Quizzes 7-12 Flashcards
A patient who had type 2 diabetes mellitus will begin taking a bile acid sequestrant. Which bile acid sequestrant should the primary care NP order? Colesevelam (Welchol) Colestipol (Colestid) Cholestyramine (Questran) Cholestyramine (Questran Light)
-colesevelam (welchol)
A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFT were normal. At a 6-month follow-up visit, the patient reports occasional headache. A lipid profile reveals a decrease of 20% in the patient’s LDL cholesterol. The NP should:
order LFTs.
order CK-MM tests.
consider decreasing the dose of the medication.
reassure the patient that this side effect is common.
reassure the patient that this side effect is common
The primary care nurse practitioner (NP) sees a patient for a physical examination and orders laboratory tests that reveal low-density lipoprotein (LDL) of 100 mg/dL, high-density lipoprotein (HDL) of 30mg/dL, and triglycerides of 350 mg/dL. The patient has no previous history of coronary heart disease. The NP should consider prescribing:
ezetimibe (Zetia).
gemfibrozil (Lopid).
simvastatin (Zocor).
nicotinic acid (Niaspan).
-gemfibrozil (lopid)
A patient who has atrial fibrillation (AF) has been taking warfarin (coumadin). The primary care nurse practitioner (NP) plans to change the patient’s medication to dabigatran (Pradaxa). To do this safely, the NP should:
initiate dabigatran when the patient’s international normalized ratio (INR) is less than 2.
start dabigatran 7 to 14 days after discontinuing warfarin.
begin giving dabigatran 1 week before discontinuing warfarin.
order frequent monitoring of the patient’s INR after dabigatran therapy begins.
-initiate dabigatran when the patient’s international normalized ration (INR) is less than 2
A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use of the following anticoagulant medications?
Aspirin
Heparin
Dabigatran
Warfarin
-heparin
An 80-year old patient who has persistent AF takes warfarin (coumadin) for anticoagulation therapy. The patient has an INR of 3.5. The primary care NP should consider:
lowering the dose of warfarin.
rechecking the INR in 1 week.
omitting a dose and resuming at a lower dose.
omitting a dose and administering 1 mg of vitamin K.
-rechecking the INR in 1 week
Which of the following statements is true regarding unfractionated heparin (UFH) and low molecular weight heparin (LMWH): SATA
- LMWH has a longer half-life and increased bioavailability compared to UFH - the anticoagulant effect of heparin starts with its binding to antithrombin III - no effect on existing clots
- LMWH has a longer half-life and increased bioavailability compared to UFH
- the anticoagulant effect of heparin starts with its binding to antithrombin III
- no effect on existing clots
The mechanism of action of clopidogrel is by inhibiting the binding of ADP to its receptors on platelets and subsequent ADP-mediated activation of IIb/IIIa complex:
True/False
True
A patient comes to the clinic with a complaint of gradual onset of left-sided weakness. The primary care NP notes slurring of the patient’s speech. A family member accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago. The NP will activate the emergency medical system and expects to administer: 325 mg of chewable aspirin. LMWH. intravenous alteplase and aspirin. warfarin (Coumadin) and aspirin.
-325 mg of chewable aspirin
A patient who has disabling intermittent claudication is not a candidate for surgery. Which of the following medications should the primary care NP prescribe to treat this patient? Cilostazol (Pletal) Warfarin (Coumadin) Pentoxifylline (Trental) Low-dose, short-term aspirin
cilostazol (pletal)
A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the primary care NP about using a statin medication. The NP should:
-begin therapy with atorvastatin 10 mg per day
begin therapy with atorvastatin 10 mg per day
A patient who has diabetes is taking simvastatin (zocor) 80 mg daily to treat LDL cholesterol level of 170 mg/dl. The patient has a body mass index of 29. At a follow-up visit, the patient’s LDL level is 120 mg/dl. The primary care NP should consider:
increasing the simvastatin to 80 mg twice daily.
adding nicotinic acid to the patient’s drug regimen.
changing the medication to ezetimibe/simvastatin (Vytorin).
referring the patient to a dietitian for assistance with weight reduction.
changing the medication to ezetimibe/simvastatin (vytorin)
A primary care NP sees a 46-year old male patient and orders a fasting lipoprotein profile that reveals LDL of 190 mg/dl, HDL of 40 mg/dl, and triglycerides of 200 mg/dl. The patient has no previous history of coronary heart disease, but the patient’s father developed coronary heart disease at age 55 years. The NP should prescribe: atorvastatin (Lipitor). gemfibrozil (Lopid). cholestyramine (Questran). lovastatin/niacin (Advicor).
atorvastatin (Lipitor)
Which of the following statements is true regarding the RX product Vascepa (icosapent ethyl)? SATA
- it contains only EPA - it is used for lowering triglyceride levels
it contains only EPA
-it is used for lowering triglyceride levels
There is a boxed warning about stopping DOAC agents in AF patients because DOAC agents are short-acting and if stopped can quickly return patients to their risk of stroke before starting therapy.
True/False
-true
A male patient was released from the hospital after the placing of a coronary stent. The patient needs to be treated with an antiplatelet medication. After reviewing the drugs available with the NP, the patient shares with the NP that he has no insurance and that he recently lost his job. Based on the patient’s needs and current drugs available, which medication will the NP most likely prescribed?
-clopidogrel
-clopidogrel
Which of the following statements is true regarding the new oral anticoagulants Eliquis, Pradaxa, and Xarelto? SATA
- xarelto is the only one given once per day - eliquis leads to FEWER bleeds when compared to warfarin
- xarelto is the only one given once per day
- eliquis leads to FEWER bleeds when compared to warfarin
A 55-year-old African American patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s body
mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care
NP should order:
-A thiazide diuretic
-Dietary and lifestyles changes only
-An angiotensin-converting enzyme inhibitor
-A beta-blocker
-A thiazide diuretic
An 80-year-old male patient will begin taking an a-antiadrenergic medication. The primary care NP should teach this patient to:
- be aware that priapism is a common side effect.
- take the medication in the morning with food.
- restrict fluids to aid with diuresis.
- ask for assistance while bathing.
-ask for assistance while bathing
A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and learns that the
patient is taking a ß-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical examination, and performs a
review of systems. Which finding may warrant discontinuation of the B-blocker in this patient?
-Increased triglycerides
-Decreased exercise tolerance
-Wheezing, dyspnea, and cough
-Nausea, vomiting, and anorexia
Wheezing, dyspnea, and coughV
An 80-year-old patient has begun taking propranolol (Inderal) and reports feeling tired all of the time. The primary care NP
should:
-recommend that the patient take the medication at bedtime.
-tell the patient that tolerance to this side effect will occur over time.
-contact the patient’s cardiologist to discuss decreasing the dose of propranolol.
-tell the patient to stop taking the medication immediately.
contact the patient’s cardiologist to discuss decreasing the dose of propranolol
A patient will begin treatment with a beta-blocker. The patient wants to know about the most common side effects. The NP should educate the patient
and discuss the folowing: (SELECT ALL THAT APPLY)
-Fatigue
-Tachycardia
-Insomnia
-Sexual dysfunction
- Fatigue
- Insomnia
- Sexual dysfunction
A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and verapamil. The
patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil. The NP should tell the patient that
verapamil:
-improves blood flow and oxygen delivery to the heart.
-has a positive inotropic effect to increase cardiac output.
-increases the rate of cantraction of the cardiac muscle.
-increases the force of contraction of the cardiac muscle.
improves blood flow and oxygen delivery to the heart.
A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist
to discuss:
-Increasing the dose of nifedipine.
-evaluation of left ventricular function.
-ordering renal function tests.
-changing to amlodipine.
changing to amlodipine
Which of the following adverse effects are associated with calcium channel blockers? (SELECT ALL THAT APPLY)
- Dizziness
- Headache
- Hyperlipidemia
- Sedation
Dizziness
-Headache
Clinical studies have found that ACEIS are clinically proven to reduce total mortality by preventing deaths from progressive heart
failure. ACEIS should be given to all patients with symptomatic or asymptomatic heart failure because ACEIS: (SELECT ALL THAT
APPLY)
-Decrease renal blood flow
-Reverse ventricular remodeling
-Restore the heart to its normal elliptical shape
-Reduce ventricular dilation
- Reverse ventricular remodeling
- Restore the heart to its normal elliptical shape
- Reduce ventricular dilation
A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit. The patient reports having a persistent
cough. The NP should:
- consider changing the medication to an ARB.
- reassure the patient that tolerance to this adverse effect will develop over time.
- order a bronchodilator to counter the bronchospasm caused by this drug.
- ask whether the patient has had any associated facial swelling with this cough.
consider changing the medication to an ARB
A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:
- report wheezing and shortness of breath, which may occur with these drugs,
- discuss taking an increased dose of the thiazide diuretic with the cardiologist.
- minimize fuid intake for several days when beginning therapy with the ACE inhibitor.
- take care when getting out of bed or a chair after the first dose of the ACE Inhibitor.
take care when getting out of bed or a chair after the first dose of the ACE Inhibitor
Which of the following statements is true regarding the use of loop diuretics? (SELECT ALL THAT APPLY)
- May cause hyperkalemia
- May cause ototoxicity
- It is a potent diuretic that, if given in excessive amounts, may lead to profound losses of water and electrolyte depletion
- Loop diuretics relieve the congestive symptoms of pulmonary and peripheral edema
May cause ototoxicity
- It is a potent diuretic that, if given in excessive amounts, may lead to profound losses of water and electrolyte depletion
- Loop diuretics relieve the congestive symptoms of pulmonary and peripheral edema
The primary care NP is preparing to prescribe a diuretic for a patient who has heart failure, The patient reports having had an
allergic reaction to sulfamethoxazole-trimethoprim (Bactrim) previously. The NP should prescribe:
-furosemide (Lasix).
-ethacrynic acid.
-acetazolamide (Diamox).
-hydrochlorothiazide (HydroDIURIL).
ethacrynic acid
A patient with congestive heart failure will begin therapy with a diuretic medication. The primary care NP orders laboratory tests,
which reveal a glomerular filtration rate (GFR) of 25 mL/minute. The initial drug the NP should prcscribe is:
-hydrochlorothiazide (HydroDIURIL).
-metolazone.
-furosemide (Lasix).
-spironolactone (Aldactone).
metolazone
Mrs. Smith is a 43-year-old Caucasian female patient who presents to the clinic for a follow up appointment. She has diabetes and
hypertension and has been taking a thiazide diuretic for 6 months. Her blood pressure at the beginning of treatment was 155/95
mm Hg. The blood pressure today is 144/90 mm Hg. The NP should:
-continue the current drug regimen
-change to an aldasterone antagonist medication
-add an angiotensin-converting enzyme inhibitor
-order a Beta-blocker
add an angiotensin-converting enzyme inhibitor
A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular
systolic dysfunction. The primary care NP should expect this patient to be taking:
-carvedilol (Coreg).
-propranolol (Inderal).
-timolol (Blocadren).
-nadolol (Corgard).
carvedilol (Coreg
A patient who takes a calcium channel blocker is in the clinic for an annual physical examination. The cardiovascular examination
is normal. As part of routine monitoring for this patient, the primary care NP should evaluate:
-thyroid and insulin levels.
-complete blood count and electrolytes.
-liver function tests (LFTS) and renal function.
-serum calcium channel blocker level.
liver function tests (LFTS) and renal function
A patient who has stable angina is taking nitroglycerin and a B-blocker. The patient tells the primary care NP that the cardiologist is considering adding a calcium channel blocker. The NP should anticipate that the cardiologist will prescribe:
- nifedipine (Procardia XL).
- verapamil HCI (Calan).
- isradipine (DynaCirc).
- nicardipine (Cardene).
verapamil HCI (Calan).
A patient has been taking furosemide 80 mg once daily for 4 weeks and returns for a follow-up visit. The primary care NP notes a
blood pressure of 100/60 mm Hg. The patient’s lungs are clear, and there is no peripheral edema. The patient’s serum potassium
is 3.4 mEg/L. The NP should:
-change furosemide dose the 40 mg twice daily.
-increase furosemide to 80 mg twice daily.
-decrease furosemide to 60 mg once daily.
-continue furosemide at the current dose.
5 pts
decrease furosemide to 60 mg once daily
A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary
care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should:
-obtain a serum drug level.
-order an electrocardiogram (ECG) and serum electrolytes.
-change the medication to a thiazide diuretic.
-question the patient about potassium intake.
order an electrocardiogram (ECG) and serum electrolytes
A patient who has a history of angina has sublingual nitroglycerin tablets to use as needed. The primary care nurse practitioner (NP) reviews this medication with the patient at the patient’s annual physical examination. Which statement by the patient
indicates understanding of the medication?
“I should call 9-1-1 if chest pain persists 5 minutes after the first dose.”
“I should take 3 nitroglycerin tablets 5 minutes apart and then call 9-1-1.”
“I should take aspirin along with the nitroglycerin when I have chest pain.”
“I should take nitroglycerin and then rest for 15 minutes before taking the next dose.”
“I should call 9-1-1 if chest pain persists 5 minutes after the first dose
A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. NP should teach the patient to:
change the patch four times daily.
use the patch as needed for angina pain.
use two patches daily and change them every 12 hours.
apply one patch daily in the morning and remove in 12 hours.
apply one patch daily in the morning and remove in 12 hours.
A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The NP should consult a cardiologist to discuss prescribing a(n):
B-blocker.
A loop diuretic.
An angiotensin-converting enzyme (ACE) inhibitor.
An angiotensin receptor blocker (ARB).
A loop diuretic.
A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient's cardiologist has added digoxin to the patient's medication regimen. The primary care NP who cares for this patient should expect to monitor: serum electrolytes. blood glucose levels. serum thyroid levels. complete blood counts (CBCs).
serum electrolytes.
A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The primary care NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 µg/mL. The NP should:
discontinue the medication immediately.
reassure the patient that this is a therapeutic drug level.
order an ECG, CBC, liver function tests (LFTS), and renal function tests.
admit the patient to the hospital and obtain a cardiology consultation.
order an ECG, CBC, liver function tests (LFTS), and renal function tests.
The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to:
drink extra fluids when exercising.
reduce stress with yoga and hot baths.
ask the cardiologist about an implantable defibrillator.
ask the cardiologist about adding procainamide to the drug regimen.
drink extra fluids when exercising.
Which of the following statements is true regarding the mechanism of action of digoxin in the treatment of HF? (SELECT ALL THAT APPLY)
has an inotropic effect on cardiac cells
produces a decreased force of contraction of the cardiac muscle
increases CO and produces mild diuresis, helping to relieve symptoms
It is most effective in HF caused by decreased left ventricular function and other low-output syndromes.
has an inotropic effect on cardiac cells
increases CO and produces mild diuresis, helping to relieve symptoms
It is most effective in HF caused by decreased left ventricular function and other low-output syndromes.
Which of the following drugs can exacerbate HF and should be avoided, when possible? (SELECT ALL THAT APPLY): ibuprofen lisinopril pioglitazone Furosemide
ibuprofen
pioglitazone
Which of the following statements is true regarding the use of organic nitrates?
ensure a nitrate-free interval to prevent tolerance
produce vascular smooth muscle relaxation
are contraindicated with PDES inhibitors (sildenafil and others)
Only first and second statements are correct
All of the above statements are correct
All of the above statements are correct
