreased B/P
d) Syncope
Answer: b. Increased HR
When arterial pressure decreases, the vasoconstriction center causes vasoconstriction of nearly all arterioles. This causes peripheral resistance, constriction of veins increasing venous return, and subsequent increase in HR. Would not cause decrease in B/p or HR. No syncope. From Lehne’s pharmacotherapeutics test bank, 1st edition
55
5. A patient is brought to the ER with SOB, RR 30, intercostal retractions and frothy, pink sputum. The nurse caring for this patient would expect to administer which drug?
a) Furosemide (Lasix)
b) HCTZ (Hydrodiuril)
c) Mannitol (Osmitrol)
d) Spironolactone (Aldactone)
Answer: a. Furosemide (Lasix)
Lasix, a potent diuretic is used when rapid or massive mobilization of fluids is needed. This patient shows severe CHF with respiratory distress and pulmonary edema needing immediate mobilization of fluids. HCTZ and spironolactone are not indicated for CHF because their diuretic effects are less rapid. Mannitol is indicated for increased ICP and must be d/c’d immediately if signs of HF or pulmonary congestion occur. From Lehne’s pharmacotherapeutics test bank, 1st edition
56
6. An older patient with CHF develops crackles in both lungs and pitting edema in all extremities. The physician orders HCTZ. Before administering, the nurse reviews the chart. Which finding would be concerning in giving this medication?
a) Elevated creatine clearance
b) Elevated serum potassium
c) Normal blood glucose
d) Low LDL
Answer: a. Elevated creatine clearance
HCTZ should not be given to patient with severe renal impairment. Therefore, an elevated CC would be of concern. Thiazide diuretics are potassium sparing. Thiazides can increase BG in diabetics. And can increase LDL but this patient’s is low. From Lehne’s pharmacotherapeutics test bank, 1st edition
57
7. A patient is taking gentamycin and Lasix. The nurse should counsel the patient to report which symptom?
a) Nocturia
b) Headaches
c) Ringing in the ears
d) Urinary retention
Answer: c. Ringing in the ears
Patients taking Lasix should be advised that the risk of furosemide induced hearing loss can be increased when other ototoxic drugs like gentamycin are taken. Patient should report tinnitus, dizziness, or hearing loss. Nocturia may be expected on a diuretic. Urinary retention and headaches are not likely a side effect of Lasix. From Lehne’s pharmacotherapeutics test bank, 1st edition
58
8. A patient with chronic CHF has repeated hospitalizations in spite of ongoing treatment with HCTZ and Digoxin. The provider adds spironolactone, and the nurse provides education. Which statement by the patient confirms they understand teaching?
a) I will feel better a few hours after taking this drug
b) I need to stop my potassium supplements
c) I should use salt substitutes form now on
d) I should watch for signs of dehydration
Answer: b. I need to stop my potassium supplements
spironolactone is an adjunct therapy that is potassium sparing in comparison to thiazides and loop diuretics. Continuing potassium supplements would put a patient at risk for hyperkalemia- even more concerning because they are taking digoxin. Spironolactone takes up to 48 hours to take effect. Salt substitutes are high in potassium. Spironolactone is a weak diuretic; risk of dehydration is minimal. From Lehne’s pharmacotherapeutics test bank, 1st edition
59
9. A patient has a new diagnosis of hypertension and the provider wants to start a daily thiazide diuretic. Which of these conditions would not be a contraindication for thiazide treatment?
a) Sulfa allergy
b) Gout
c) Pregnancy
d) Renal insufficiency with a GFR of 20
Answer: c. Pregnancy
Thiazides are a Pregnancy Category B drug meaning they are used routinely. Gout, sulfa and GFR < 30 are contraindications of thiazide diuretic therapy. In renal insufficiency use a loop. Tara Hillard ppt presentation, slide 11
60
10. Aterial Pressure is regulated by:
a) The autonomic nervous system
b) RAAS
c) The kidneys
d) All of the above
Answer: d. All of the above
The ANS responds in seconds or minutes through baroreceptors (pressure sensors) in the carotid sinus and aortic arch and send messages to the brain the respond. The RAAS responds more slowly- hours (vasoconstriction) to days (water retention because of increased sodium reabsorption), through angiotensin 2, a powerful vasoconstrictor. This is where ACE I, ARBs and Renin antagonists work. When AP remains low for a long time (weeks, etc.) the kidneys retain water, release renin and activate the RAAS. Lehne pg. 288
61
Which medications are most likely to cause postural hypotension? Select all that apply.
```
A. Minoxidil
B. Diltiazem (Cardizem)
C. Prazosin (Minipres)
D. Captopril (Capoten)
E. Losartan (Cozaar)
```
ANS: C, D, E
C. Prazosin (Minipres)
D. Captopril (Capoten)
E. Losartan (Cozaar)
Postural, or orthostatic hypotension is defined as a fall in blood pressure related to a change in position. Minoxidil and diltiazem dilate arterioles, therefore they are not likely to cause postural hypotension. Prazosin, captopril, and losartan all reportedly can cause orthostatic hypotension. (pg. 314)
62
A nurse is obtaining a medication history on a newly admitted patient, who reports taking Minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats/min and a BP of 120/80. What is an important part of the initial assessment for this patient?
A. evaluating ankle edema
B. monitoring for nausea and vomiting
C. noting the presence of hypertrichosis
D. obtaining a blood glucose
ANS: A -evaluating ankle edema
Fluid retention is a common and serious adverse effect of minoxidil, because it can lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and vomiting may occur with this drug but it is not a serious side effect. Hypertrichosis occurs in about 80% of patients taking this drug, but its effects are cosmetic and not life threatening. It may be important to monitor the blood glucose level in some patients, because the drug can alter glucose tolerance, but this effect is not as serious as fluid retention. (pg. 314)
63
A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse’s teaching about this drug?
A. “I will need to ask for assistance when getting up out of a chair”
B. “I will also take a beta blocker medication with this drug to prevent rapid heart rate”
C. “I may develop joint pain, but this side effect will decrease over time”
D. “This drug may cause excessive hair growth on my face, arms and back”
ANS: B
“I will also take a beta blocker medication with this drug to prevent rapid heart rate”
Hydralazine can cause severe reflex tachycardia. A beta blocker is usually given to counter this effect. Postural hypotension is minimal with hydralazine. Patients should be taught to report joing pain, which indicates and SLE syndrome and requires discontinuation of the drug. Minoxidil can cause excessive hair growth, no hydralazine. (pg. 313)
64
A hospitalized patient has a blood pressure of 145/96. The nurse caring for this patient notes that the BP the day before was 132/98. The patient reports ambulatory blood pressure readings of 136/98 and 138/92. The patient has a history of a myocardial infarction and has adopted a lifestyle that includes a DASH diet and regular exercise. What will the nurse do?
A. Notify the provider and suggest a thiazide diuretic as initial therapy.
B. Order a diet low in sodium and high in potassium for this patient.
C. Recheck the patients BP in 4 hrs to verify the result.
D. Notify the provider and discuss ordering a beta blocker for this patient
ANS: D: Notify the provider and discuss ordering a beta blocker for this patient
Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI. Beta blockers are indicated for patients with preexisting heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet so closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the BP to verify the condition. (pg. 320)
65
Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?
A. hydralazine and minoxidil
B. hydrochlorothiazide and nadolol
C. spironolactone and amiloride
D. trichlormethiazide and hydrochlorothiazide
ANS: B hydrochlorothiazide and nadolol
When two or more drugs are used to treat hypertension, each drug should come from a different class. (og. 321) HCTZ is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are vasodilators. Spironolactone and amiloride are potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics.
66
A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?
A. “Beta blockers block the actions of angiotensin II”
B. “Beta blockers decrease heart rate and contractility”
C. “Beta blockers decrease peripheral vascular resistance”
D. “Beta blockers decrease the release of renin”
ANS: A “Beta blockers block the actions of angiotensin II”
Beta blockers reduce the release of rennin by blockade of b-1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin-II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resitance, and decrease the release of rennin. (pg. 318)
67
A 5-year old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child’s parents, the nurse will expect to:
A. perform a detailed health history on the child
B. provide teaching about antihypertensive medications
C. reassure the parents that their child may outgrow this condition
D. teach the parents about lifestyle changes and a special diet
ANS: A: perform a detailed health history on the child
Because the incidence of secondary hypertension is much higher in children than in adults, it is important to obtain an accurate health history to help uncover primary causes. Once the type of hypertension is established, the teaching interventions may be useful. Hypertension must be treated, and it is incorrect to reassure the parents that their child may just outgrow the condition. (pg. 323)
68
A 60 year old African-American patient has a BP of 120/80 and reports a family history of HTN. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?
A. Alcohol cessation
B. potassium supplementation
C. sodium restriction
D. weight loss
ANS: C - sodium restriction
Current recommendations for African-Americans to prevent HTN include sodium due to an increased sensitivity to salt. The patient has a normal BMI and does not consume alcohol excessively, so weight loss and alcohol cessation are not necessary. Potassium supplements are not indicated. Patients should be advised to consume foods high in potassium. (pg. 322).
69
A patient is taking clonidine for HTN and reports having dry mouth and drowsiness. What will the nurse tell the patient?
A. Beta blockers can reverse these side effects
B. Discontinue the medication immediately and notify the provider
C. Drink extra fluids and avoid driving when drowsy
D. Notify the provider if symptoms persist after several weeks
ANS: C - Drink extra fluids and avoid driving when drowsy
Clonidine can cause dry mouth and sedation. Patients should be warned to drink extra fluids and avoid driving. Beta blockers do not reverse these drug side effects. D/C clonidine abruptly can cause severe rebound HTN. These are common side effects that do not abate over time.
70
A patient who does not consume alcohol or nicotininc products reports a strong family history of HTN and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:
A. 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
ANS: B- the DASH diet, sodium restriction and exercise
This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If BP rises to HTN levels , other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated. (pg. 317).
71
In which of the following should you not take a ACE Inhibitor ? Select all that apply
A. Patient with renal artery stenosis
B. Pregnant women
C. Patients with Diabetic Nephropathy and hypertension
D. Patients that exhibit a cough as a side effect to ACE Inhibitors
The answers are A,B&D
A. Patient with renal artery stenosis
B. Pregnant women
D. Patients that exhibit a cough as a side effect to ACE Inhibitors
It is contraindicated to take ACE Inhibitors for patients with renal artery stenosis, in pregnant women it is a teratogen, and for patients that exhibit a cough they should stop talking an ACE Inhibitor. ACE Inhibitors help delay renal progression in diabetic patients with renal disease. They do NOT prevent renal disease.
P.303
72
How does an ARB work?
A. They catalyze the formation of angiotensin 1 from angiotensinogen
B. They reduce the risk for cardiovascular mortality caused by HTN
C. They inhibit the block production of Angiotensin II
D. They block the actions of Angiotensin II.
The answer is D. They block the actions of Angiotensin II.
ARB block the actions of Angiostensin II.
A. Is the model of action of a DRI
B.&C. is true for ACE Inhibitors
P. 304
73
Which of the following ARBs are approved for Heart Failure (HF)?
A. Losartan and Irbesartan
B. Varsartan and Candesartan
C. Losartan only
D. Telimisartan
The answer is B. Varsartan and Candesartan are the only ARBs approved for HF
A. Losartan and Irbesartan are approved for diabetic nephropathy
C. Losartan is also approved for stroke prevention and diabetic retinopathy
D. Telimisartan is approved for reducing risk for MI , stroke, death from cardiovascular causes in patients 55 years and older only if they are intolerant to an ACE.
p.305
74
What are the adverse effects of a ARB? select all that apply
A.hypokalemia
B. Hyperkalemia
C.Cough
D. Angioedema
The answers are B and D,
B. Hyperkalemia
D. Angioedema
ARBs cause hyperkalemia and in some cases angioedema although angioedema is less common in ARBS than in ACE Inhibitors In addition, the cough is seen in patients taking ACE Inhibitors the cough comes from increased bradykinnin.
P.305
75
What is the black box warming in spironlactone?
A. Pose a risk for major congenital malformation and fetal death
B. Use of spironlactone is a tumorigenic in chronic toxicity studies in rats.
C. Can injure the developing fetus in the second and third trimester.
D. There is no black box warning for spironlactone.
The answer is B. Use of spironlactone is a tumorigenic in chronic toxicity studies in rats.
A. is a black box warning for Alisken which is a DRI
C. Is a black box warning for ACE/ARB
D. there is a black box warning.
p.307
76
What are the adverse effects of spironlactone? Select all that apply?
```
A, Hypokalemia
B. Hyperkalemia
C. gynemastia
D. menstrual irregularites
E. Anguiedema
```
The answers are B,C,& D
The Adverse effects of spironlactone are hyperkalemia, (it is a potassium sparring diuretic, and aldosterone antagonist). Spironlactone can cause gynemastia and menstrual irregularities.
Angioedema think ACE and ARB
p.307
77
Which class of Calcium channel blockers affect the heart and the lungs?
A. Dihydropyridine
B. NonDihyropyridine
C. Both dihydropyridine and nondihydropydine
D. lisinopril
the answer is B NonDihyropyridine
```
It is important to know which type of calcium channel blacker affects the conduction system. Non-Dihydropyridine affect both the heart and the blood vessels.Medications in this class include Verapamil and Diltiazem.
p.308
```
78
What are the indications for Verapamil and Diltiazem? Select all that apply
```
A. Angina Pectoris
B. AV block
C.essential HTN
D.Cardiac dysrhymias
E. Heart failure
```
The answer is A, C & D.
Verapamil and Diltiazem are used for angina pectoris, HTN and cardiac dysrhythmias.
They are contraindicated in patients with 2nd and 3rd atrioventricular block.
p.310
79
Which blood pressure medication causes reflexive tachycardia?
A. lisinopril
B. Diltiazem
C. nifedipine
D. Verapamil
The answer is C.
Nifedipine causes reflexive tachycardia. Important to note beta blockers can be used to prevent reflexive tachycardia in dihydropyidines like (nifedipine) but they can INTENSIFY adverse effects of nondihyopyidines like verapamil and diltiazem causing CARDIO SUPPRESSION.
p. 312
80
Vasodilators are used for essential HTN, HTN crisis , angina pectoris , Heart failure and MI. What are some important key points to teach patients in regardless to Vasodilators? Select all that apply
A. They increase the risk of falls
B. Patients should be taught S/S of hypotension such as light head and dizzy
C. Avoid Grapefruit
D. Postural HTN
The answer is A,B & D.
patients should be taught s/s of hypotension. Vasodilators placed patients at increase risk for falls and postural hypotension.
Grapefruit is not an issue for vasodilators but they do pose a risk of toxicity for verapamil which is a calcium channel blacker.
p.313.
81
Which combination of drugs increases the risk for gallstones?
a. Gemifibrozil plus Ezetimibe
b. Alirocumab plus Atrovastatin
c. Simavstatin plus Ezetimibe
d. Colesevalam plus Evolocumab
Answer: A Gemifibrozil plus Ezetimibe
Explanation: pg. 361 under Drug interactions.
Both ezetimibe and fibrates can increase the cholesterol content of bile and can thereby increase the risk of gallstone.
82
Which drug should be carefully monitored and even reduced in patients of Asian backgrounds?
a. Atrovastatin
b. Pravastatin
c. Rosuvastatin
d. Simvastatin
Answer: C - Rosuvastatin
Explanation: pg. 358
Rouvastatin reaches abnormally high levels in people of Asian heritage. Accordingly, if rosuvastatin is used by Asians, dosage should be reduced.
83
Which of the following is not a group that would benefit from Statins?
a. Individuals with primary elevations of LDL cholesterol of greater than 190mg/dL
b. Individuals 40-75 years of age with diabetes and LDL cholesterol of greater than 150mg/dL
c. Individuals with clinical ASCVD
d. Individuals with an estimated 10-year ASCVD risk of 7.3%
Answer: D Individuals with an estimated 10-year ASCVD risk of 7.3%
Explanation: pg. 353
Box 44.1 lists the statin benefit groups as defined by the 2018 American College of Cardiology/American Heart Association Blood Cholesterol Guidelines
84
Which drug is no longer used for the treatment of hypertriglyceridemia?
a. Fenofibrate
b. Nicotinic Acid
c. Pitavastatin
d. Colestipol
Answer: B - Nicotinic Acid
Explanation: pg. 359. Panel of experts recommended that niacin be removed from the guidelines for use in hypertriglyceridemia and in lowering LDL cholesterol
85
A patient with a history of HIV who is currently taking Ritonavir, which statin should be avoided?
a. Atorvastatin
b. Pravastatin
c. Pitavastatin
d. Fluvastatin
Answer: A - Atorvastatin
Explanantion: pg. 358/359.
Atorvastatin, Lovastatin, and Simvastatin are metabolized by CYP3A4. Drugs that inhibit CYP3A4 can raise levels of these drugs. Inhibitors of CYP3A4 are macrolide antibiotics, azole antifungals, HIV protease inhibitors, amiodarone, and cyclosporine.
86
Which of the following statements is true?
a. Immediate-release Lovastatin tablet can be taken without regard to meals
b. Fluvastatin is recommended for patients with renal impairment
c. Atorvastatin is preferred when taking with Amiodarone (a CYP3A4 inhibitors)
d. Myopathy and renal toxicity is the two adverse effects of statins
Answer: B - Fluvastatin is recommended for patients with renal impairment
Explanation: Page359-360
Immediate-release Lovastatin tablets should be taken with evening meals to increase absorption. Atorvastatin, Lovastatin and Simvastatins should not be taken with drugs that inhibit CYP2A4 and the two adverse effects of statins are: myopathy and hepatotoxicity
87
Which of the following statements is false regarding statins?
a. Statins undergo rapid hepatic metabolism
b. The synthesis of LDH receptors should decrease with statins
c. Primarily excreted in the bile
d. Statins are acceptable therapy with nonalcoholic fatty liver
Answer: B - The synthesis of LDH receptors should decrease with statins
Explanation: Page 357-359
The synthesis of LDH receptors should increase with statins, which will allow hepatocytes to remove more LDL from the blood.
88
Metabolic Syndrome is diagnosed with: (select all that apply)
a. HDL < 50 mg/dL
b. TG > 150mg/dL
c. Fasting blood glucose > 100
d. Systolic blood pressure > 130
e. Waist circumference > 33 inches for women
Answer:
B TG > 150mg/dL
C Fasting blood glucose > 100
D Systolic blood pressure > 130
Explanation: Pg 353
Metabolic Syndrome is diagnosed when 3 or more following characteristics are present: TG levels > 150mg/dL; HDL < 40 mg/dL; fasting blood glucose > 100; High blood pressure: SBP > 130mmHg or DBP > 85mmg and waist circumference > 40in in men or > 35 in in women.
89
Which of the following drugs decrease the uptake of fat-soluble vitamins? Select all that apply.
a. Cholestyramine
b. Colesevelam
c. Ezetimibe
d. Colestipol
Answer:
A Cholestyramine
D Colestipol
Explanation: 360-361
Colestipol and Cholestyramine decrease the uptake of fat-soluble vitamins. Colesevelam does not reduce the absorption of fat-soluble vitamins.
90
Which of the following statements is false?
a. Colesevelam does not reduce the absorption of Vitamin C
b. Constipation is the main side effect of Colesevelam
c. Bile acid sequestrants are not absorbed from the GI tract
d. Thiazide should be administered 1 hours before giving Colesevelam
Answer: A Colesevelam does not reduce the absorption of Vitamin C
Explanation: 360-361
The fat soluble vitamins are A,D, E and K and Colesevelam does not reduce the absorption of these vitamins.
91
A patient is seen in clinic who has advanced renal insufficiency. Her BP is 162/90. Which of the following drug combinations are you most likely to prescribe?
a. ACEI and a thiazide diuretic
b. ARB and a loop diuretic
c. ACEI and a potassium sparing diuretic
d. Diuretics are contraindicated in these patients; none of the above
Answer: B – ARB and a loop diuretic
Rationale: Lowering the blood pressure is the most effective strategy to slow the progression of renal damage. ACEIs and ARBs work best, and in the absence of contraindications, all patients should be prescribed one of these drugs. In most cases, a diuretic is also used. In patients with advanced renal insufficiency, thiazide diuretics are ineffective; hence a loop diuretic should be employed. Potassium sparing diuretics should be avoided. (p. 321)
92
You are seeing a diabetic patient in clinic with a BP of 150/88. What is your first line drug of choice?
a. ACEI
b. CCB
c. Beta blocker
d. Thiazide
Answer: A – ACEI
Rationale: ACEI can delay progression of diabetic nephropathy. Beta blockers can suppress glycogenolysis and mask early signs of hypoglycemia and should be used with caution. Thiazides promote hyperglycemia and should be used with caution as well. The book references a large study that indicates ACEI are better than CCB because they possibly protect against MI where CCB possibly increases the risk for MI (p. 321).
93
A 68-year-old African American male is being seen in clinic for elevated BP. What is the first line drug of choice, considering this patient does not have any other comorbidities?
a. Thiazide diuretic
b. ACEI
c. CCB
d. Beta blocker
Answer: A – Thiazide diuretics
Rationale: Controlled trials have shown that diuretics can decrease morbidity and mortality in African Americans. CCBs and alpha/beta blockers are also effective. When BP cannot adequately be controlled with a single drug, one of several two-drug combinations are recommended: ACEI plus a thiazide, an ACEI plus a CCB, or a beta blocker plus a thiazide
(p. 322).
94
You are discharging a patient home from the hospital after their stay due to heart failure. The patient’s prior medications include furosemide and spironolactone. You are adding captopril to the patient’s medication regiment. Which medication should be reconsidered and discontinued, if any?
a. Furosemide
b. Spironolactone
c. Captopril
d. None of the medications should be discontinued as this patient is in heart failure
Answer: B – Spironolactone
Rationale: This patient is at risk for hyperkalemia with the combination of ACEI and a potassium-sparing diuretic, because ACEI also carry a risk for hyperkalemia. The spironolactone should be discontinued. (p. 328)
95
You are trying to decide between prescribing a patient a ARB or an ACEI. Which of the following do you know is NOT true to consider between these two medications?
a. ARBs do not increase levels of kinin and their effects on cardiac remodeling are less favorable
b. There is more clinical experience overall with the use of ACEI than ARBs
c. ARBs do not cause cough
d. ARBs have not been shown to reduce mortality
Answer: D – ARBs have not been shown to reduce mortality
Rationale: Clinical trials have shown that ARBs improve LV ejection fraction, reduce HF symptoms, increase exercise tolerance, decrease hospitalization, enhance quality of life, and reduce mortality. However, because ARBs do not increase levels of kinins, their effects on cardiac remodeling are less favorable than those of ACEIs. For this reason and because ACEI is much greater than that with ARBs, ACEIs are generally preferred. (p. 328-329).
96
Cardiac glycosides work by:
a. increase glycogenesis to prevent hypoglycemia in patients with HF
b. reducing blood volume to decrease venous pressure and afterload
c. increasing myocardial contractile force
d. increasing preload
Answer: C – increasing myocardial contractile force
Rationale: Digoxin is known for their positive inotropic agents or their ability to increase myocardial contractile force (p. 330). By increasing contractile force, digoxin can increase cardiac output.
97
What should be prescribed for a patient presenting with BP 170/90 and who is also 30 weeks pregnant?
a. Labetalol
b. Captopril
c. Losartan
d. None of the above, all are contraindicated due to their potential for fetal harm
Answer: Labetalol
Rationale: When drug therapy is initiated during pregnancy, methyldopa and labetalol are the traditional agents of choice. ACEI, ARBs, and DRIs are contraindicated owing to their potential for harm. (p. 324)
98
You prescribe a thiazide for a patient. What would be most important to assess upon a clinic visit, considering the side effects of this drug?
a. HR
b. BP
c. Chemistry labs
d. EKG
Answer: C – chemistry labs
Rationale: The principal adverse effect of thiazides is hypokalemia. You should check a chemistry panel to assess potassium level.
99
Which of the following is not a result of an ACEI?
a. Arteriolar dilation that improves blood flow in the kidneys
b. Venous dilation that reduces venous pressure
c. increases myocardial contractile force
d. Suppression of aldosterone release that enhances the excretion of sodium and water and retains potassium
Answer: C – increases myocardial force
Rationale: Digoxin increases myocardial force, not ACEIs. ACEI suppress the production of angiotensin II, causing dilation of arterioles and veins and decreasing the release of aldosterone. This results in answers A, B, and D. (p. 328)
100
A patient is considered stage C on the ACC/AHA scheme of classifying heart failure. You understand this to mean:
a. The patient has structural heart disease with prior or current symptoms of HF
b. The patient has structural heart disease but without symptoms of HF
c. The patient has marked limitation of physical activity: even mild activity produces symptoms
d. refractory HF requiring specialized interventions
Answer: A - The patient has structural heart disease with prior or current symptoms of HF
Rationale: Answer B is stage B on the ACC/AHA scheme. Answer C is class III on the NYHA scheme. Answer D is stage D on the ACC/AHA scheme. The New York Heart Association classifies HF based on the functional limitations it causes. A newer scheme was developed by the American College of Cardiology and the American Heart Association that is based on the observation that HF is a progressive disease that moves through stages of increasing severity. The ACC/AHA scheme is intended to complement the NYHA scheme, not replace it. (p. 327)
101
True or False: Heart failure in children is the same as in adults.
False. The definition of HF in children is ever changing and there is no precise definition that practitioners can agree on.
found in the video “Overview of HF in Children and Treatment”
102
Heart Failure in children is much more costly than heart failure in adults due to: (choose all that apply)
a. Needing more therapies- physical therapy, occupational therapy, etc.
b. They are hospitalized longer and more frequently
c. They live longer with advances in treatment technology
d. They require extra care in the hospital due to the nature of being a child
a. Needing more therapies- physical therapy, occupational therapy, etc.
b. They are hospitalized longer and more frequently
c. They live longer with advances in treatment technology
All apply except for D. Children do not necessarily require extra care just because they are children.
found in the video “Overview of HF in Children and Treatment”
103
Dilated cardiomyopathy is: (choose all that apply)
a. The most common cause of HF in children
b. Usually caused by acute viral myocarditis
c. Not a cause of HF in children
d. An etiology that varies by age
a. The most common cause of HF in children
b. Usually caused by acute viral myocarditis
Dilated cardiomyopathy is the most common cause of HF in children, and it is usually caused by acute viral myocarditis.
found in the video “Overview of HF in Children and Treatment”
104
True/False- Presentation of HF in children can be very misleading and can mimic sicknesses like Pneumonia, GI illnesses, and viral processes.
True. All illnesses listed above can mimic HF—however, HF should always be a differential diagnosis if a newborn, infant, and toddlers present with signs such as nasal flaring, crackles, wheezing, displaced PMI, pallor, hepatomegaly and poor perfusion in. Children ages 5 and up that present with tachycardia, increased WOB, peripheral edema, JVD, wheezing, gallop, hepatomegaly should also have a differential diagnosis of heart failure.
found in the video “Overview of HF in Children and Treatment”
105
When managing pediatric heart failure, (select all that apply)
a. You should recognize and treat the underlying cause of the heart failure
b. Correct the precipitating event
c. Treat systemic and/or pulmonary congestion
d. Put the patient on digoxin as this has a wide therapeutic range and can be easily monitored for therapeutic effect
a. You should recognize and treat the underlying cause of the heart failure
b. Correct the precipitating event
c. Treat systemic and/or pulmonary congestion
Management of pediatric heart failure revolve around 3 main principles. Treating the cause of the heart failure, correcting the precipitating event and treating systemic and pulmonary congestion. D is completely false- Digoxin has a narrow therapeutic index and is not considered a first line therapy in pediatric heart failure and is rarely used.
found in the video “Overview of HF in Children and Treatment”
106
True or False: There are 4 stages of pediatric heart failure in which all but the first stage requires medication. The aim of these medications is to decrease afterload to decrease systemic and pulmonary congestion.
True. The aim of treating heart failure is to decrease systemic and pulmonary congestion to decrease the cardiac workload.
found in the video “Overview of HF in Children and Treatment”
107
Timmy, a well-known 4-year-old loveable patient at Texas Children’s hospital has been recently diagnosed with Stage B Pediatric Heart Failure. Previously, he was not on any medications. What medication would you, as an advanced pediatric practitioner, start Timmy on now that his heart failure has progressed to Stage B?
a. Beta Blocker
b. HCTZ
c. ACE Inhibitor
d. Angiotensin Receptor Blocker
c. ACE Inhibitors are first line treatment for Stage B Pediatric HF
found in the video “Overview of HF in Children and Treatment”
108
Timmy has been on Lisinopril now for two months. He comes to your clinic for a follow-up appointment. What side effects are you looking for that indicate Timmy is not tolerating the newly prescribed med?
a. Cough, headache, dizziness, abdominal symptoms
b. Blurred vision, bradycardia, nausea/vomiting
c. Loss of albumin on his labs
d. Fatigue, dizziness, hypotension, hypoglycemia
a. Cough, headache, dizziness, abdominal symptoms
these are symptoms that Timmy is not tolerating his lisinopril very well. B, C, & D are adverse effects of Digoxin, Loop diuretics, and beta blockers, respectively.
found in the video “Overview of HF in Children and Treatment”
109
Beta Blockers in the treatment of pediatric HF are/is:
a. Recommended in asymptomatic patients that have ventricular systolic dysfunction
b. Given to slow the heart rate, thereby decreasing myocardial demand
c. Usually well tolerated
d. All of the above
D. All of the above.
found in the video “Overview of HF in Children and Treatment”
110
Timmy, now 5 years old, presents to your clinic with worsening fatigue, worsening shortness of breath and increasing peripheral edema. He states he has been sick for about a week now and can hardly breathe. You admit Timmy to the hospital expecting that the first line of treatment for his decompensated heart failure will be:
a. The addition of a beta blocker to his home medication treatment regimen
b. Changing his ACE Inhibitor to an ARB
c. An inotropic drug to be given IV STAT to decrease the workload on the heart
d. Lasix to decrease systemic and pulmonary congestion
D. Lasix to decrease systemic and pulmonary congestion
a loop diuretic is first line treatment for decompensated heart failure as well as Stages C & D of pediatric heart failure.
found in the video “Overview of HF in Children and Treatment”
111
Which of the following is representative of the passive occurrence or end-diastolic pressure?
A. systemic vascular resistance
B. preload
C. total peripheral vascular resistance
D. afterload
B. preload
Rationale: Preload = volume in the left ventricle as it prepares for the next contraction, it is a passive occurrence and is representative of end-diastolic volume. Afterload is synonymous with systemic vascular resistance and total peripheral vascular resistance (older term) it is defined as the stretch of the left ventricle and the pressure in the systemic vascular system that the left ventricle must overcome as it contracts.
found in the Antihypertensive video
112
Which of the following drugs acts in the distal convoluted tubule and may be used to treat hypertension and as an adjunct to heart failure?
A. spironolactone
B. furosemide (lasix)
C. potassium chloride
D. hydrochlorothiazide
D. hydrochlorothiazide
Rationale: Hydrochlorothiazide is a thiazide diuretic which works in the distal convoluted tubule and is used as adjunct therapy to HF. spironolactone and furosemide do not work in the distal convoluted tubule. Potassium chloride is not used to treat HTN or HF.
found in the Antihypertensive video
113
A 43-year-old male patient presents to your clinic complaining of a dry cough with no other remarkable symptoms. The patient’s vitals are within normal limits. He has a history of hypertension, heart failure, and osteoarthritis. Upon reviewing their medication list, you discover they recently started taking an ACE inhibitor. Which of the following interventions would you recommend?
A. Ordering a viral panel to test for a potential viral infection
B. Switch the patients ACE inhibitor to an ARB to relieve the symptoms of the cough
C. Conducting a CBC to assess for an elevated white blood cell count
D. Telling the patient that the cough is due to their heart failure
B. Switch the patients ACE inhibitor to an ARB to relieve the symptoms of the cough
Rationale: ACE inhibitors promote the accumulation of bradykinin which results in a dry cough, switching the patient to an ARB will most likely relieve the cough. Although a cough can be an indication of a bacterial or viral infection, the patient’s vital signs are within normal limits and he has no other complaints, therefore a viral panel and CBC are not necessary. A cough associated with heart failure is generally wet, not dry.
found in the Antihypertensive video
114
4. What is the proper sequence of the renin-angiotensin-aldosterone
(RAAS) system?
A. Angiotensinogen is activated by renin, producing angiotensin I. Renin then converts angiotensin I to angiotensin II. Angiotensin II results in vasoconstriction which leads to a decrease in blood pressure.
B. Angiotensinogen is activated by angiotensin converting enzyme, producing angiotensin I. Renin then converts angiotensin I to angiotensin II. Angiotensin II results in vasoconstriction which leads to an increase in blood pressure
C. Angiotensinogen is activated by renin, producing angiotensin I. Renin then converts angiotensin I to angiotensin II. Angiotensin II results in vasodilation which leads to a decrease in blood pressure.
D. Angiotensinogen is activated by renin producing angiotensin I, angiotensin converting enzyme then converts angiotensin I to angiotensin II. Angiotensin II results in vasoconstriction which leads to an increase in blood pressure
D. Angiotensinogen is activated by renin producing angiotensin I, angiotensin converting enzyme then converts angiotensin I to angiotensin II. Angiotensin II results in vasoconstriction which leads to an increase in blood pressure
Rationale: Angiotensinogen is activated by renin which produces angiotensin I. Angiotensin converting enzyme then converts angiotensin I to angiotensin II. Angiotensin II, a potent vasoconstrictor, results in vasoconstriction which leads to an increase in blood pressure.
found in the Antihypertensive video
115
Which of the following drug classes act on the RAAS system to indirectly inhibit the action of aldosterone?
A. diuretics
B. CCBs
C. ACE inhibitors
D. ARBs
D. ARBs
Rationale: ARBs act on the receptor sites for angiotensin in thee renal system and block aldosterone.
found in the Antihypertensive video
116
The two types of calcium channel blockers (CCBs) can be explained by which of the following?
A. Dihydropyridines are vasodilators which work to dilate smooth muscle and slow heart rate and SA node conduction. Whereas non-Dihydropyridines are vasoconstrictors which work to contract smooth muscle and increase heart rate and SA node conduction.
B. Non-Dihydropyridines and Dihydropyridines are both vasoconstrictors which have an effect on smooth muscle to decrease blood pressure. Non-dihydropyridines slow heart rate and SA node conduction whereas dihydropyridines do not.
C. Dihydropyridines are vasoconstrictors which work to dilate smooth muscle and increase heart rate and SA node conduction. Whereas non-Dihydropyridines are vasodilators which work to dilate smooth muscle and slow heart rate and SA node conduction.
D. Non-Dihydropyridines and Dihydropyridines are both vasoconstrictors which have an effect on smooth muscle to decrease blood pressure. slow the heart rate and conduction of the SA node. Dihydropyridines slow heart rate and SA node conduction whereas non-dihydropyridines do not.
B. Non-Dihydropyridines and Dihydropyridines are both vasoconstrictors which have an effect on smooth muscle to decrease blood pressure. Non-dihydropyridines slow heart rate and SA node conduction whereas dihydropyridines do not.
Rationale: Both types of CCBs (Non-dihydropyridines and dihydropyridines) are vasodilators. The biggest difference is that Non-dihydropyridines slow heart rate and SA node conduction whereas dihydropyridines do not.
found in the Antihypertensive video
117
A patient has been newly diagnosed with hypertension and you are discussing possible options for therapy. The patient refuses to be medicated and asks if there are any options outside of pharmacological therapy. What is your best response?
A. “There are natural products I can suggest to help you manage your hypertension.”
B. “These medications aren’t that bad. We will start off slow and increase from there if we need to.”
C. “Since you have already been diagnosed, unfortunately medication is your only option.”
D. “Let’s discuss your lifestyle habits and develop a plan to make some modifications to decrease your blood pressure”
D. “Let’s discuss your lifestyle habits and develop a plan to make some modifications to decrease your blood pressure”
Rationale: The only exception to treatment with ONLY lifestyle modifications after the diagnosis of hypertension is the patient refusing to medication. The best option would be to discuss possible changes to be made in their lifestyle that can aid in decreasing their BP.
found in the Antihypertensive video
118
8. You have a patient who has a recent diagnosis of HTN and history of coronary artery disease which of the following adjunct treatments are you most likely to recommended?
A. a thiazide diuretic
B. an ARB
C. a beta blocker
D. a calcium channel blocker
C. a beta blocker
Rationale: Beta blockers will aid in the patient’s hypertension and will provide some cardiac protection by preventing cardiac remodeling, this would be beneficial with the added diagnosis of coronary artery disease.
found in the Antihypertensive video
119
9. Which medication therapy are you most likely to recommend to a patient with hypertension and diabetes?
A. an ACE inhibitor
B. an ACE inhibitor + thiazide diuretic
C. Calcium channel blocker
D. an ARB + an ACE inhibitor
A. an ACE inhibitor
Rationale: ACE inhibitors provide renal protection, which is crucial in the case of a diabetic, however, in a patient with diabetes that does not have a comorbidity of hypertension, it is not necessary to treat them with an ACE inhibitor.
found in the Antihypertensive video
120
What is the drug of choice for the treatment of moderate hypertension in a pregnant woman?
A. vermapil
B. methyldopa
C. manoxadil
D. None of the above
B. methyldopa
Rationale: Although most antihypertensives are contraindicated in pregnant women. Uncontrolled moderate hypertension can present risks to the mother and unborn fetus; therefore, it must be treated. The drug of choice is methyldopa.
found in the Antihypertensive video
121
Alpha 1 receptor blockers mechanism of action include all of the following EXCEPT
A) Blocks postsynaptic alpha 1 adrenergic receptors resulting in vasodilation and decreased peripheral vascular resistance
B) Tends to affect systolic BP more than diastolic BP
C) Results in relaxation of the bladder neck and prostate therefor are often used for the treatment of bladder outlet obstruction conditions such as BPH
Answer: B Tends to affect systolic BP more than diastolic BP
Reasoning: Alpha 1 tends to affect diastolic BP more than systolic BP (HTN PPT, Slide 8)
122
Your patient is taking Methyldopa and should have LFT’s checked _____ (Select all that apply)
A) 4 Weeks after initial therapy
B) 6 Weeks after initial therapy
C) 12 Weeks after initial therapy
D) Periodically
answer:
C) 12 Weeks after initial therapy
D) Periodically
(HTN PPT, Slide 14)
123
You are treating an adult patient for hypertension with no history of diabetes or CKD, which type of drug would be the best choice for initial treatment?
A) ACEI
B) ARB
C) Thiazide-Type Diuretic
D) Beta Blocker
Answer: C Thiazide-Type Diuretic
| JNC8 handout p516
124
You are treating an adult patient for hypertension with a history of diabetes, which type of drug would be the best choice for initial treatment?
A) Beta Blocker
B) Thiazide-Type Diuretic
C) Aldosterone Antagonist
D) ACEI
Answer: D - ACEI
| JNC8 handout p516
125
It is recommended that Lipid Panels should be ordered on patients
A) Ages 40 and older every 5 years
B) Ages 20 and older every 5 years
C) Ages 60 and older every 5 years
D) Ages 60 and older every 2 years
Answer: B Ages 20 and older every 5 years
| Antihyperlipidemic PPT
126
Current guidelines target high risk groups that necessitate statin therapy include (Select all that apply)
A) Patients with known ASCVD
B) Patients with an LDL > 50 mg/dl
C) Diabetics aged 40-75 with an LDL of 79-189mg/dl
D) 10 year risk for ASCVD > 7.5% and an LDL 70-189mg/dl
Answer:
A - Patients with known ASCVD
C - Diabetics aged 40-75 with an LDL of 79-189mg/dl
D-10 year risk for ASCVD > 7.5% and an LDL 70-189mg/dl
(Antihyperlipidemic PPT)
127
Patients with Known ASCD should be treated with
A) High intensity statin
B) Moderate intensity statin
C) Low intensity statin
Answer: A -High intensity statin
| Antihyperlipidemic PPT
128
Patients with a LDL > 190mg/dl should be treated with
A) High intensity statin
B) Moderate intensity statin
C) Low intensity statin
Answer: A High intensity statin
| Antihyperlipidemic PPT
129
Patients with a 10 year risk for ASCVD > 7.5% and an LDL 70-189mg/dl should be treated with
A) High intensity statin
B) Moderate intensity statin
C) Low intensity statin
Answer: B -Moderate intensity statin
| Antihyperlipidemic PPT
130
Statin use (Select all that apply)
A) Is safe during pregnancy and lactation
B) Is the Primary treatment for hyperlipidemia according to ATP IV guidelines
C) Can Cause Erectile Dysfunction
D) May need dose reduced when prescribed to elderly
Answer:
B) Is the Primary treatment for hyperlipidemia according to ATP IV guidelines
C) Can Cause Erectile Dysfunction
D) May need dose reduced when prescribed to elderly
(Antihyperlipidemic PPT)
131
A diuretic used for the treatment of hypertension & heart failure that can decrease glucose tolerance, produce hypokalemia (in high doses), aggravate gout by interfering with urine acid secretion, and produce a small rise in LDL.
a. Amiloride
b. Furosemide
c. Hydrochlorothiazide
d. Mannitol
Correct answer: C-hydrochlorothiazide.
Amiloride is a K-sparing diuretic that blocks epithelial Na channels in the collecting duct. Furosemide is a loop diuretic that is indicated for reducing edema in patients with CHF and is not commonly used for treating hypertension. Mannitol is an osmotic diuretic that is not used to treat hypertension or heart failure.
132
A 65-year-old woman who is diagnosed with hypercalcemia related to a parathyroid hormone-secreting tumor. Other than chemotherapy what other treatment could be included to help with hypercalcemia?
a. Acetazolamide
b. Furosemide
c. Hydrochlorothiazide
d. Spiralactone
Correct answer: B-furosemide.
It is a loop diuretic often used to treat severe edema, hyperkalemia, acute renal failure, and hypercalcemia
133
Acts on the collecting duct and can block the reabsorption of only 3% of filtered sodium.
a. Hydrochlorothiazide
b. Acetazolamide
c. Mannitol
d. Triamterene
Correct Answer: D- triamterene.
It is a K-sparing diuretic that blocks epithelial Na channels in the collecting duct and can prevent reabsorption of 3% of filtered sodium. Hydrochlorothiazide, a thiazide, acts on the Na/Cl transporter on the luminal side of the distal convoluted tubule. Mannitol, an osmotic diuretic exerts their effects in the segments that are freely permeable to water, such as the proximal tubule and descending limb of Henle’s loop.
134
Your 63-year-old male patient with a past medical history of hypertension and MI one year ago is now showing signs of congestive heart failure. You, therefore, add spironolactone to his drug regimen. What side effect should you warn him about?
a. Gynecomastia
b. Hypokalemia
c. Ototoxicity
d. Uricemia
Correct answer: A- gynecomastia-
along with impotence and BPH have all been reported with the use of spironolactone because it also affects other steroid receptors. Spironolactone is K-sparing so hypokalemia would not occur. Ototoxicity can occasionally occur with loop diuretics. Loop diuretics can also cause hyperuricemia and precipitate attacks of gout. This is caused by hypovolemia- associated enhancement of uric acid reabsorption in the proximal tubule.
135
Your 70-year-old male patient who is diagnosed with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. When prescribing hydrochlorothiazide for this patient, what laboratory value would cause you the most concern?
a. Elevated creatinine clearance
b. Elevated serum potassium level
c. Normal blood glucose level
d. Low levels of low- density lipoprotein (LDL) cholesterol
Answer: A elevated creatinine clearance.
Hydrochlorothiazide should not be given to patients with severe renal impairment: therefore an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and may actually improve the patient’s potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL
136
A patient is taking gentamicin and furosemide. The nurse practitioner should counsel this patient to report which symptoms?
a. Frequent nocturia
b. Headaches
c. Ringing in ears
d. Urinary retention
Answer: C-ringing in ears;
patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin are also taken. Patients should be told to report, tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide.
137
Toxicities/toxicity associated with thiazide diuretic.
a. Hyperkalemia
b. Hypouricemia
c. Hypolipidemia
d. Hyponatremia
Answer: D-hyponatremia.
Thiazides cause hypokalemia, hyperuricemia, hyperlipidemia
138
Besides serum potassium level what other diagnostic tests should the advanced practice nurse order for a patient newly started on a potassium-sparing diuretic like spironolactone?
a. Serum uric acid
b. Blood glucose
c. CBC
d. Serum Lithium
Answer: C-CBC
adverse side effect of K-sparing is agranulocytosis or complete loss of patient’s white blood cell count
139
Osmotic diuretics act on which site in the nephron?
a. Proximal tubule
b. Glomerulus
c. Ascending limb of the loop of Henle
d. Collecting tubule
Answer: B- glomerulus,
osmotic diuretics are poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism.
140
A patient has just been prescribed furosemide. After reviewing the patient’s medication history, what drug would cause the advance practice nurse concern when taken with furosemide?
a. Acetaminophen
b. Ferrous sulfate (Feosol)
c. Naproxen sodium (Naprosyn)
d. Ampicillin
Answer: C- naproxen sodium
Naproxen is a NSAID. There may also be a decreased loss of sodium and decreased antihypertensive effects of these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal anti-inflammatory drugs. The patient receiving this combination should be monitored closely, and appropriate dosage adjustments should be made. There is no contraindication to the intercurrent use of acetaminophen, ferrous sulfate, or ampicillin.
141
A women with no prenatal care just had a baby. She has a list of the medications that she has been taking while pregnant and one of them is lisinopril. What should the newborn baby be observed for?
a) Hypotension, hypokalemia, periodic apnea
b) Hypoglycemia, hypotension, hypokalemia
c) Hypotension, oliguria and hyperkalemia.
ANSWER C - Hypotension, oliguria and hyperkalemia.
P. 302 Infants who have been exposed to ACE inhibitors during the second or third trimester should be closely monitored for hypotension, oliguria, and hyperkalemia.
142
A patient calls the NP’s office as instructed after developing a sore throat and fever. She was recently prescribed captopril and has been taking it as directed. Her little girl is currently being treated for strep throat and she thinks that’s probably what is going on. She has some amoxicillin from a previous prescription. What should the NP advise the patient to do?
a) Take 1000 mg of Tylenol for the fever and schedule an appointment within the next few days
b) Stop taking the captopril immediately and come in immediately
c) Take a dose of amoxicillin and come in the next day
ANSWER B -Stop taking the captopril immediately and come in immediately
p. 302 If neutropenia develops, ACE inhibitors should be withdrawn immediately. Neutrophil counts should normalize in approximately 2 weeks. In the absence of early detection, neutropenia may progress to fatal agranulocytosis. Patients should be informed about early signs of infection (e.g., fever, sore throat) and instructed to report them immediately. Neutropenia is more common with captopril than with other ACE inhibitors
143
Which of the following ACE inhibitors does not require a dose reduction for patient’s with kidney disease?
a) Captopril
b) Fosinopril
c) Lisinopril
d) Ramipril
ANSWER B- Fosinopril
p. 300 All ACE inhibitors are excreted by the kidneys. As a result, nearly all can accumulate to dangerous levels in patients with kidney disease and hence dosages must be reduced in these patients. Only one agent—fosinopril—does not require a dosage reduction.
144
The NP has a 65 year old patient with a history of type 2 diabetes, heart failure, and hypercholesteremia. When reviewing the patient’s recent lab results, the NP noted that the patient had an HA1C of 6.0, potassium is 3.8, and GFR of 12 mL/min. Which one of the following patient’s medications needs to be changed?
a) Hydrochlorothiazide
b) Metformin
c) Simvastatin
d) Triamterene
ANSWER A - Hydrochlorothiazide
p. 294 These drugs (Thiazide diuretics) are ineffective when GFR is low (less than 15 to 20 mL/min)
145
A 70 year old patient had to be taken off of Ramipril due to a hacking cough. The patient has a history of diabetes, hypertension and smokes 1 pack of cigarettes daily. Which medication could this patient most benefit from?
a) Telmisartan (Micardis)
b) Robitussin
c) Valsartan (Diovan)
d) Nicorette patch
ANSWER A - telmisartan (Micardis)
p. 305 telmisartan (Micardis)— is approved for reducing the risk for MI, stroke, and death from cardiovascular causes in patients 55 years and older but only if they are intolerant of ACE inhibitors
146
What should the NP include in the education for a patient with a new prescription for spironolactone?
a) Avoid salt substitutes and potassium supplements
b) This medication is effective within a couple of hours after taking it
c) Take this medication in the morning as this medication will have a significant effect on the amount that you urinate
d) Take this medication at night as it can cause your blood pressure to drop and cause dizziness when first starting to take it (first-dose hypertension)
ANSWER A: Avoid salt substitutes and potassium supplements
significant potassium accumulation can occur when taking a potassium-sparing diuretic in conjunction with potassium supplements, salt substitutes (which contain potassium).
147
A 50 year old man states that he feels as if he has started growing breasts. Which one of the following medications could be the cause of this?
A) Spironolactone
B) HCTZ
C) Captopril
D) Valsartan
ANSWER A
p. 295 Spironolactone is a steroid derivative with a structure similar to that of steroid hormones (e.g., progesterone, estradiol, testosterone). As a result, spironolactone can cause a variety of endocrine effects, including gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice.
148
ACE inhibitors completely block angiotensin II production.
a) True
b) False
ANSWER B - False
p. 299 It should be noted that some angiotensin II is produced by pathways that do not involve ACE. As a result, drugs that inhibit ACE cannot completely block angiotensin II production.
149
The following all increase the risk for cough from taking ACE inhibitors EXCEPT:
a) Advanced age
b) Male sex
c) Female sex
d) Asian ancestry
ANSWER B - Male sex
P. 302 Factors that increase the risk for cough include advanced age, female sex, and Asian ancestry.
150
Losartan and enalapril both slow the development and progression of diabetic retinopathy in patients with type 2 or type 1 diabetes.
A) True
B) False
ANSWER B - False
P. 302 in patients with type 1 diabetes who do not have hypertension, nephropathy, or established retinopathy, enalapril prevented or slowed development of retinal change. In patients with type 2 diabetes, enalapril had no benefit, regardless of retinopathy status.
p. 305in patients with type 1 diabetes without established retinopathy, losartan slowed the development and progression of retinopathy—but had no benefit in patients with established retinopathy. In patients with type 2 diabetes, the drug offered no benefit at all, regardless of retinopathy status.
151
What action does Digoxin exert on the heart?
a. Increase myocardial contractile force
b. Decrease myocardial contractile force
c. Increased heart rate
d. Increased sympathetic tone
P.330
a. Increase myocardial contractile force
152
What relationship does Potassium to Inotropic Action of Digoxin have?
a. When potassium levels are high, binding of digoxin to NA+, K+-ATPase Increases
b. No effect occurs between potassium level and NA+, K+-ATPase
c. When potassium levels are low, binding of digoxin to NA+, K+-ATPase Increases
d. When potassium levels are low, binding of digoxin to NA+, K+-ATPase decreases
P.330
c. When potassium levels are low, binding of digoxin to NA+, K+-ATPase Increases
153
The optimal therapeutic range of digoxin is ¬¬¬¬?
a. 0.3 to 0.6 ng/mL
b. 0.4 to 0.6 ng/mL
c. 0.8 to 1.0 ng/mL
d. 0.5 to 0.8 ng/mL
P. 332
d. 0.5 to 0.8 ng/mL
154
The most common cause of dysrhythmias in patients receiving digoxin is?
a. Hyperkalemia
b. Hypokalemia
c. Hyponatremia
d. Hypercalcemia
P. 332
b. Hypokalemia
155
Which of the following are considered noncardiac adverse effects of digoxin toxicity?
a. Anorexia
b. Nausea, vomiting and fatigue
c. Visual Disturbances (blurred vision, yellow tinge to vision, halos around dark objects)
d. All of the above
P.332
d. All of the above
156
Which diuretic(s) increases the risk for digoxin-induced dysrhythmias?
a. Loop Diuretics
b. Spironolactone
c. Thiazides and Loop Diuretics
d. Thiazides
P.333
c. Thiazides and Loop Diuretics
157
Patients in stage C Heart Failure should avoid which drug(s)?
a. Antidysrhythmics
b. NSAIDS
c. Calcium Channel Blockers
d. All of the above
P. 336
d. All of the above
158
Hepatic cholesterol synthesis is catalyzed by the enzyme HMG-CoA reductase. Drugs that inhibit this enzyme are known as __________.
a. Statins
b. Diuretics
c. Macrolide Antibiotics
d. Amiodarone
P. 349
a. Statins
159
Elevated Total Cholesterol is considered ________ and elevated LDL cholesterol is considered _______.
a. 170-199 mg/dL, > 130 mg/dL
b. 170-199 mg/dL, 110-129
c. > 200 mg/dL, > 130 mg/dL
d. > 200 mg/dL, < 110 mg/dL
P. 350 (Table 44.1)
c. > 200 mg/dL, > 130 mg/dL
160
Which of the risk factors below is considered an Atherosclerotic Cardiovascular Disease (ASCVD) equivalent to having ASCVD as a predictor of a major coronary event?
a. Hypertension
b. Diabetes
c. Cigarette Smoking
d. Low HDL Cholesterol
P. 351
b. Diabetes
161
There are 2 basic steps in the process by which the neuron influences the behavior of the post synaptic cell.
a. Axonal conduction and Synaptic transmission
b. Axonal conduction and receptor
c. Transmitter storage and transmitter release
d. Receptor binding and transmitter storage
a. Axonal conduction and Synaptic transmission
Reference: pg 67 & chapter 11 study guide audio clip
162
_____________ is simply the process of conduction an action protentional down the axon of the neuron.
a. Synaptic transmission
b. Axonal Conduction
c. A Receptor
d. A nucleus
b. Axonal Conduction
Reference: pg 67 & chapter 11 study guide audio clip
163
The Baroreceptor reflex are considered the most important feedback loop because they help regulate___________.
a. Kidney function
b. Heart rate
c. Blood pressure
d. The amount of oxygen
c. Blood pressure
Reference: chapter 12 video and pg. 73
164
The parasympathetic nervous system performs seven regulatory functions that have relevance to drugs: slowing of heart rate, increased gastric secretion, emptying bladder, emptying bowel, focusing the eye for near vision, constricting pupils, and contracting bronchial smooth muscles. Which of the following poisons or toxic foods can act by mimicking or blocking the effects of parasympathetic stimulation.
a. Insecticides
b. Nerve gases
c. Mushrooms
d. All of the above
d. All of the above
Reference: Chapter 12 study guide video and pg 72
165
5. The sympathetic nervous system has 3 main functions: regulating the cardiovascular system, implementing the acute stress response and _____________?
a. Eye movement (constricting pupils)
b. Gastric motility
c. Regulating body temperature
d. Hearing
c. Regulating body temperature
Reference: Chapter 12 video and pg 72
166
In many organs that receive dual innervation, the influence of sympathetic nerves opposes that of the parasympathetic nerves. Which of the follow is an example of this?
a. In the heart sympathetic nerves increase the heart rate, whereas the parasympathetic nervous system increases the heart rate
b. In the heart sympathetic nerves decrease the heart rate, whereas the parasympathetic nervous system decreases the heart rate.
c. In the heart sympathetic nerves increase the heart rate, whereas the parasympathetic nervous system decreases the heart rate
c. In the heart sympathetic nerves increase the heart rate, whereas the parasympathetic nervous system decreases the heart rate
Reference: Chapter 12 and pg 73
167
The presence of ________ makes possible a dramatic increase in drug selectivity. This group influences certain receptors without altering all of the activity for the specific receptors. This in turn makes drug actions possible by being selective.
a. Receptor subtypes
b. Neurons
c. Receptors
d. Transmitters
a. Receptor subtypes
Reference: chapter 12 video and pg.75-77
168
8. Cholinergic drugs are agents that influence the activity of cholinergic receptors. Most of these drugs act directly at cholinergic receptors where they mimic or block the actions of ____________.
a. Nicotinic n
b. Nicotinic m
c. Alpha 1
d. Acetylcholine
d. Acetylcholine
Reference: Chapter 13 study guide video and pg 82
169
9. What are the pharmacologic actions of Muscarinic agents?
a. Muscarinic receptors are Associated with parasympathetic nervous system, therefore responses to muscarinic agonist mimic those produced by stimulation of parasympathetic nerves
b. Bind to muscarinic receptors
c. Also known as parasympathomimetic agents (stimulates the parasympathetic nervous system and ACh is the neurotransmitter used by the PSNS)
d. All of the above
d. All of the above
Reference: Chapter 13 study guide video and pg 82-83
170
10. Cholinesterase inhibitors are drugs that prevent the degradation of acetylcholine by acetylcholinesterase. By preventing the breakdown of acetylcholine, cholinesterase inhibitors increase the amount of acetylcholine available to activate receptors thus enhancing cholinergic action. These drugs transmit at all cholinergic junctions and elicit a broad spectrum of responses causing lack of selectivity. Which of the following is treated with Cholinesterase inhibitors?
a. Myasthenia Gravis
b. Hypertension
c. Alzheimer disease
d. A and C
d. A and C
a. Myasthenia Gravis
c. Alzheimer disease
Reference: Chapter 13 study guide video and pg 85
171
Receptors that respond to the same transmitter are (select all that apply)?
a. Different
b. Receptor subtypes
c. Nicotine
d. Muscarine
Answer: a, b, pg 76
a. Different
b. Receptor subtypes
172
Which of the following, does NOT explain what the effects of nicotine on skeletal muscle and ciliary muscle suggest?
a. Skeletal muscle has receptors which nicotine can act
b. Ciliary muscle does not respond to nicotine
c. Nicotine may act at the same skeletal muscle receptors as Ach
d. Ach receptors on skeletal muscle is the same as ACH receptors on ciliary muscle
d. Ach receptors on skeletal muscle is the same as ACH receptors on ciliary muscle
pg 77
173
You can predict what major effects of the PNS drug NicotinicM?
a. Release of epi
b. Contraction of skeletal muscle
c. Decreased heart rate
d. Vasodilation
b. Contraction of skeletal muscle
pg 78
174
Cholinergic Receptors are NOT associated with?
a. Nervous system
b. Heart
c. Sweat glands
d. Parasympathetic target organs
a. Nervous system
pg 78
175
Which of the following is incorrect regarding functions of the Peripheral Adrenergic Receptor subtypes?
a. A1 is located in the bladder
b. A2 is located in nerve terminals
c. B1 is located in the heart and kidneys
d. B2 is located in the heart
d. B2 is located in the heart
pg 78
176
A2 receptors are located on nerve terminals, this can help reduce transmitter release when
a. too much transmitter has accumulated in the synaptic gap
b. too little transmitter has accumulated in the synaptic gap
c. too much dilation has occurred in the blood vessels
d. too little free fluid is available in the blood vessels
a. too much transmitter has accumulated in the synaptic gap
pg 80
177
Dopamine receptors are located in the kidney, activation results in (select all that apply)?
a. Dilation of renal blood vessels
b. Enhanced renal perfusion
c. Constriction of renal blood vessels
d. Decreased renal perfusion
a. Dilation of renal blood vessels
b. Enhanced renal perfusion
pg 80
178
8. Norepinephrine can interact with all of the following except?
a. Postsynaptic a1
b. B1
c. Presynaptic a2
d. B2
Answer: d, pg. 81
d. B2
179
9. Muscarinic agonist activation closely resembles those produced by stimulation of
a. Sympathetic nerves
b. Parasympathetic nerves
c. Skeletal nerves
d. Ocular nerves
b. Parasympathetic nerves
pg 83
180
10. Cholinesterase inhibitors are drugs that (select all that apply)?
a. Prevent breakdown of Ach
b. Increase the amount of Ach available
c. Are known as anticholinesterase drugs
d. Treat Myasthenia gravis, glaucoma and dementia
a. Prevent breakdown of Ach
b. Increase the amount of Ach available
c. Are known as anticholinesterase drugs
d. Treat Myasthenia gravis, glaucoma and dementia
Pg 86
181
What are the major underlying causes of heart failure?
a. Coronary Artery Disease
b. Chronic HTN and myocardial infarction
c. Aging of the myocardium
d. Congenital heart disease
b. Chronic HTN and myocardial infarction
Reasoning: While all are right answers, according to page 42, the major underlying cause is HTN and MI while the others are still factors, they are not the focus.
182
What is an important lab index of cardiac status?
a. Lipid Panel
b. CRP
c. BNP
d. CBC, CMP
c. BNP
Reasoning: The BNP can be a predictor of long-term survival. High levels of BNP indicate poor cardiac health and can predict a lower chance of survival according to page 326.
183
Of the NYHA scheme, summarize class III.
a. Marked limitation of physical activity: even mild activity produces symptoms
b. No limitation of ordinary physical activity
c. Slight limitation of physical activity: normal activity produces fatigue, dyspnea, palpitations, or angina
d. Symptoms occur at rest
a) Marked limitation of physical activity: even mild activity produces symptoms
Reasoning: Class III is A. Class I is B. Class II is C. Class IV is D
184
Of the ACC/AHA scheme, which is stage B?
a. Structural heart disease with prior or current symptoms of HF
b. Refractory HF requiring specialized interventions
c. Structural heart disease but without symptoms of HF
d. High risk for HF but without structural heart disease or symptoms of HF
c. Structural heart disease but without symptoms of HF
Reasoning: Stage A is D. Stage B is C. Stage C is A. Stage D is B.
185
What drug is associated with tumorigenesis in studies completed with rats?
a. Losartan
b. Captopril
c. Spironolactone
d. Eplerenone
c. Spironolactone
Reasoning: This drug is a black box warning on page 329. In the zoom, the black boxes were important to be noted for the exam.
186
In heart failure, is a thiazide diuretic appropriate to treat the patient?
a. No, because you see less potency from a thiazide diuretic than a loop diuretic
b. Yes, thiazide diuretics are the most appropriate treatment for HF patients
c. No, because thiazide diuretics are too potent and will cause too much fluid loss
d. Yes, you can treat a heart failure patient with a thiazide or a loop diuretic depending on their other pre-existing conditions
a) No, because you see less potency from a thiazide diuretic than a loop diuretic
Reasoning: Thiazide diuretics are much less potent than a loop diuretic. Our major concern with these patients is fluid overload. Loop diuretics are the most appropriate medication for HF patients.
187
What would you give a patient with HTN and a history of heart failure or an MI?
a. Thiazide diuretics
b. Loop diuretics
c. Betablocker
d. Potassium sparing diuretic
c. Betablocker
Reasoning: Thiazides are recommended first line for treatment of HTN, but a patient with HTN and a previous MI should not be given a thiazide. Guidelines say to give the betablocker. This is because with an MI, there is cardiac remodeling that happens after and MI and betablockers help to lessen the remodeling.
188
What is the biggest side effect of statins and the most important to educate the patient on when prescribing these medications?
a. Abdominal pain and bloating
b. Headache
c. Rash
d. Body aches and pains
d. Body aches and pains
Reasoning: Body aches and pains are the most common side effect of statins, although side effects are not commonly noted with statins, aches and pains are important to be noted. Educate the patient to report these symptoms, if experienced, to the provider.
189
What are the most important labs to monitor while taking statin drugs?
a. Liver panel/LFTs/cholesterol levels
b. Urine characteristics
c. Creatinine clearance
d. CK
a. Liver panel/LFTs/cholesterol levels
Reasoning: Guidelines state to monitor liver and LFTs specifically while taking statin drugs. Page 360.
190
When are statins contraindicated?
a. Pregnancy
b. Depression
c. Alcoholic hepatitis
d. Viral hepatitis
e. Acid reflux
f. A, C, and D
Answer: F: Pregnancy, alcoholic and viral hepatitis are contraindications according to page 360. There should be exercise caution in patients with fatty liver disease and with those taking fibrates or ezetimibe.
191
What functions does the autonomic nervous system have control over?
A) regulation of the heart
B) regulation of the secretory glands (salivary, gastric, sweat, and bronchial glands)
C) regulation of smooth muscles (muscles of the bronchi, blood vessels, urogenital system and
GI tract)
D) All of the above
D) All of the above
Reasoning: Pg. 103-104. The autonomic system is divided into parasympathetic and
sympathetic system and regulates these bodily functions depending on which system is being
activated.
192
What feedback loop of the autonomic nervous system is responsible for regulating
blood pressure?
A) Brachioradialis Reflex
B) Baroreceptor Reflex
C) Feedback Reflex
D) Effector Refelex
B) Baroreceptor Reflex
Reasoning: pg. 105. Baroreceptors are receptors that sense blood pressure.
193
Which neurotransmitter is released by all preganglionic neurons of the
parasympathetic nervous system, all preganglionic neurons of the sympathetic nervous system,
all postganglionic neurons of the pns, all motror neurons to skeletal muscles, and most
pogtganglionic neurons of the sympathetic nervous system that go to sweat glands?
A) Acetylcholine
B) Norepinephrine
C) Epinephrine
D) Dopamine
A) Acetylcholine
Reasoning: pg. 106
194
What neurotransmitter is primarily released by the adrenal medulla?
A) Epinephrine
B) Acetylcholine
C) Dopamine
D) Norepinephrine
A) Epinephrine
Reasoning: pg. 106. Epinephrine is the major transmitter released by the adrenal medulla.
(Also releases some norepinephrine.)
195
What neurotransmitter of the sympathetic nervous system primarily is released from
the postganglionic neuron that effects sweat glands?
A) Epinephrine
B) Acetylcholine
C) Dopamine
D) Norepinephrine
B) Acetylcholine
Reasoning: Pg. 106. Ach is the neurotransmitter released by most postganglionic neurons of the
sympathetic nervous system that go to sweat glands.
196
Question: __________ receptors are defined as receptors that mediate responses to Ach.
A) Cholinergic
B) Adrenergic
C) Both
D) Neither
A) Cholinergic
Reasoning: pg. 107
197
Question: ___________ receptors are defined as receptors that mediate response to
epinephrine and/or norepinephrine
A) Cholinergic
B) Adrenergic
C) Both
D) Neither
B) Adrenergic
Reasoning: Pg. 107
198
Question: NicotinicN, NicotinicM, an dmuscarinic are subtypes of which receptor?
A) Cholinergic
B) Adrenergic
C) Both
D) Neither
A) Cholinergic
Reasoning: pg. 107. These are the three major subtypes of Cholinergic receptors.
199
Alpha and beta subtype receptors are found on which of the following?
A) Postganglionic neuron of the sympathetic nervous system
B) postganglionic neuron of the parasympathetic nervous system
C) organs regulated by epinephrine released from the adrenal medulla
D) A & C
D) A & C
A) Postganglionic neuron of the sympathetic nervous system
C) organs regulated by epinephrine released from the adrenal medulla
Reasoning: See fig 12.5 on pg. 109
200
A1 receptors are located in
A) the eyes
B) blood vessels
C)bladder
D) all of the above
D) all of the above
Reasoning: A1 receptors are located in following places.
201
25-year old female presents to the ER with findings of macrocytes in her blood and megaloblasts in her bone marrow. What would be the best course of treatment?
a. IM dose of Vitamin B12 and folic acid
b. Oral B12 Vitamin
c. A large dose of folic acid PO
d. B and C
b. Oral B12 Vitamin
Reasoning: Pg. 394. These findings are consistent with moderate deficiency of B12 which can be managed by B12 alone. Severe deficiency would require IM injection of Vitamin B12 and folic acid, administration of 2-3 units of Packed RBCs, transfusion of platelets and therapy with antibiotics if infection has developed. A large dose of folic acid will help with reversing the hematologic effects of B12 deficiency but will not alleviate neurologic deficits. It can lead to undertreatment of B12 and permit neurologic damage to progress.
202
A patient presents with megaloblastic anemia, what type of deficiency could this be?
a. Folic Acid
b. Vitamin B12
c. Iron
d. A, B or both
e. All of the above
d. A, B or both
Reasoning: Pg 395 – When a patient presents with megaloblastic anemia, it is essential to determine whether the cause is deficiency of folic acid, vitamin B, or both.
203
The US preventative services task force now recommends that all women who may become pregnant consume
a. an increased amount of dairy with enhanced vitamin D
b. animal proteins
c. Supplemental folic acid each day in addition to the folate they get in food
d. fiber
c. Supplemental folic acid each day in addition to the folate they get in food
Reasoning pg 395 – Folic acid deficiency very early in pregnancy can cause neural tube defects. The folate you get from diet alone is not enough. It is recommended that all women who may become pregnant consume 400 – 800 ug of supplemental folic acid each day, in addition to the folate they get from food.
204
What enhances the absorption of iron?
a) food
b) Vitamin C
c) Dairy
d) all of the above
b) Vitamin C
Reasoning: Vitamin C will enhance the absorption of iron while food reduces the absorption of iron (ch47)
205
If the requirements of iron is determined by the rate of erythrocyte production, which patient population has the highest requirement for iron intake?
a) adult men due to body mass
b) adult women due to menstruation
c) pregnant women due to blood volume expansion
d) child due to blood volume expansion
c) pregnant women due to blood volume expansion
Reasoning: Pg 390 Pregnant women have the highest requirement for iron which they cannot obtain from diet alone.
206
In young children, what is the leading cause of poisoning fatalities?
a) Homicide
b) rat poison
c) iron containing products
d) household cleaning products
c) iron containing products
Reasoning: pg 392 – for children the lethal dose of elemental iron is 2g-10g
207
What supplements should be avoided during iron therapy?
a) folic acid
b) St. Johns wort
c) Vit C
d) Vitamin B12
e) A and D
Answer: e) A and D
a) folic acid
d) Vitamin B12
Reasoning: the use of oral iron should cease before iron injections are given. Combinations of iron with vit b12 or folic acid should also be avoided because it can confuse the interpretation of hematologic responses. Pg 392
208
What stages of RBC development does the RBC contain hemoglobin but is present in the bone marrow?
a) Proerythroblast
b) Erythrocyte
c) Erythroblast
d) Reticulocyte
c)Erythroblast
Reasoning: Pg. 390
A proerythroblast is the first stage with no hemoglobin and resides in the bone marrow. The second stage is the erythroblast that is present in the bone marrow and contains hemoglobin. The third stage is the reticulocyte which contains hemoglobin and is present in the blood. The fourth stage is erythrocytes that contains hemoglobin and is present in the blood.
209
What is the most significant adverse affect when taking Ferrous Sulfate?
a) syncopy
b) Gastrointestinal disturbances such as nausea, constipation, diarrhea, heartburn, and bloating
c) Neurological deficits such as neuropathy and slurred speech
d) lack of taste
b) Gastrointestinal disturbances such as nausea, constipation, diarrhea, heartburn, and bloating
Reasoning: Pg 391 The most significant adverse effects involve the GI tract
210
Select the true statement regarding Carbonyl Iron (Select all that apply)
a) Due to the microparticles, iron is absorbed more slowly, so the risk for toxicity is reduced.
b) You will need to prescribe a higher dosage in relation to Ferrous Sulfate
c) Carbonyl iron has a reduced risk to children in the event of an accidental ingestion
d) None of the above
a) Due to the microparticles, iron is absorbed more slowly, so the risk for toxicity is reduced.
c) Carbonyl iron has a reduced risk to children in the event of an accidental ingestion
Reasoning: Pg 392
Carbonyl Iron is absorbed more slowly therefore reducing the risk of a toxic overdose where an accidental ingestion occurs. You will need a higher dose of Carbonyl iron as opposed to Ferrous Sulfate to cause serious harm. The dose providing 100 mg of elemental iron for Ferrous Sulfate is 500mg and for Carbonyl Iron is 100mg.
