Cardiac Drugs Questions

Part I
A patient who is recovering from a STEMI 3 months prior is in the clinic
for a follow-up evaluation. The patient is taking 81 mg of aspirin, a
beta blocker, and an ACE inhibitor daily and uses nitroglycerine as
needed for angina. The patient’s BMI is 24.5 kg/m2, and serum LDL is
150 mg/dL. The patient has a blood pressure of 135/80 mm Hg. What
will the nurse expect the provider to order for this patient?

a. An antihypertensive medication
b. Counseling about a weight loss diet
c. Discontinuing the ACE inhibitor
d. High-dose statin therapy
e. Answer: D
f. To help prevent recurrence of MI in patients post-STEMI, a high-
dose statin should be given to patients with elevated cholesterol.
This patient’s blood pressure and BMI are normal, so
antihypertensives and a weight loss diet are not recommended.
The three drugs should be continued indefinitely.
A patient has undergone a PCI, and the provider
orders clopidogrel to be given for 12 months, along
with an ACE inhibitor and heparin. What will the
nurse do?

a. Question the need for heparin.

b. Request an order for a beta blocker.
c. Request an order for aspirin.
d. Suggest ordering clopidogrel for 14 days.
Answer: C
Patients who have undergone a PCI should receive heparin, ASA, and a fibrinolytic; therefore, this
patient needs ASA added to the drug regimen. Heparin should be given before, during, and for at least
48 to 72 hours after the procedure. Beta blockers are not necessarily indicated. Clopidogrel should be
given at least 12 months after the procedure.
A patient takes an ACE inhibitor to treat hypertension and tells the
nurse that she wants to become pregnant. She asks whether she
should continue taking the medication while she is pregnant. What will
the nurse tell her?

a. Controlling her blood pressure will decrease her risk of

preeclampsia.
b. Ask the provider about changing to an ARB during pregnancy.
c. Continue taking the ACE inhibitor during her pregnancy.
d. Discuss using methyldopa instead while she is pregnant.
e. Answer: D
f. Methyldopa has limited effects on uteroplacental and fetal
hemodynamics and does not adversely affect the fetus or
neonate. Controlling blood pressure does not lower the risk of
preeclampsia. ACE inhibitors and ARBs are specifically
contraindicated during pregnancy
A patient with a recent onset of nephrosclerosis has been taking an ACE
inhibitor and a thiazide diuretic. The patient’s initial blood pressure was
148/100 mm Hg. After 1 month of drug therapy, the patient’s blood pressure
is 130/90 mm Hg. The nurse will contact the provider to discuss:
a. adding a calcium channel blocker to this patient’s drug regimen.
b. lowering doses of the antihypertensive medications.
c. ordering a high-potassium diet.
d. adding spironolactone to the drug regimen.
• Answer: A
• In patients with renal disease, the goal of antihypertensive
therapy is to lower the blood pressure to 130/80 mm Hg or
less. Adding a third medication is often indicated. Lowering
the dose of the medications is not indicated because the
patient’s blood pressure is not in the target range. Adding
potassium to the diet and using a potassium-sparing
diuretic are contraindicated.
A patient who has been taking an antihypertensive medication for several years is
recovering from a myocardial infarction. The prescriber changes the patient’s
medication to an ACE inhibitor. The patient asks the nurse why a new drug is
necessary. What is the nurse’s response?

a. “ACE inhibitors can prevent or reverse pathologic changes in the heart’s

structure.”
b. “ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol.”
c. “ACE inhibitors increase venous return to the heart, improving cardiac output.”
d. “ACE inhibitors regulate electrolytes that affect the cardiac rhythm.”
• Answer: A
• ACE inhibitors have many advantages over other antihypertensive
medications, the most important of which is their ability to prevent
or reverse pathologic changes in the heart and reduce the risk of
cardiac mortality caused by hypertension. They are useful in
patients with high low-density lipoprotein (LDL) or low high-density
lipoprotein (HDL) cholesterol, but they do not directly affect this
comorbidity. They reduce venous return to the heart, thereby
reducing right heart size. They do not alter serum electrolyte levels.
A nurse administers an ACE inhibitor to a patient who is taking the
drug for the first time. What will the nurse do?

a. Instruct the patient not to get up without assistance.

b. Make sure the patient takes a potassium supplement.
c. Report the presence of a dry cough to the prescriber.
d. Request an order for a diuretic to counter the side effects of the
ACE inhibitor.
• Answer: A
• Severe hypotension can result with the first dose of an ACE
inhibitor. The patient should be discouraged from getting up
without assistance. Potassium supplements are contraindicated. A
dry cough is an expected side effect that eventually may cause a
patient to discontinue the drug; however, it is not a contraindication
to treatment. Diuretics can exacerbate hypotension and should be
discontinued temporarily when a patient starts an ACE inhibitor.
A patient begins taking an ACE inhibitor and complains of a dry cough.
What does the nurse correctly tell the patient about this symptom?

a. It indicates that a serious side effect has occurred.

b. It is a common side effect that occurs in almost all patients taking
the drug.
c. It may be uncomfortable enough that the drug will need to be
discontinued.
d. It occurs frequently in patients taking the drug but will subside
over time.
• Answer: C
• A cough occurs in about 10% of patients taking ACE inhibitors and is
the most common reason for discontinuing therapy. It does not
indicate a serious condition. It occurs in about 10% of all patients
and is more common in women, older adults, and those of Asian
ancestry. It does not subside until the medication is discontinued.
A female patient taking an ACE inhibitor learns that she is pregnant. What will
the nurse tell this patient?

a. The fetus most likely will have serious congenital defects.

b. The fetus must be monitored closely while the patient is taking this drug.
c. The patient’s prescriber probably will change her medication to an ARB.
d. The patient should stop taking the medication and contact her provider
immediately.
• Answer: D
• ACE inhibitors are known to cause serious fetal injury during the second
and third trimesters of pregnancy. Whether injury occurs earlier in
pregnancy is unknown, and the incidence probably is low. However,
women should be counseled to stop taking the drug if they become
pregnant, and they should not take it if they are contemplating becoming
pregnant. Women who take ACE inhibitors in the first trimester should be
counseled that the risk to the fetus is probably low. Women should stop
taking the drug when pregnant. ARBs carry the same risk as ACE inhibitors.
A nurse is caring for a patient prescribed doxazosin
[Cardura] for hypertension. Safety is a priority because of
which associated adverse effect?

a. Reflex tachycardia
b. Heart palpitations
c. Cardiac dysrhythmias
d. Orthostatic hypotension
• Answer: D
• Doxazosin is an alpha1 blocker and can cause
orthostatic hypotension. Common symptoms include
dizziness or lightheadedness on standing, which may
impair the patient's balance and increase the risk of a
fall
A patient with heart failure has developed a cough while taking an
angiotensin-converting enzyme (ACE) inhibitor. The health care provider
discontinued the ACE inhibitor and prescribed an angiotensin II receptor
blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to
have symptoms of heart failure despite using an ARB. Which medication
should the nurse anticipate will be prescribed?

a. Eplerenone [Inspra]
b. Triamterene [Dyrenium]
c. Hydrochlorothiazide [Microzide]
d. BiDil [Isosorbide Dinitrate and Hydralazine]
• Answer: D
• BiDil is a fixed-dose combination of isosorbide dinitrate plus hydralazine
and it can be used for patients who cannot tolerate ACE inhibitors or ARBs.
BiDil is approved specifically for treating heart failure in blacks.
• Answer: D
• BiDil is a fixed-dose combination of isosorbide dinitrate plus hydralazine
and it can be used for patients who cannot tolerate ACE inhibitors or ARBs.
BiDil is approved specifically for treating heart failure in blacks
A patient has heart failure and is taking an ACE inhibitor. The patient
has developed fibrotic changes in the heart and vessels. The nurse
expects the provider to order which medication to counter this
development?

a. Aldosterone antagonist
b. Angiotensin II receptor blocker (ARB)
c. Beta blocker
d. Direct renin inhibitor (DRI)
• Answer: A
• Aldosterone antagonists are added to therapy for patients with
worsening symptoms of HF. Aldosterone promotes myocardial
remodeling and myocardial fibrosis, so aldosterone antagonists can
help with this symptom. ARBs are given for patients who do not
tolerate ACE inhibitors. Beta blockers do not prevent fibrotic
changes. DRIs are not widely used.
A patient with Stage C heart failure (HF) who has been taking
an ACE inhibitor, a beta blocker, and a diuretic begins to have
increased dyspnea, weight gain, and decreased urine output.
The provider orders spironolactone [Aldactone]. The nurse
will instruct the patient to:

a. avoid potassium supplements.

b. monitor for a decreased heart rate.
c. take extra fluids.
d. use a salt substitute instead of salt.
• Answer: A
• Spironolactone is added to therapy for patients with
worsening symptoms of HF. Because spironolactone is a
potassium-sparing diuretic, patients should not take
supplemental potassium. Patients taking digoxin need to
monitor their heart rate. Extra fluids are not indicated. Salt
substitutes contain potassium.
A patient with heart failure who has been taking an ACE inhibitor, a
thiazide diuretic, and a beta blocker for several months comes to the
clinic for evaluation. As part of the ongoing assessment of this patient,
the nurse will expect the provider to evaluate:

a. complete blood count.

b. ejection fraction.
c. maximal exercise capacity.
d. serum electrolyte levels.
• Answer: D
• Patients taking thiazide diuretics can develop hypokalemia, which
can increase the risk for dysrhythmias; therefore, the serum
electrolyte levels should be monitored closely. A complete blood
count is not recommended. This patient is taking the drugs
recommended for patients with Stage C heart failure; although the
patient’s quality of life and ability to participate in activities should
be monitored, routine measurement of the ejection fraction and
maximal exercise capacity is not recommended.
A patient is prescribed lisinopril [Prinvil] as part of the
treatment plan for heart failure. Which finding indicates the
patient is experiencing the therapeutic effect of this drug?

a. + 2 edema of the lower extremities

b. Potassium level of 3.5 mEq/L
c. Crackles in the lungs are no longer heard
d. Jugular vein distention
• Answer: C
• Because ACE inhibitors promote venous dilation, they
provide the therapeutic effect of reducing pulmonary
congestion and peripheral edema. Absence of previously
heard crackles would be an indicator of effectiveness.
Edema and jugular vein distention are manifestations of
heart failure. A potassium level of 3.5 mEq/L is a normal
value.
The nurse should monitor for which adverse effect after
administering hydrochlorothiazide [HydroDIURIL] and
digoxin [Lanoxin] to a patient?

a. Digoxin toxicity
b. Decreased diuretic effect
c. Dehydration
d. Heart failure
• Answer: A
• Digoxin levels have an inverse relationship with
potassium levels. Because hydrochlorothiazide can
lower potassium levels, combined use of
hydrochlorothiazide and digoxin poses a risk for
elevated digoxin levels and ensuing digoxin toxicity.
A patient with hypertension with a blood pressure of 168/110 mm Hg begins
taking hydrochlorothiazide and verapamil. The patient returns to the clinic
after 2 weeks of drug therapy, and the nurse notes a blood pressure of
140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse
do?

a. Notify the provider and ask about adding a beta blocker medication.
b. Reassure the patient that the medications are working.
c. Remind the patient to move slowly from sitting to standing.
d. Request an order for an electrocardiogram.
• Answer: A
• Beta blockers are often added to drug regimens to treat reflex tachycardia,
which is a common side effect of lowering blood pressure, caused by the
baroreceptor reflex. The patient’s blood pressure is responding to the
medications, but the tachycardia warrants treatment. Reminding the
patient to move slowly from sitting to standing is appropriate with any
blood pressure medication, but this patient has reflex tachycardia, which
must be treated. An electrocardiogram is not indicated.
An older adult patient with congestive heart failure develops crackles
in both lungs and pitting edema of all extremities. The physician orders
hydrochlorothiazide [HydroDIURIL]. Before administering this
medication, the nurse reviews the patient’s chart. Which laboratory
value causes the nurse 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
• Beta blockers are often added to drug regimens to treat reflex
tachycardia, which is a common side effect of lowering blood
pressure, caused by the baroreceptor reflex. The patient’s blood
pressure is responding to the medications, but the tachycardia
warrants treatment. Reminding the patient to move slowly from
sitting to standing is appropriate with any blood pressure
medication, but this patient has reflex tachycardia, which must be
treated. An electrocardiogram is not indicated.
The nurse is teaching a patient about the side effects associated with
doxazosin [Cardura]. Which statement by the patient indicates an
understanding of the nurse's instructions?

a. "I may experience an increase in hair growth as a side effect."

b. "I'll notify the healthcare provider if I develop a persistent cough."
c. "I'll make sure I include extra sources of potassium in my diet,
such as bananas and baked potatoes."
d. "When getting out of bed in the morning, I will sit on the side of
the bed for several minutes before standing."
• Answer: D
• The most disturbing side effect of alpha blockers, such as doxazosin,
is orthostatic hypotension, because it can affect the patient's safety.
Patients should change positions slowly and carefully. Excessive hair
growth is a side effect of minoxidil. Persistent cough is an adverse
effect of ACE inhibitors. Hypokalemia is a side effect of thiazide and
loop diuretics, so additional sources of potassium should be
incorporated into the diet.
A patient with a history of benign prostatic hyperplasia is
admitted to the unit. The patient is taking multiple
medications, including terazosin [Hytrin]. During the evening
rounds, the patient begins to complain of dizziness and nasal
congestion. Upon assessment, the patient is somnolent and
has a blood pressure of 101/42 mm Hg. The nurse is correct to
suspect:
a. priapism.
b. sinus infection.
c. allergic reaction.
d. adverse effects.
• Answer: D
• The principal adverse effects of terazosin and doxazosin are
hypotension, fainting, dizziness, somnolence, and nasal
congestion. No evidence indicates priapism, sinus infection,
or an allergic reaction.
Prior to discharge, the nurse provides teaching related to
adverse effects of terazosin [Hytrin] to the patient and
caregivers. Which adverse effects should the nurse
include in the teaching of this drug? (Select all that
apply.)
a. Headache
b. Hypoglycemia
c. Nasal congestion
d. Erectile dysfunction
e. Orthostatic hypotension
• Answer: A, C, D, E
• Terazosin adverse effects include nasal congestion,
inhibition of ejaculation, and orthostatic hypotension.
In addition, terazosin is associated with a high
incidence (16%) of headache
Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with
erectile dysfunction. The patient also takes prazosin [Minipress]
for hypertension. Which statement by the patient best
demonstrates understanding of the use of tadalafil [Cialis]?
a. “I can take this up to 2 times a day, just before intercourse.”
b. “I have a little renal trouble, so I should take a higher dose.”
c. “I should take this medication with food.”
d. “I should take this medication no more than once a day.”
• Answer: D
• Tadalafil should be taken no more than once a day and
without regard to meals. Tadalafil has a half-life of 17.5
hours and should not be taken twice a day. Men with
moderate renal or hepatic insufficiency should take a
reduced dosage. This patient may be confusing the
actions of tadalafil and prazosin.
A patient is to be discharged home with a new prescription for
prazosin [Minipress]. Which statement is most important for the nurse
to include in the teaching plan?
a. "You should increase your intake of fresh fruits and vegetables."
b. "You should move slowly from a sitting to a standing position."
c. "Be sure to wear a Medic Alert bracelet while taking this
medication."
d. "Take your first dose of this medication first thing in the morning."
• Answer: B
• Orthostatic hypotension is the most serious adverse effect of
prazosin and other alpha1 blockers. Patients should be taught to
move slowly when changing from a supine or sitting position to an
upright position to avoid dizziness and prevent falls. Fresh fruits and
vegetables are good to include in the dietary teaching, but this is
not as important as preventing hypotension. A Medic Alert bracelet
should not be needed for this drug. This drug causes significant
first-dose hypotension. The initial dose should be taken at bedtime.
Patients should avoid driving and other hazardous activities for 12
to 24 hours after the first dose.
The nurse is teaching the patient about atenolol [Tenormin].
Which statement by the patient indicates a correct
understanding of the nurse's instruction?
a. "I will need to wait for 6 months and then stop this
medication."
b. "One missed dose will not affect my blood pressure."
c. "I may experience occasional chest pain and discomfort."
d. "I will not stop taking this drug without the approval of my
healthcare provider."
• Answer: D
• Atenolol is a beta blocker and can cause rebound cardiac
excitation if withdrawn abruptly. To decrease the risk of
rebound excitation the dose should be tapered over 1 or 2
weeks. Patients should carry an adequate supply when
traveling.
The nurse is preparing to administer diltiazem and
atenolol. What is the priority nursing intervention before
administering these two medications to the patient?

a. Obtain blood glucose

b. Observe for lower leg edema
c. Assess the heart rate
d. Apply a pulse oximeter
• Answer: C
• The cardiac effects of diltiazem and atenolol are the
same. Both reduce heart rate, suppress AV conduction,
and suppress myocardial contractility. When these
drugs are administered together, excessive
cardiosuppression may result.
Which assessment should a nurse monitor more frequently in
a patient who takes both an alpha blocker for BPH and
metoprolol [Lopressor]?

a. Blood glucose level

b. Hemoglobin level
c. Blood pressure
d. Urine output
• Answer: C
• Caution must be exercised in combining an alpha blocker
(terazosin [Hytrin], doxazosin [Cardura], Tamsulosin
[Flomax], alfuzosin [Uroxatral]) with an antihypertensive
medication such as metoprolol, because severe
hypotension could result. Blood glucose, hemoglobin, and
urine output are not affected by combining an alpha
blocker and a hypertensive medication.
A patient begins taking nifedipine [Procardia], along with
metoprolol, to treat hypertension. The nurse understands
that metoprolol is used to:

a. reduce flushing.
b. minimize gingival hyperplasia.
c. prevent constipation.
d. prevent reflex tachycardia.
• Answer: D
• Beta blockers are combined with nifedipine to prevent
reflex tachycardia. Beta blockers do not reduce
flushing, minimize gingival hyperplasia, or prevent
constipation. Beta blockers can reduce the adverse
cardiac effects of nifedipine.
Why does the nurse anticipate administering metoprolol
[Lopressor] rather than propranolol [Inderal] for diabetic
patients who need a beta-blocking agent?

a. Metoprolol is less likely to cause diabetic nephropathy.

b. Propranolol causes both beta1 and beta2 blockade.
c. Metoprolol helps prevent retinopathy in individuals with
diabetes.
d. Propranolol is associated with a higher incidence of foot
ulcers.
• Answer: B
• Metoprolol is a second-generation beta blocker and as such
is more selective. At therapeutic doses, it causes less
bronchoconstriction and suppression of glycogenolysis,
which can cause problems in diabetic patients. Propranolol
blocks both beta1 and beta2 receptors.
A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A
nurse notes that the patient is also taking metoprolol [Lopressor]. What
education should the nurse provide to the patient?

a. “Metoprolol has no effect on diabetes mellitus or on your insulin

requirements.”
b. “Metoprolol interferes with the effects of insulin, so you may need to
increase your insulin dose.”
c. “Metoprolol may mask signs of hypoglycemia, so you need to monitor
your blood glucose closely.”
d. “Metoprolol may potentiate the effects of the insulin, so the dose should
be reduced.”
• Answer: C
• Because metoprolol may mask the signs of hypoglycemia, the patient
should monitor the blood glucose closely and report changes to the
prescriber. Metoprolol does have an indirect effect on diabetes mellitus
and/or insulin requirements in that it may mask the signs of hypoglycemia,
causing the patient to make a healthcare decision based on the drug-to-
drug interaction rather than actual physiologic factors. The patient should
not increase the insulin, because metoprolol will cause a decrease in
blood glucose, increasing the risk of a hypoglycemic reaction. The patient
should not reduce the dose of insulin when taking metoprolol, because
this might alter serum glucose levels.
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.”
• Answer: A
• Beta blockers reduce the release of renin by blockade of
beta1 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 resistance, and decrease the
release of renin.
A patient taking a beta blocker complains of shortness of breath. The
patient has respirations of 28 breaths per minute, a blood pressure of
162/90 mm Hg, and a pulse of 88 beats per minute. The nurse
auscultates crackles in all lung fields. The nurse understands that these
assessments are consistent with:
a. bronchoconstriction.
b. left-sided heart failure.
c. rebound cardiac excitation.
d. sinus bradycardia.
• Answer: B
• The signs and symptoms describe left-sided heart failure, in which
the blood normally handled by the left ventricle and forced out
through the aorta into the body backs up into the lungs, producing
respiratory signs and symptoms. The patient’s signs and symptoms
are not indicative of bronchoconstriction, which would cause
wheezing and diminished breath sounds. Rebound cardiac
excitation occurs when the beta blocker is withdrawn, not during
administration of the drug. The patient’s heart rate is elevated, so
sinus bradycardia is not present.
Which are conditions that may be treated using
beta blockers? (Select all that apply.)

a. Cardiac dysrhythmias
b. Heart failure
c. Hypotension
d. Hypothyroidism
e. Stage fright
• Answer: A, B, E
• Beta blockers are used to treat cardiac
dysrhythmias, heart failure, and stage fright. They
are used to treat hypertension and
hyperthyroidism.
A patient with migraines is started on a beta blocker. The
nurse explains the benefits of taking the medication for
migraines. Which statement by the patient indicates an
understanding of the medication’s effects?
a. “I need to take it every day to reduce the frequency of
migraines.”
b. “I will take it as needed to get relief from migraines.”
c. “I will take it to shorten the duration of my migraines.”
d. “I will take this drug when a migraine starts.”
• Answer: A
• When taken prophylactically, beta blockers can reduce the
frequency of migraine attacks. Beta blockers do not provide
complete relief from migraines. They do not reduce the
duration of migraines. They are not effective for treating a
migraine once the migraine has begun.
A patient with stable exertional angina has been receiving a beta
blocker. Before giving the drug, the nurse notes a resting heart rate of
55 beats per minute. Which is an appropriate nursing action?
a. Administer the drug as ordered, because this is a desired effect.
b. Withhold the dose and notify the provider of the heart rate.
c. Request an order for a lower dose of the medication.
d. Request an order to change to another antianginal medication.
• Answer: A
• When beta blockers are used for anginal pain, the dosing goal is to
reduce the resting heart rate to 50 to 60 beats per minute. Because
this heart rate is a desired effect, there is no need to withhold the
dose or notify the provider. The dosage does not need to be
lowered, because a heart rate of 55 beats per minute is a desired
effect. There is no indication of a need to change medications for
this patient.
A nursing student asks a nurse how beta blockers increase the
oxygen supply to the heart in the treatment of anginal pain.
The nurse tells the student that beta blockers:
a. dilate arterioles to improve myocardial circulation.
b. improve cardiac contractility, which makes the heart more
efficient.
c. increase arterial pressure to improve cardiac afterload.
d. increase the time the heart is in diastole.
• Answer: D
• Beta blockers increase the time the heart is in diastole,
which increases the time during which blood flows through
the myocardial vessels, allowing more oxygen to reach the
heart. Beta blockers do not dilate arterioles. They do not
increase cardiac contractility; they decrease it, which
reduces the cardiac oxygen demand. They do not increase
arterial pressure, which would increase the cardiac oxygen
demand.
A patient with variant angina wants to know why a beta blocker cannot
be used to treat the angina. Which response by the nurse is correct?
a. “A beta1-selective beta blocker could be used for variant angina.”
b. “Beta blockers do not help relax coronary artery spasm.”
c. “Beta blockers do not help to improve the cardiac oxygen supply.”
d. “Beta blockers promote constriction of arterial smooth muscle.”
• Answer: B
• Variant angina occurs when coronary arteries go into spasm, thus
reducing the circulation and oxygen supply to the heart. CCBs help
to reduce coronary artery spasm; beta blockers do not. Beta1-
selective beta blockers are used for stable angina for patients who
also have asthma, because they do not activate beta2 receptors in
the lungs to cause bronchoconstriction. Beta blockers help improve
the oxygen supply in stable angina, but they do not relieve coronary
artery spasm, so they are not useful in variant angina. Beta blockers
do not constrict arterial smooth muscle.
The nurse is assessing a patient in a clinic who has been
taking clonidine [Catapres] for hypertension. Which
clinical findings are most indicative of an adverse effect of
this drug?

a. Cough and wheezing

b. Epigastric pain and diarrhea
c. Drowsiness and dry mouth
d. Positive Coombs' test result and anemia
• Answer: A
• Rebound hypertension is a potential adverse effect of
clonidine. Patients should be warned against abrupt
withdrawal. Clonidine is not associated with anemia. It
can cause drowsiness and usually is taken at night.
Clonidine is not recommended for pregnant patients.
Which statement is most appropriate for the nurse to include
in the discharge teaching plan for a 30-year-old woman
beginning a new prescription of clonidine [Catapres]?
a. "If you stop taking this drug abruptly, your blood pressure
might go up very high."
b. "You will need to have your blood drawn regularly to
check for anemia."
c. "Take this medication first thing in the morning to reduce
nighttime wakefulness."
d. "This medication often is used to manage hypertension
during pregnancy."
• Answer: A
• Rebound hypertension is a potential adverse effect of
clonidine. Patients should be warned against abrupt
withdrawal. Clonidine is not associated with anemia. It can
cause drowsiness and usually is taken at night. Clonidine is
not recommended for pregnant patients.
The nurse is preparing to administer a dose of clonidine [Catapres].
Which is the best description of the action of this drug?

a. It selectively activates alpha2 receptors in the central nervous

system (CNS).
b. It causes peripheral activation of alpha1 and alpha2 receptors.
c. It depletes sympathetic neurons of norepinephrine.
d. It directly blocks alpha and beta receptors in the periphery.
• Answer: A
• Clonidine is an alpha2-adrenergic agonist that causes selective
activation of alpha2 receptors in the CNS. This in turn reduces
sympathetic outflow to the blood vessels and the heart. Although
the body's responses are similar to those from a peripheral
adrenergic blocker, clonidine's action occurs in the CNS.
The nurse is evaluating the teaching done with a patient who
has a new prescription for transdermal clonidine [Catapres-
TTS]. Which statement by the patient indicates understanding
of the nurse's teaching?

a. "I will apply the patch to a hairless, intact skin area on my

upper arm."
b. "I need to apply the patch before my evening meal."
c. "The patch will not cause any skin reaction."
d. "I will need to apply a new patch once every 3 to 4 days."
• Answer: A
• For a transdermal clonidine patch the patient is instructed
to apply the patch to hairless, intact skin on the upper arm
or torso, and to apply a new patch every 7 days. Localized
skin reactions are common with transdermal clonidine
patches.
A patient is taking clonidine for hypertension 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.
• Answer: C
• 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. Discontinuing clonidine abruptly can
cause severe rebound hypertension. These are common side effects
that do not abate over time.
A provider orders clonidine [Catapres] for a patient withdrawing from
opioids. When explaining the rationale for this drug choice, the nurse
will tell this patient that clonidine [Catapres] is used to:
a. prevent opioid craving.
b. reduce somnolence and drowsiness.
c. relieve symptoms of nausea, vomiting, and diarrhea.
d. stimulate autonomic activity.
• Answer: C
• When administered to an individual physically dependent on
opioids, clonidine can suppress some symptoms of abstinence.
Clonidine is most effective against symptoms related to autonomic
hyperactivity, including nausea, vomiting, and diarrhea. Clonidine
does not stimulate autonomic activity; it is effective against
symptoms of autonomic hyperactivity. Clonidine does not reduce
somnolence and drowsiness. Clonidine does not prevent opioid
craving.
A patient complains to the nurse that the clonidine [Catapres] recently
prescribed for hypertension is causing drowsiness. Which response by the
nurse to this concern is appropriate?
a. “Drowsiness is a common side effect initially, but it will lessen with
time.”
b. “You may also experience orthostatic hypotension along with the
drowsiness.”
c. “You may be at risk for addiction if you have central nervous system side
effects.”
d. “You should discontinue the medication and contact your prescriber.”
• Answer: A
• CNS depression, evidenced in this patient by drowsiness, is common in
about 35% of the population. These responses become less intense with
continued drug use. Orthostatic hypotension is less likely with clonidine,
because its antihypertensive effects are not posture dependent. The
experience of drowsiness does not indicate abuse potential. The patient
should not discontinue the medication abruptly because of the potential
for rebound hypertension; the patient should contact the prescriber
before stopping the medication.
Clonidine is approved for the treatment of which
conditions? (Select all that apply.)

a. ADHD
b. Hypertension
c. Opioid withdrawal
d. Severe pain
e. Smoking cessation
• Answer: A, B, D
• Clonidine has three approved uses: treatment of
ADHD, hypertension, and severe pain. It has
investigational uses for management of opioid
withdrawal and for smoking cessation
A prescriber orders transdermal clonidine [Catapres TTS] for a patient
with hypertension. What will the nurse teach this patient?

a. That medication given by transdermal patch has fewer systemic

side effects
b. That localized skin reactions are uncommon
c. To apply the patch to intact skin on the forearm or leg
d. To change the patch every week
• Answer: D
• Transdermal patches are to be changed every 7 days. Medication
administered by patch has the same therapeutic effect and adverse
effects as that given by other routes, except that localized skin
reactions may occur and are common with clonidine patches. The
patch should be applied to intact, hairless skin on the upper arm or
torso.
A prescriber orders clonidine [Kapvay] ER tablets for
a 12-year-old child. The nurse understands that this
drug is being given to treat which condition?

a. ADHD
b. Hypertension
c. Severe pain
d. Tourette’s syndrome
• Answer: A
• Kapvay ER is used to treat ADHD and is given as a
single dose at bedtime. This form of clonidine is
not used for hypertension, severe pain, or
treatment of Tourette’s syndrome
A prescriber has ordered clonidine [Catapres] for a patient who has hypertension. The
nurse teaches the patient about side effects of this drug. Which statement by the
patient indicates understanding of the teaching?
a. “I should chew sugar-free gum or drink water to reduce dry mouth.”
b. “I should not drive as long as I am taking this drug.”
c. “I should stand up slowly when taking this medication.”
d. “I should stop taking this drug if I feel anxious or depressed.”
• Answer: A
• Xerostomia is a common side effect of clonidine and is often uncomfortable
enough that patients stop using the drug. Counseling patients to chew sugar-free
gum and take frequent sips of liquid can help alleviate this discomfort. Drowsiness
is common, but this side effect becomes less intense over time. Patients should be
counseled to avoid hazardous activities in the first weeks of therapy if they feel
this effect. The hypertensive effects of clonidine are not posture dependent, as
they are with the peripheral alpha-adrenergic blockers, so orthostatic hypotension
is minimal with this drug. Clonidine causes euphoria, hallucinations, and sedation
in high doses and can cause anxiety or depression, although the last two effects
are less common. The drug should not be stopped abruptly because of the risk of
rebound hypertension, so patients experiencing unpleasant central nervous
system (CNS) effects should consult their provider about withdrawing the
medication slowly.
A patient who has been taking clonidine [Catapres] for several weeks
complains of drowsiness and constipation. What will the nurse do?

a. Recommend that the patient take most of the daily dose at bedtime.
b. Suggest asking the provider for a transdermal preparation of the drug.
c. Suspect that the patient is overusing the medication.
d. Tell the patient to stop taking the drug and call the provider.
• Answer: A
• CNS depression is common with clonidine, but this effect lessens over
time. Constipation is also a common side effect. Patients who take most of
the daily amount at bedtime can minimize daytime sedation. Transdermal
forms of clonidine do not alter adverse effects. Patients who are abusing
clonidine often experience euphoria and hallucinations along with
sedation, but they generally find these effects desirable and would not
complain about them to a healthcare provider. Clonidine should not be
withdrawn abruptly, because serious rebound hypertension can occur.
A prescriber has ordered methyldopa for a patient with hypertension. The
nurse teaches the patient about drug actions, adverse effects, and the
ongoing blood tests necessary with this drug. The nurse is correct to tell the
patient what?
a. “If you have a positive Coombs’ test result, you will need to discontinue
the medication, because this means you have hemolytic anemia.”
b. “Methyldopa can be used for its analgesic effects and for its
hypertensive effects.”
c. “Xerostomia and orthostatic hypotension are serious side effects and
indications for withdrawing the medication.”
d. “You will need to contact the provider and stop taking the medication if
your eyes look yellow.”
• Answer: D
• Hepatotoxicity is a serious adverse effect of methyldopa and is an
indication for withdrawal of the drug to prevent fatal hepatic necrosis.
Jaundice is a sign of liver toxicity. Patients should undergo periodic liver
function tests while taking the drug. Liver function usually improves when
the drug is withdrawn. A positive Coombs’ test result is not an indication
for withdrawal of the drug in itself. About 5% of patients with a positive
Coombs’ test result develop hemolytic anemia; withdrawal of the drug is
indicated for those patients. Methyldopa does not have analgesic effects.
Xerostomia and orthostatic hypotension are known side effects of
methyldopa but usually are not serious.
A prescriber has ordered methyldopa for a female patient with hypertension.
The nurse understands that which laboratory tests are important before
beginning therapy with this drug? (Select all that apply.)

a. Coombs’ test
b. Hemoglobin and hematocrit (H&H)
c. Liver function tests
d. Pregnancy test
e. Urinalysis
• Answer: A, B, C
• A positive Coombs’ test result occurs in 10% to 20% of patients who take
methyldopa chronically. A few of these patients (5%) develop hemolytic
anemia. Blood should be drawn for a Coombs’ test and an H&H before
treatment is started and at intervals during treatment. Because
methyldopa is associated with liver disorders, liver function tests should
be performed before therapy is started and periodically during treatment.
Clonidine, not methyldopa, is contraindicated during pregnancy. A
urinalysis is not indicated.
A nurse is teaching nursing students about the pharmacology of
methyldopa. Which statement by a student indicates the need for
further teaching?
a. “Methyldopa results in alpha2 agonist activation, but it is not itself
an alpha2 agonist.”
b. “Methyldopa is not effective until it is converted to an active
compound.”
c. “Methyldopa reduces blood pressure by reducing cardiac output.”
d. “Methyldopa’s principal mechanism is vasodilation, not
cardiosuppression.”
• Answer: C
• Methyldopa does not reduce the heart rate or cardiac output, so its
hypotensive actions are not the result of cardiac depression. The
drug is not, in itself, an alpha2 agonist. When taken up into
brainstem neurons, it is converted into methylnorepinephrine,
which is an alpha2 agonist; it is not effective until converted to this
active compound. Its hypotensive effects are the result of
vasodilation, not cardiosuppression.
A patient is taking a calcium channel blocker (CCB) for stable
angina. The patient’s spouse asks how calcium channel
blockers relieve pain. The nurse will explain that CCBs:

a. help relax peripheral arterioles to reduce afterload.

b. improve coronary artery perfusion.
c. increase the heart rate to improve myocardial
contractility.
d. increase the QT interval.
• Answer: A
• CCBs promote relaxation of peripheral arterioles, resulting
in a decrease in afterload, which reduces the cardiac
oxygen demand. CCBs do not improve coronary artery
perfusion. CCBs reduce the heart rate and suppress
contractility; they do not affect the QT interval.
A patient who has been taking verapamil [Calan] for hypertension
complains of constipation. The patient will begin taking amlodipine
[Norvasc] to avoid this side effect. The nurse provides teaching about
the difference between the two drugs. Which statement by the patient
indicates that further teaching is needed?

a. “I can expect dizziness and facial flushing with nifedipine.”

b. “I should notify the provider if I have swelling of my hands and
feet.”
c. “I will need to take a beta blocker to prevent reflex tachycardia.”
d. “I will need to take this drug once a day.”
• Answer: C
• Amlodipine produces selective blockade of calcium channels in
blood vessels with minimal effects on the heart. Reflex tachycardia
is not common, so a beta blocker is not indicated to prevent this
effect. Dizziness and facial flushing may occur. Peripheral edema
may occur and should be reported to the provider. Amlodipine is
given once daily.
A nurse develops a plan of care for a pregnant patient
receiving nifedipine [Procardia]. Which outcome should
be included?

a. Cervix shows softening and dilation.

b. Whole blood glucose is 110 mg/dL or less.
c. Delivery is postponed for at least 24 hours.
d. Breasts are soft with no evidence of engorgement.
• Answer: C
• Nifedipine acts to block the entry of calcium into
myometrial cells, thus suppressing preterm labor for at
least 24 hours. Cervical ripening and breast
engorgement are not affected. Procardia has no effect
on blood glucose.
A patient with angina pectoris has been prescribed nifedipine
[Procardia].Which possible adverse effects should the nurse
expect with this medication? (Select all that apply.)

a. Headache
b. Constipation
c. Nausea and vomiting
d. Edema of ankles and feet
e. Overgrowth of gum tissue
• Answer: A, D, E
• Some adverse effects of nifedipine are headache, edema of
ankles and feet, and gingival hyperplasia (overgrowth of
gum tissue). Nifedipine causes very little constipation.
Nausea and vomiting are common side effects of
clevidipine.
A nurse is teaching a patient who will begin taking verapamil [Calan]
for hypertension about the drug’s side effects. Which statement by the
patient indicates understanding of the teaching?
a. “I may become constipated, so I should increase fluids and fiber.”
b. “I may experience a rapid heart rate as a result of taking this
drug.”
c. “I may have swelling of my hands and feet, but this will subside.”
d. “I may need to increase my digoxin dose while taking this drug.
• Answer: A
• Constipation is common with verapamil and can be minimized by
increasing dietary fiber and fluids. Verapamil lowers the heart rate.
Peripheral edema may occur secondary to vasodilation, and
patients should notify their prescriber if this occurs, because the
prescriber may use diuretics to treat the condition. Verapamil and
digoxin have similar cardiac effects; also, verapamil may increase
plasma levels of digoxin by as much as 60%, so digoxin doses may
need to be reduced.
A nurse is caring for a patient who is receiving verapamil
[Calan] for hypertension and digoxin [Lanoxin] for heart
failure. The nurse will observe this patient for:

a. AV blockade.
b. gingival hyperplasia.
c. migraine headaches.
d. reflex tachycardia.
• Answer: A
• Verapamil and digoxin both suppress impulse conduction
through the AV node; when the two drugs are used
concurrently, the risk of AV blockade is increased. Gingival
hyperplasia can occur in rare cases with verapamil, but it is
not an acute symptom. Verapamil can be used to prevent
migraine, and its use for this purpose is under investigation.
Verapamil and digoxin both suppress the heart rate.
Nifedipine causes reflex tachycardia.
Which are therapeutic uses for verapamil? (Select all that
apply.)

a. Angina of effort
b. Cardiac dysrhythmias
c. Essential hypertension
d. Sick sinus syndrome
e. Suppression of preterm labor
• Answer: A, B, C
• Verapamil is used to treat both vasospastic angina and
angina of effort. It slows the ventricular rate in patients
with atrial flutter, atrial fibrillation, and paroxysmal
supraventricular tachycardia. It is a first-line drug for the
treatment of essential hypertension. It is contraindicated in
patients with sick sinus syndrome. Nifedipine has
investigational uses in suppressing preterm labor.
A nursing student is helping to care for a patient who takes verapamil
for stable angina. The nurse asks the student to explain the purpose of
verapamil in the treatment of this patient. Which statement by the
student indicates a need for further teaching?
a. “It relaxes coronary artery spasms.”
b. “It reduces peripheral resistance to reduce oxygen demands.”
c. “It reduces the heart rate, AV conduction, and contractility.”
d. “It relaxes the peripheral arterioles to reduce afterload.”
• Answer: A
• Verapamil does relax coronary artery spasms, but this is not useful
in stable angina. Verapamil is used to relax coronary artery spasms
in variant asthma. When used to treat stable angina, verapamil
promotes relaxation of peripheral arterioles, which reduces
peripheral resistance and decreases afterload. It also reduces the
heart rate, AV conduction, and contractility
What is the most appropriate nursing consideration for a patient who
is prescribed verapamil [Calan] and digoxin [Lanoxin]?
a. Restrict intake of oral fluids and high-fiber food.
b. Take an apical pulse for 30 seconds before administration.
c. Notify the healthcare provider of nausea, vomiting, and visual
changes.
d. Hold the medications if the heart rate is greater than 110 beats
per minute.
• Answer: C
• Verapamil can raise digoxin blood serum levels, increasing the risk
of digoxin toxicity. Symptoms of digoxin toxicity may include
nausea, vomiting, and visual changes. Increase intake of oral fluids
and high-fiber food to decrease the adverse effect of constipation.
An apical pulse should be taken for a full minute prior to
administering digoxin. Verapamil and digoxin can cause bradycardia
not tachycardia.
The nurse is teaching a patient with essential hypertension who has a
new prescription for verapamil [Calan]. Which statements by the
patient indicate that the teaching was effective? (Select all that apply.)

a. "I will increase my intake of fluid and foods high in fiber."

b. "I should stay out of direct sunlight to prevent exposing my skin to
the sun."
c. "I will call my healthcare provider if I notice swelling in my ankles."
d. "I need to avoid salt substitutes and potassium supplements."
e. "I may notice easy bruising and bleeding with this drug."
• Answer: A, C
• Verapamil often causes constipation and can also cause peripheral
edema. Patients should take measures to prevent constipation and
should call about new symptoms of peripheral edema. Patients
taking verapamil should not experience photosensitivity,
hyperkalemia, or increased bruising and bleeding.
The nurse is caring for a patient with hypertension who is
receiving verapamil [Calan]. The patient has a healthy heart.
What pharmacodynamic effects does the nurse expect from this
drug? (Select all that apply.)
a. Peripheral vasoconstriction
b. Peripheral vasodilation
c. Coronary vasodilation
d. Increased heart rate
e. Increased force of contraction
• Answer: B, C
• Verapamil causes peripheral vasodilation and coronary
vasodilation, which lead to decreased blood pressure and
improved coronary perfusion. It does not cause
vasoconstriction and usually has little effect on the heart rate
or contractility in healthy hearts.
The nurse provides discharge instructions to a patient prescribed
verapamil [Calan] SR 120 mg PO daily for essential hypertension.
Which statement by the patient indicates understanding of the
medication?

a. "I will take the medication with grapefruit juice each morning."
b. "I should expect occasional loose stools from this medication."
c. "I'll need to reduce the amount of fiber in my diet."
d. "I must make sure I swallow the pill whole."
• Answer: D
• "SR" indicates that the drug is sustained release; therefore, the
patient must swallow the pill intact, without chewing or crushing,
which would result in a bolus effect. Grapefruit juice should be
avoided, because it can inhibit intestinal and hepatic metabolism of
the drug, thereby raising the drug level. Constipation, not loose
stools, is a common side effect of Calan; increasing fluids and
dietary fiber can help prevent this adverse effect.
A nurse is teaching a patient who is about to undergo direct-current
(DC) cardioversion to treat atrial flutter. The patient has been taking
verapamil and warfarin for 6 months. Which statement by the patient
indicates understanding of the teaching?

a. “I may need long-term therapy with another cardiac medication

after the procedure.”
b. “I should stop taking warfarin a few days before the procedure.”
c. “I will need to take a beta blocker after the procedure to prevent
recurrence of atrial flutter.”
d. “I will not have to take antidysrhythmia medications after the
procedure.”
• Answer: A
• After cardioversion for atrial flutter, patients may continue to need
long-term therapy with either a class IC agent or a class III agent to
prevent recurrence. Patients undergoing DC cardioversion need to
take warfarin 3 to 4 weeks before the procedure and for several
weeks afterward. Beta blockers are not indicated for postprocedural
prophylaxis. Class IC and class III agents are antidysrhythmic drugs
A prescriber orders verapamil [Covera-HS] for a patient
who is taking digoxin [Lanoxin] and warfarin. The nurse
will expect the prescriber to ____ the dose of ____.

a. lower; digoxin
b. increase; digoxin
c. lower; warfarin
d. increase; warfarin
• Answer: A
• Calcium channel blockers, such as verapamil, can
increase levels of digoxin, so patients taking these
drugs may need to have their digoxin dose reduced.
Increasing the dose of digoxin can result in digoxin
toxicity. Verapamil does not affect warfarin levels
Which instructions should the nurse include when developing a
teaching plan for a patient prescribed diltiazem [Cardizem] for atrial
fibrillation? (Select all that apply.)
a. Weigh yourself daily at the same time each day.
b. The medication will not cause dizziness or headache.
c. Notify the healthcare provider if a skin rash develops.
d. Do not take daily oral calcium supplements.
e. Rise slowly from a lying to a sitting position.
• Answer: A, C, E
• An adverse effect of diltiazem is heart failure. Daily weighing
monitors for signs of fluid retention, which may indicate
cardiac dysfunction. Chronic eczematous rash may occur,
especially in older patients. Orthostatic hypotension is an
adverse effect; patients must be taught to rise slowly from
lying to sitting positions. Diltiazem causes vasodilation, which
can cause dizziness or headache. Daily calcium supplements
do not affect the action of diltiazem.
a.
The healthcare provider prescribes an intravenous dose of
diltiazem [Cardizem] for treatment of a patient with atrial
fibrillation. What is the priority nursing intervention?

a. Assist with cardioversion.

b. Monitor electrocardiogram.
c. Obtain baseline coagulation studies.
d. Assess for increased urinary output.
• Answer: B
• Monitor the electrocardiogram (ECG) continuously during
IV administration of diltiazem for AV block, sudden
reduction in heart rate, and prolongation of the PR or QT
interval. Cardioversion is not necessary; however, have
equipment for cardioversion available. Baseline laboratory
studies are needed for liver and kidney function. Increased
urinary output is not an adverse effect of diltiazem.
The nurse is caring for a patient receiving a nitroprusside [Nipride]
intravenous infusion. The patient's wife asks why furosemide [Lasix] is
being prescribed along with this drug. The nurse's response is based
on which concept?
a. Furosemide will help reduce reflex tachycardia.
b. Many vasodilators cause retention of sodium and water.
c. Thiocyanate may accumulate in patients receiving nitroprusside.
d. Vasodilators can cause serious orthostatic hypotension.
• Answer: B
• Nitroprusside is a potent vasodilator that can cause retention of
sodium and water. Furosemide, a diuretic, often is combined with
nitroprusside to reduce the risk of edema and fluid retention.
Furosemide does not reduce reflex tachycardia. Thiocyanate can
accumulate in patients receiving nitroprusside, but furosemide does
not help prevent or treat that. Vasodilators can cause serious
orthostatic hypotension, but that is not the rationale for adding
furosemide to the regimen.
The nurse plans to closely monitor for which clinical
manifestation after administering furosemide [Lasix]?

a. Decreased pulse
b. Decreased temperature
c. Decreased blood pressure
d. Decreased respiratory rate
• Answer: C
• High-ceiling loop diuretics, such as furosemide, are the
most effective diuretic agents. They produce more loss of
fluid and electrolytes than any others. A sudden loss of
fluid can result in decreased blood pressure. When blood
pressure drops, the pulse probably will increase rather than
decrease. Lasix should not affect respirations or
temperature. The nurse should also closely monitor the
patient's potassium level.
While performing an admission assessment on a patient, the nurse learns that the
patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet
history reveals the use of salt substitutes. The patient is confused and dyspneic and
complains of hand and foot tingling. Which is an appropriate nursing action for this
patient?

a. Contact the provider to request orders for an electrocardiogram and serum

electrolyte levels.
b. Evaluate the patient’s urine output and request an order for intravenous
potassium.
c. Hold the next dose of furosemide and request an order for intravenous
magnesium sulfate.
d. Request an order for intravenous insulin to help this patient regulate
extracellular potassium.
• Answer: A
• This patient is taking a potassium-sparing diuretic and is ingesting dietary
potassium in salt substitutes. The patient shows signs of hyperkalemia: confusion,
shortness of breath, and tingling of the hands and feet. The cardiac effects can be
fatal, especially if a patient also is taking digoxin. The most appropriate first action
would be to obtain an ECG and serum electrolyte levels to evaluate the extent of
the patient’s hyperkalemia. The patient does not need increased potassium.
Furosemide is a potassium-wasting diuretic and would be helpful. Magnesium
sulfate is not indicated. Until the patient’s status has been assessed further,
intravenous insulin is not indicated.
A patient with hypertension is taking furosemide [Lasix] for
congestive heart failure. The prescriber orders digoxin to help
increase cardiac output. What other medication will the nurse
expect to be ordered for this patient?

a. Bumetanide [Bumex]
b. Chlorothiazide [Diuril]
c. Hydrochlorothiazide [HydroDIURIL]
d. Spironolactone [Aldactone]
• Answer: D
• Spironolactone is used in conjunction with furosemide
because of its potassium-sparing effects. Furosemide can
contribute to hypokalemia, which can increase the risk of
fatal dysrhythmias, especially with digoxin administration.
The other diuretics listed are all potassium-wasting
diuretics
A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The
nurse should counsel this patient to report which symptom?

a. Frequent nocturia
b. Headaches
c. Ringing in the ears
d. Urinary retention
• Answer: C
• 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. Urinary
retention is not an expected side effect.
An older male patient with an increased risk of MI is taking furosemide [Lasix]
and low-dose aspirin. The patient is admitted to the hospital, and the nurse
notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-
pound weight gain since a previous admission 3 months earlier. The patient
has voided only a small amount of concentrated urine. The serum creatinine
and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the
provider to discuss:

a. adding an antihypertensive medication.

b. obtaining serum electrolytes.
c. ordering a potassium-sparing diuretic.
d. withdrawing the aspirin.
• Answer: D
• This patient shows signs of renal impairment, as evidenced by weight gain
despite the use of diuretics, decreased urine output, hypertension, and
elevated serum creatinine and BUN. ASA can cause acute, reversible renal
impairment and should be withdrawn. Hypertensive medications do not
treat the underlying cause. Serum electrolytes are not indicated. Addition
of a potassium-sparing diuretic is not indicated.
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix]
40 mg, daily. Upon routine assessment by the nurse, the patient states, “I see
yellow halos around the lights.” The nurse should perform which action based
on this assessment?

a. Check the patient for other symptoms of digitalis toxicity.

b. Withhold the next dose of furosemide.
c. Continue to monitor the patient for heart failure.
d. Document the findings and reassess in 1 hour.
• Answer: A
• Yellow halos around lights indicate digoxin toxicity. The use of furosemide
increases the risk of hypokalemia, which in turn potentiates digoxin
toxicity. The patient should also be assessed for headache, nausea, and
vomiting, and blood should be drawn for measurement of the serum
digoxin level. The nurse should not withhold the dose of furosemide until
further assessment is done, including measurement of a serum digoxin
level. No evidence indicates that the patient is in worsening heart failure.
Documentation of findings is secondary to further assessment and
prevention of digoxin toxicity.
A nurse is providing teaching to a patient newly diagnosed with partial
seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes
furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient
indicates understanding of the teaching?

a. “I may need to increase my dose of Trileptal while taking these

medications.”
b. “I may develop a rash and itching, but these are not considered serious.”
c. “I should report any nausea, drowsiness, and headache to my provider.”
d. “I should use salt substitutes instead of real salt while taking these
drugs.”
• Answer: C
• Oxcarbazepine can cause clinically significant hyponatremia in 2.5% of
patients. If oxcarbazepine is combined with other drugs that reduce
sodium, the patient should be monitored. Signs of hyponatremia include
nausea, drowsiness, confusion, and headache, and patients should be
taught to report these symptoms. Increasing the dose of oxcarbazepine is
not indicated. Rashes can indicate a serious drug reaction, and providers
should be notified so that the oxcarbazepine can be withdrawn. Salt
substitutes would compound the problem of hyponatremia.
The nurse should monitor for which adverse effect after
administering hydrochlorothiazide [HydroDIURIL] and
digoxin [Lanoxin] to a patient?

a. Digoxin toxicity
b. Decreased diuretic effect
c. Dehydration
d. Heart failure
• Answer: A
• Digoxin levels have an inverse relationship with
potassium levels. Because hydrochlorothiazide can
lower potassium levels, combined use of
hydrochlorothiazide and digoxin poses a risk for
elevated digoxin levels and ensuing digoxin toxicity.
A nurse is obtaining a drug history from a patient about to
receive sulfadiazine. The nurse learns that the patient takes
warfarin, glipizide, and a thiazide diuretic. Based on this
assessment, the nurse will expect the provider to:
a. change the antibiotic to TMP/SMZ.
b. increase the dose of the glipizide.
c. monitor the patient’s electrolytes closely.
d. monitor the patient’s coagulation levels.
• Answer: D
• Sulfonamides interact with several drugs and through
metabolism-related interactions can intensify the effects of
warfarin. Patients taking both should be monitored closely
for bleeding tendencies. Changing to the combination
product will not help, because sulfonamides are still
present. Sulfonamides intensify glipizide levels, so this drug
may actually need to be reduced. Trimethoprim, not
sulfonamides, raises potassium levels.
A patient with congestive heart failure is admitted to the hospital. During the
admission assessment, the nurse learns that the patient is taking a thiazide
diuretic. The nurse notes that the admission electrolyte levels include a
sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium
level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately.
What will the nurse do initially?

a. Give the digoxin and maintain close cardiac monitoring.

b. Hold the digoxin and report the laboratory values to the provider.
c. Hold the thiazide diuretic and give the digoxin.
d. Request an order for an electrocardiogram (ECG).
• Answer: B
• Potassium depletion is common with thiazide diuretics, and hypokalemia
is especially dangerous for patients receiving digoxin, because the drug
can precipitate a fatal dysrhythmia and digoxin toxicity. The provider
should be notified of the serum potassium level so that it can be corrected
before the digoxin is administered. Giving the digoxin could produce a fatal
adverse effect, so this is not an appropriate course of action. Holding the
thiazide diuretic will not correct the potassium deficiency. An ECG is not
the initial priority.
Which laboratory result may be a consequence of therapy
with a thiazide diuretic?

a. Serum glucose level of 58 mg/dL

b. Serum potassium level of 5.3 mEq/L
c. Serum sodium level of 135 mEq/L
d. Serum uric acid level of 10.4 mg/dL
• Answer: D
• Hyperuricemia is a side effect of thiazide diuretics.
Normal uric acid levels typically range from 3.6 to 8.5
mg/dL. Hyperglycemia, not hypoglycemia, and
hypokalemia, not hyperkalemia, are side effects of
thiazides. A serum sodium of 135 mEq/L is a normal
value.
Besides having diuretic effects for patients with congestive heart
failure, thiazides are also used to treat what? (Select all that apply.)

a. Diabetes insipidus
b. Hepatic failure
c. Increased intracranial pressure
d. Intraocular pressure
e. Postmenopausal osteoporosis

• Answer: A, B, E
• Thiazide diuretics have the paradoxical effect of reducing urine
output in patients with diabetes insipidus. They can also be used to
mobilize edema associated with liver disease. They promote tubular
reabsorption of calcium, which may reduce the risk of osteoporosis
in postmenopausal women. Mannitol is used to treat edema that
causes increased intracranial pressure and intraocular pressure.
• Answer: A
• 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
thus may actually improve the patient’s
potassium level. Thiazides may elevate the
serum glucose level in diabetic patients.
Thiazides increase LDL cholesterol; however,
this patient’s levels are low, so this is not a risk
A patient with volume overload begins taking a thiazide
diuretic. The nurse will tell the patient to expect which
outcome when taking this drug?

a. Improved exercise tolerance

b. Increased cardiac output
c. Prevention of cardiac remodeling
d. Prolonged survival
• Answer: A
• Diuretics help reduce fluid volume overload, which, by
reducing pulmonary edema, can improve exercise
tolerance. Diuretics do not improve cardiac output.
ACE inhibitors are used to prevent cardiac remodeling
and to improve long-term survival
A patient with heart failure who takes a thiazide diuretic and digoxin
[Lanoxin] is admitted for shortness of breath. The patient’s heart rate
is 66 beats per minute, and the blood pressure is 130/88 mm Hg. The
serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL.
The nurse admitting this patient understands that the patient:
a. has digoxin toxicity.
b. is showing signs of renal failure.
c. is experiencing worsening of the disease.
d. needs a potassium-sparing diuretic.
• Answer: C
• This patient has a normal serum potassium level, and the digoxin
level is normal. The patient is showing signs of pulmonary edema,
which indicates progression of heart failure. The digoxin level is
within normal limits, and the heart rate is above 60 beats per
minute, so digoxin toxicity is not likely. There is no sign of renal
failure. A potassium-sparing diuretic is not indicated.
A patient is taking a thiazide diuretic for hypertension and
quinidine to treat a dysrhythmia. The prescriber orders
digoxin 0.125 mg to improve this patient’s cardiac output. The
nurse should contact the provider to request:
a. adding spironolactone [Aldactone].
b. reducing the dose of digoxin.
c. discontinuing the quinidine.
d. giving potassium supplements.
• Answer: C
• Quinidine can cause plasma levels of digoxin to rise;
concurrent use of quinidine and digoxin is contraindicated.
There is no indication for adding spironolactone unless this
patient’s potassium level is elevated. The dose of digoxin
ordered is a low dose. Potassium supplements are
contraindicated with digoxin.
The nurse is caring for a patient who is taking a vasodilator
that dilates capacitance vessels. The nurse will expect which
effect in this patient?

a. Decrease in cardiac work

b. Increase in cardiac output
c. Increase in tissue perfusion
d. Increase in venous return
• Answer: A
• Vasodilators that dilate capacitance vessels, or veins, lead
to a decrease in venous return to the heart, which reduces
preload and the force of ventricular contraction. The
resultant effect is a decrease in cardiac work. With a
decrease in ventricular contraction, cardiac output is
reduced, as is tissue perfusion. Dilation of veins causes a
decrease in venous return.
A nurse is administering a vasodilator that dilates resistance
vessels. The nurse understands that this drug will have which
effect on the patient?

a. Decreased cardiac preload

b. Decreased cardiac output
c. Increased tissue perfusion
d. Increased ventricular contraction
• Answer: C
• Vasodilators that dilate resistance vessels, or arterioles,
cause a decrease in afterload, which allows cardiac output
and tissue perfusion to increase. A decrease in preload
would be the result of dilation of capacitance vessels, or
veins. Dilation of arterioles increases cardiac output.
Ventricular contraction results when preload is increased.
A patient is receiving isosorbide dinitrate [Isordil] 20 mg 3 times per day for
management of newly diagnosed stable angina. Which assessment finding
would require an immediate nursing intervention?
a. A change in blood pressure from 122/70 to 108/66 mm Hg
b. An increase in the resting heart rate to 110 beats per minute from
baseline rates of 68 to 72 beats per minute
c. A headache the patient rates as a 5 on a pain scale of 0 to 10
d. Report of increased frequency of urination
• Answer: B
• Because nitrates lower blood pressure, isosorbide dinitrate can activate
the baroreceptor reflex, causing sympathetic stimulation of the heart; this
negates the benefits of treatment with nitrates, because it increases the
cardiac oxygen demand. For these reasons, addressing the tachycardia
becomes the nurse's immediate priority. A decrease in blood pressure
would be expected, and there is no indication the patient is experiencing
side effects of decreased cardiac output. Headache is an adverse effect
and should be treated (eg, with acetaminophen), but it does not require
immediate intervention. Increased frequency of urination may be related
to the presence of a urinary tract infection and requires follow-up, but it is
not the immediate concern.
The nurse is caring for a patient who is receiving enteral feedings
because of dysphagia. The healthcare provider prescribes isosorbide
mononitrate [Imdur] 60 mg SR daily via the enteral tube. What is the
most appropriate action by the nurse?

a. Have the patient swallow the pill, because it cannot be crushed.

b. Call the healthcare provider about an alternate form of nitrate for
administration.
c. Crush the Imdur into a fine powder, dilute it with water, and
administer it via the enteral tube.
d. Place the nitrate under the patient's tongue and let it dissolve,
because the person has dysphagia.
• Answer: B
• The nurse should contact the prescriber for an alternate form of
nitrate, such as a non–sustained-release pill, transdermal patch,
topical ointment, or immediate release. Because isosorbide
mononitrate is a sustained-release pill, it cannot be crushed.
Because the patient has dysphagia, attempting to administer the
pill orally could result in aspiration. Sustained-release tablets must
be administered whole
A patient in the emergency department reports taking sildenafil
[Viagra] and nitroglycerin 1 hour before sexual activity. Which finding
should the nurse immediately report to the physician?

a. White blood cell (WBC) count of 3200 units/L

b. Respiratory rate of 26 breaths per minute
c. Body temperature of 100.4°F (38°C)
d. Blood pressure (BP) of 70/50 mm Hg
• Answer: D
• When taken in conjunction with nitroglycerin, sildenafil can cause
severe hypotension that is unresponsive to treatment. At least 24
hours should elapse between the last dose of sildenafil and a
nitrate. A WBC count of 3200 units/L, a respiratory rate of 26
breaths per minute, and a body temperature of 100.4°F are
abnormal findings and must be reported. However, they are not as
important to report as the BP of 70/50 mm Hg, which is directly
related to sildenafil and nitroglycerin.
The nurse is preparing to administer an intravenous (IV) nitroglycerin infusion.
For which patient should the nurse question the healthcare provider's
prescription to administer IV nitroglycerin infusion?
a. A patient with an inferior wall myocardial infarction (MI); blood pressure
of 170/60 mm Hg
b. A patient with an anterior wall MI who has pulmonary congestion; heart
rate of 92 beats per minute
c. A patient with a right ventricular infarction, confirmed by right-sided ECG
changes
d. A patient with chest pain unrelieved to 3 sublingual nitroglycerin tablets;
took tadalafil 4 days ago
• Answer: C
• Nitroglycerin should be avoided in patients with hypotension (systolic BP
below 90 mm Hg), severe bradycardia (heart rate below 50 beats per
minute), marked tachycardia (heart rate above 100 beats per minute), or
suspected right ventricular infarction. If the patient has taken sildenafil,
avanafil, or vardenafil in the past 24 hours or tadalafil in the past 48 hours,
nitroglycerin should not be given. According to current guidelines, the
patient should receive 3 doses of sublingual nitroglycerin before a
continuous infusion is considered. Signs of pulmonary congestion also
warrant use of IV nitroglycerin.
A patient arrives in the emergency department complaining of chest pain that
has lasted longer than 1 hour and is unrelieved by nitroglycerin. The patient’s
electrocardiogram reveals elevation of the ST segment. Initial cardiac
troponin levels are negative. The patient is receiving oxygen via nasal cannula.
Which drug should be given immediately?
a. Aspirin 325 mg chewable
b. Beta blocker given IV
c. Ibuprofen 400 mg orally
d. Morphine intravenously
• Answer: A
• This patient shows signs of acute ST-elevation myocardial infarction
(STEMI). Because cardiac troponin levels usually are not detectable until 2
to 4 hours after the onset of symptoms, treatment should begin as
symptoms evolve. Chewable aspirin (ASA) should be given immediately to
suppress platelet aggregation and produce an antithrombotic effect. Beta
blockers are indicated but do not have to be given immediately. Ibuprofen
is contraindicated. Morphine is indicated for pain management and should
be administered after aspirin has been given
• The nurse understands patients receiving
nitroglycerin are at risk for which adverse effects?
(Select all that apply.)

a. Headache
b. Wheezing
c. Dizziness
d. Tachycardia
e. Bradycardia
• Answer: A, C, D
• The primary adverse effects of nitroglycerin are
headache; orthostatic hypotension, which can
lead to dizziness; and reflex tachycardia.
The nurse is providing discharge teaching for a patient with a new
prescription for a nitroglycerin transdermal patch. Which statement by
the patient indicates a need for further teaching?
a. "I will remove my patch at bedtime each evening."
b. "I will limit my alcohol to one drink per day."
c. "I will not use Viagra as long as I am on nitroglycerin."
d. "I will move slowly when changing positions.“
• Answer: B
• Alcohol can intensify the hypotensive effects of nitrates, so the
patient should avoid alcohol. Patients develop tolerance to nitrates
rather quickly. Patients receiving transdermal nitrates are
recommended to have 10 to 12 hours of patch-free time each
evening. Sildenafil [Viagra] and other drugs for erectile dysfunction
also can cause significant hypotension with nitroglycerin and are
contraindicated. Nitroglycerin causes orthostatic hypotension;
therefore, patients should change positions slowly.
a.
A hospitalized patient complains of acute chest pain. The
nurse administers a 0.3-mg sublingual nitroglycerin tablet, but
the patient continues to complain of pain. Vital signs remain
stable. What is the nurse’s next step?

a. Apply a nitroglycerin transdermal patch.

b. Continue dosing at 10-minute intervals.
c. Give a second dose of nitroglycerin in 5 minutes.
d. Request an order for intravenous nitroglycerin.
• Answer: C
• An initial dose of sublingual nitroglycerin is taken, and if the
chest pain persists, as in this case, the patient should take
another dose in 5 minutes. Transdermal delivery systems
are not useful for terminating an ongoing attack. Dosing at
10-minute intervals is incorrect. If the patient fails to
respond or if the pain intensifies, intravenous nitroglycerin
may be indicated.
A patient with angina who uses sublingual nitroglycerin tells the nurse that
the episodes are increasing in frequency and usually occur when the patient
walks the dog. The patient reports needing almost daily doses of the
nitroglycerin and states that one tablet usually provides complete relief. What
will the nurse do?

a. Contact the provider to suggest ordering a transdermal patch for this

patient.
b. Question the patient about consumption of grapefruit juice.
c. Suggest that the patient limit walking the dog to shorter distances less
frequently.
d. Suggest that the patient take two tablets of nitroglycerin each time,
because the symptoms are increasing in frequency.
• Answer: A
• Transdermal patches are good for sustained prophylaxis for anginal attacks
and are especially useful when patients have a regular pattern of attacks.
Grapefruit juice does not affect the metabolism of nitroglycerin. Patients
with angina should be encouraged to increase, not decrease, exercise.
Taking two tablets is not recommended when one is effective.
A patient with new-onset exertional angina has taken three nitroglycerin sublingual
tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the
patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm
Hg. The electrocardiogram is normal. The patient’s lips and nail beds are pink, and
there is no respiratory distress. The nurse will anticipate providing:

a. an angiotensin-converting enzyme (ACE) inhibitor.

b. intravenous nitroglycerin and a beta blocker.
c. ranolazine (Ranexa) and quinidine.
d. supplemental oxygen and intravenous morphine.
e. Answer: B
f. This patient has unstable angina, and the next step, when pain is unrelieved by
sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker.
ACE inhibitors should be given to patients with persistent hypertension if they
have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a
first-line angina drug, but it should not be given with quinidine because of the
risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or
respiratory distress is present. IV morphine may be given if the pain is unrelieved
by nitroglycerin.
A patient who has begun using transdermal nitroglycerin for angina
reports occasional periods of tachycardia. The nurse will expect the
prescriber to order:
a. digoxin [Lanoxin] to slow the heart rate.
b. immediate discontinuation of the nitroglycerin.
c. periods of rest when the heart rate increases.
• verapamil as an adjunct to nitroglycerin therapy.
• Answer: D
• Nitroglycerin lowers blood pressure by reducing venous return and
dilating the arterioles. The lowered blood pressure activates the
baroreceptor reflex, causing reflex tachycardia, which can increase
cardiac demand and negate the therapeutic effects of nitroglycerin.
Treatment with a beta blocker or verapamil suppresses the heart to
slow the rate. Digoxin is not recommended. Discontinuation of the
nitroglycerin is not indicated. Resting does not slow the heart when
the baroreceptor reflex is the cause of the tachycardia.
A patient who takes nitroglycerine to treat stable angina reports
having erectile dysfunction and states that he plans to ask his primary
provider for a prescription for tadalafil [Cialis]. What will the nurse tell
this patient?
a. “You may take these two drugs together safely as long as you take
them as directed.”
b. “You should not take tadalafil and nitroglycerine within 30 to 60
minutes of each other.”
c. “You should discuss another anti-angina medication with your
provider.”
d. “You should avoid sexual activity since this increases oxygen
demands on the heart.”
• Answer: C
• Use of nitroglycerine with any phosphodiesterase type 5 inhibitor,
such as sildenafil or tadalafil is absolutely contraindicated. The
patient should be advised to discuss another antianginal agent with
the provider. Patients should be taught to increase all activity to
maintain as normal a lifestyle as possible.
A patient who has renal impairment will begin taking ranolazine
[Ranexa] as an adjunct to nitroglycerine to treat angina. What will the
nurse include when teaching this patient?

a. “You will need to monitor your blood pressure closely while taking
this drug.”
b. “You should take this drug 1 hour before or 2 hours after a meal.”
c. “You may experience rapid heart rate while taking this
medication.”
d. “You do not need to worry about drug interactions with this
medication.”
• Answer: A
• Ranolazine can elevate blood pressure in patients with renal
impairment, so patients taking this drug will need to monitor blood
pressure. The drug can be taken without regard to food. It does not
cause reflex tachycardia. It has many significant drug interactions.
a.
A nurse is providing teaching for a patient with stable angina who will
begin taking nitroglycerin. Which statement by the patient indicates
understanding of the teaching?
a. “I should not participate in aerobic exercise while taking this
drug.”
b. “I should take aspirin daily to reduce my need for nitroglycerin.”
c. “If I take nitroglycerin before exertion, I can reduce the chance of
an anginal attack.”
d. “I take nitroglycerin to increase the amount of oxygen to my
heart.”
• Answer: C
• Nitroglycerin can be taken before stressful events or exertion to
reduce the chance of an attack of angina. Aerobic exercise is an
important part of nondrug therapy to reduce the risk of heart
attack. Aspirin therapy is an important adjunct to treatment to
prevent coronary thrombus formation, but it does not reduce the
need for nitroglycerin. Nitroglycerin reduces cardiac oxygen
demand, but it does not increase the amount of oxygen available to
the heart.
A patient is scheduled to start taking sildenafil [Viagra]. A
nurse should recognize that the patient is at risk for
developing an adverse cardiac event if the patient's history
reveals which of these conditions?
a. Angina
b. Hypertension
c. Varicose veins
d. Prosthetic mitral valve
• Answer: A
• Sildenafil is used in the treatment of erectile dysfunction. It
should be used with caution by men with coronary heart
disease (CHD), which may be manifested by angina.
Research has suggested that in men with CHD, sexual
activity, not sildenafil, is the likely cause of adverse cardiac
events. Sildenafil is not contraindicated in patients with
hypertension, varicose veins, or a prosthetic mitral valve.
A patient with a history of heart disease develops pulmonary
arterial hypertension (PAH), and the provider is considering
prescribing sildenafil [Revatio]. The nurse caring for this patient
will perform a careful drug history and notify the provider if the
patient is taking which medication?
a. A beta blocker
b. A calcium channel blocker
c. Nitroglycerin
d. Warfarin
• Answer: C
• Patients taking sildenafil should not take nitroglycerin, since
the combination can produce a life-threatening drop in blood
pressure. Beta blockers, calcium channel blockers, and
warfarin are not contraindicated with sildenafil
A patient is prescribed hydralazine [Apresoline] for the
treatment of essential hypertension. Which expected
adverse effects should the nurse discuss with the patient?
(Select all that apply.)
a. Nausea
b. Fatigue
c. Dizziness
d. Headache
e. Joint pain
• Answer: B, C, D
• Some of the common adverse effects of hydralazine
include fatigue, dizziness, and headache. Nausea is
associated with minoxidil. Joint pain is not a common
adverse effect of hydralazine.
The nurse is caring for a patient receiving hydralazine
[Apresoline]. The healthcare provider prescribes
propranolol [Inderal]. The nurse knows that a drug such
as propranolol often is combined with hydralazine for
what purpose?

a. To reduce the risk of headache

b. To improve hypotensive effects
c. To prevent heart failure
d. To protect against reflex tachycardia
e. Answer: D
f. Hydralazine is a vasodilator that lowers blood
pressure, but it also can trigger reflex tachycardia.
Beta blockers, such as propranolol, are added to the
regimen to normalize the heart rate.
Which patients may receive hydralazine to treat
hypertension? (Select all that apply.)

a. A 1-month-old infant
b. A 5-year-old child
c. A pregnant woman
d. A mother breast-feeding a newborn
e. An older adult
• Answer: A, B, E
• Hydralazine may be used in infants as young as one month
of age, in children, and in older adults. Hydralazine is
labeled pregnancy category C and data is lacking regarding
transmission of hydralazine in breast-feeding women, so
benefits should outweigh risks.
a.
A female patient with essential hypertension is being treated
with hydralazine 25 mg twice daily. The nurse assesses the
patient and notes a heart rate of 96 beats per minute and a
blood pressure of 110/72 mm Hg. The nurse will request an
order to:
a. administer a beta blocker.
b. administer a drug that dilates veins.
c. reduce the dose of hydralazine.
d. give the patient a diuretic.
• Answer: A
• This patient is showing signs of reflex tachycardia, so a beta
blocker is indicated to slow the heart rate. Patients with
heart failure who take hydralazine often require the
addition of isosorbide dinitrate, which also dilates veins.
There is no indication for reducing the dose of hydralazine.
A diuretic can be given with hydralazine if sodium and
water retention is present.
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 per minute and a blood pressure of
120/80 mm Hg. 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
A. 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 is not a
serious side effect. Hypertrichosis occurs in about 80% of patients
taking the 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.
A female patient with baldness asks a nurse about the safety and
efficacy of minoxidil [Rogaine]. What will the nurse tell the
patient?

a. Hair regrowth is most effective when baldness has

developed recently.
b. Minoxidil cannot be used by female patients.
c. Once hair has been restored, minoxidil may be discontinued,
because hair loss will stop.
d. Systemic side effects, such as headaches and flushing, are
common.
Answer: A
• Minoxidil is most effective at treating recent hair loss. It may
be used in female patients. Hair loss may continue even with
uninterrupted treatment. Systemic side effects are not
common
The nurse is caring for a patient who has been receiving intravenous sodium
nitroprusside [Nitropress] for 3 days. Which assessement data indicate the
patient may be experiencing thiocyanate toxicity?

a. Sudden confusion
b. Difficulty breathing
c. Erythematous rash
d. Gastrointestinal bleeding
Answer: A
When nitroprusside is given for several days, thiocyanate may accumulate,
which can cause adverse effects. These effects, which involve the central
nervous system (CNS), include disorientation, psychotic behavior, and
delirium. Difficulty breathing, erythematous rash, and gastrointestinal
bleeding are not adverse effects related to thiocyanate toxicity.
A patient in a hypertensive crisis is being started on a continuous sodium
nitroprusside [Nipride] infusion. What interventions are essential before the
nurse administers nitroprusside [Nipride]? (Select all that apply.)
a. Obtain a baseline weight and weigh daily.
b. Prepare for arterial line insertion.
c. Discontinue the infusion when blood pressure is controlled.
d. Observe for signs of hypertrichosis during the infusion.
e. Cover the solution with an opaque bag.
• Answer: A, B, E
• A Nipride infusion is ordered in micrograms/kilogram/minute. Knowing
the patient's weight is essential for calculating the appropriate dose. Also,
tracking daily weights and comparing them with the baseline values helps
the nurse determine whether the adverse effect of fluid retention has
developed. An arterial line allows for continuous and accurate
measurement of blood pressure. Because light degrades nitroprusside, the
infusion solution should be covered. The infusion should not be
discontinued abruptly, because the blood pressure will return to the
pretreatment levels within minutes. Hypertrichosis (excessive hair growth)
is a side effect of minoxidil.