Chapter 21: Calcium Channel Blockers Test Bank
MULTIPLE CHOICE
1. 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:
a. improves blood flow and oxygen delivery to the heart.
b. increases the rate of contraction of the cardiac muscle.
c. increases the force of contraction of the cardiac muscle.
d. has a positive inotropic effect to increase cardiac output.
2. A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The primary care NP should contact the patient’s cardiologist to discuss adding:
a. amlodipine (Norvasc).
b. diltiazem (Cardizem).
c. verapamil HCl (Calan).
d. nifedipine (Procardia XL).
3. A patient who has stable angina is taking nitroglycerin and a ?-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:
a. isradipine (DynaCirc).
b. nicardipine (Cardene).
c. verapamil HCl (Calan).
d. nifedipine (Procardia XL).
4. A patient who has angina is taking nitroglycerin and long-acting nifedipine. The primary care NP notes a persistent blood pressure of 90/60 mm Hg at several follow-up visits. The patient reports lightheadedness associated with standing up. The NP should consult with the patient’s cardiologist about changing the medication to:
a. amlodipine (Norvasc).
b. isradipine (DynaCirc).
c. verapamil HCl (Calan).
d. short-acting nifedipine (Procardia).
5. An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic. The primary care NP should consider prescribing a(n):
a. angiotensin receptor blocker.
b. ?-blocker.
c. ACE inhibitor.
d. calcium channel blocker.
6. 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:
a. serum calcium channel blocker level.
b. complete blood count and electrolytes.
c. liver function tests (LFTs) and renal function.
d. thyroid and insulin levels.
7. A patient who is taking nifedipine develops mild edema of both feet. The primary care NP should contact the patient’s cardiologist to discuss:
a. changing to amlodipine.
b. ordering renal function tests.
c. increasing the dose of nifedipine.
d. evaluation of left ventricular function.
Chapter 22: ACE Inhibitors and Angiotensin Receptor Blockers
Test Bank
MULTIPLE CHOICE
1. An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should:
a. increase the captopril dose to 50 mg twice daily.
b. add a thiazide diuretic to this patient’s regimen.
c. change the drug to losartan (Cozaar) 50 mg once daily.
d. recommend a low-sodium diet in addition to the medication.
2. A patient with a previous history of myocardial infarction (MI) who takes nitroglycerin for angina develops hypertension. The primary care NP is considering ordering an ACE inhibitor. Preliminary laboratory tests reveal decreased renal function. The NP should:
a. begin therapy with a low-dose ACE inhibitor.
b. choose an ARB instead.
c. add a low-dose thiazide diuretic to the drug regimen.
d. order a renal perfusion study before starting treatment.
3. A patient who has type 2 diabetes is seen by a primary care NP for a physical examination. The NP notes a blood pressure of 140/95 mm Hg on three occasions. A urinalysis reveals macroalbuminuria. The patient’s serum creatinine is 1.9 mg/dL. Adhering to evidence-based practice, the NP should prescribe:
a. losartan (Cozaar).
b. captopril (Capoten).
c. enalapril maleate (Vasotec).
d. fosinopril sodium (Monopril).
4. 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:
a. consider changing the medication to an ARB.
b. order a bronchodilator to counter the bronchospasm caused by this drug.
c. ask whether the patient has had any associated facial swelling with this cough.
d. reassure the patient that tolerance to this adverse effect will develop over time.
5. A patient who takes an ACE inhibitor and a thiazide diuretic for hypertension will begin taking spironolactone. The primary care NP should counsel this patient to:
a. avoid foods that are high in potassium.
b. use a salt substitute when seasoning foods.
c. discuss changing the ACE inhibitor to an ARB with the cardiologist.
d. avoid taking antacids containing magnesium while taking these drugs.
6. A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:
a. report wheezing and shortness of breath, which may occur with these drugs.
b. take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
c. discuss taking an increased dose of the thiazide diuretic with the cardiologist.
d. minimize fluid intake for several days when beginning therapy with the ACE inhibitor.
7. The primary care NP is considering prescribing captopril (Capoten) for a patient. The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney. The NP should:
a. initiate ACE inhibitor therapy at a low dose.
b. consider a different drug class to treat this patient’s symptoms.
c. give the captopril with a thiazide diuretic to improve renal function.
d. order lisinopril (Zestril) instead of captopril to avoid increased nephropathy.
Chapter 23: Antiarrhythmic Agents Test Bank
MULTIPLE CHOICE
1. Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the primary care nurse practitioner (NP) why the procedure is necessary. The NP should tell the patient:
a. this medication prevents clots but does not alter rhythm.
b. if the medication proves effective, the procedure may be canceled.
c. there are no medications that alter the arrhythmia causing AF.
d. to ask the cardiologist if verapamil may be ordered instead of cardioversion.
2. A patient undergoes a routine electrocardiogram (ECG), which reveals occasional premature ventricular contractions that are present when the patient is resting and disappear with exercise. The patient has no previous history of cardiovascular disease, and the cardiovascular examination is normal. The primary care NP should:
a. prescribe quinidine (Quinidex Extentabs).
b. tell the patient that treatment is not indicated.
c. refer the patient to a cardiologist for further evaluation.
d. consider using amiodarone if the patient develops other symptoms.
3. The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause. History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should:
a. order an ECG and refer to a cardiologist.
b. schedule a cardiac stress test and a graded exercise test.
c. order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.
d. prescribe a ?-blocker and anticoagulant and order 24-hour Holter monitoring.
4. A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should:
a. administer intravenous fluids and obtain serum electrolytes.
b. administer amiodarone in the clinic and observe closely for response.
c. order digoxin and verapamil and ask the patient to return for a follow-up examination in 1 week.
d. send the patient to an emergency department for evaluation and treatment.
5. A patient who is taking trimethoprim-sulfamethoxazole for prophylaxis of urinary tract infections tells the primary care NP that a sibling recently died from a sudden cardiac arrest, determined to be from long QT syndrome. The NP should:
a. schedule a treadmill stress test.
b. order genetic testing for this patient.
c. discontinue the trimethoprim- sulfamethoxazole.
d. refer the patient to a cardiologist for further evaluation.
6. 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:
a. drink extra fluids when exercising.
b. reduce stress with yoga and hot baths.
c. ask the cardiologist about an implantable defibrillator.
d. ask the cardiologist about adding procainamide to the drug regimen.
7. 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 ?g/mL. The NP should:
a. discontinue the medication immediately.
b. reassure the patient that this is a therapeutic drug level.
c. order an ECG, CBC, liver function tests (LFTs), and renal function tests.
d. admit the patient to the hospital and obtain a cardiology consultation.
Chapter 24: Antihyperlipidemic Agents Test Bank
MULTIPLE CHOICE
1. 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 30 mg/dL, and triglycerides of 350 mg/dL. The patient has no previous history of coronary heart disease. The NP should consider prescribing:
a. ezetimibe (Zetia).
b. gemfibrozil (Lopid).
c. simvastatin (Zocor).
d. nicotinic acid (Niaspan).
2. 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:
a. atorvastatin (Lipitor).
b. gemfibrozil (Lopid).
c. cholestyramine (Questran).
d. lovastatin/niacin (Advicor).
3. A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain and weakness. The NP should:
a. order liver function tests (LFTs).
b. order a creatine kinase-MM (CK-MM) level.
c. change atorvastatin to twice-daily dosing.
d. add gemfibrozil (Lopid) to the patient’s medication regimen.
4. A patient who has primary hyperlipidemia and who takes atorvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and dizziness a few weeks after the dose increase. The NP should:
a. change the atorvastatin dose to 15 mg twice daily.
b. change the patient’s medication to cholestyramine (Questran).
c. add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily.
d. recommend supplements of omega-3 along with the atorvastatin.
5. 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:
a. recommend dietary and lifestyle changes first.
b. begin therapy with atorvastatin 10 mg per day.
c. discuss quality-of-life issues as part of the decision to begin medication.
d. tell her there is no clinical evidence of efficacy of statin medication in her case.
6. 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:
a. increasing the simvastatin to 80 mg twice daily.
b. adding nicotinic acid to the patient’s drug regimen.
c. changing the medication to ezetimibe/simvastatin (Vytorin).
d. referring the patient to a dietitian for assistance with weight reduction.
7. A patient who has type 2 diabetes mellitus will begin taking a bile acid sequestrant. Which bile acid sequestrant should the primary care NP order?
a. Colesevelam (Welchol)
b. Colestipol (Colestid)
c. Cholestyramine (Questran)
d. Cholestyramine (Questran Light)
8. A patient with primary hypercholesterolemia is taking an HMG-CoA reductase inhibitor. All of the patient’s baseline LFTs 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:
a. order LFTs.
b. order CK-MM tests.
c. consider decreasing the dose of the medication.
d. reassure the patient that this side effect is common.
Chapter 25: Agents that Act on Blood Test Bank
MULTIPLE CHOICE
1. 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:
a. initiate dabigatran when the patient’s international normalized ratio (INR) is less than 2.
b. start dabigatran 7 to 14 days after discontinuing warfarin.
c. begin giving dabigatran 1 week before discontinuing warfarin.
d. order frequent monitoring of the patient’s INR after dabigatran therapy begins.
2. A patient who is obese is preparing to have surgery. To help prevent venous thromboembolism (VTE), the primary care NP should prescribe:
a. low-dose aspirin once daily.
b. clopidogrel (Plavix) 75 mg once daily.
c. enoxaparin (Lovenox) 30 mg twice daily.
d. warfarin (Coumadin) titrated to achieve an INR of 3.5.
3. A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively. The NP should tell the patient that it will be necessary to take:
a. daily low-dose aspirin for 1 year.
b. heparin injections as needed based on activated partial thromboplastin time levels.
c. lifelong warfarin combined with enoxaparin as needed.
d. warfarin for 3 months postoperatively plus long-term aspirin.
4. A patient in the clinic develops sudden shortness of breath and tachycardia. The primary care NP notes thready pulses, poor peripheral perfusion, and a decreased level of consciousness. The NP activates the emergency medical system and should anticipate that this patient will receive:
a. intravenous alteplase.
b. low-dose aspirin and warfarin.
c. low-molecular-weight heparin (LMWH).
d. unfractionated heparin (UFH) and warfarin.
5. 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 expect to administer:
a. 325 mg of chewable aspirin.
b. LMWH.
c. intravenous alteplase and aspirin.
d. warfarin (Coumadin) and aspirin.
6. 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:
a. lowering the dose of warfarin.
b. rechecking the INR in 1 week.
c. omitting a dose and resuming at a lower dose.
d. omitting a dose and administering 1 mg of vitamin K.
7. A patient who has had a new onset of AF the day prior will undergo cardioversion that day. The primary care NP will expect the cardiologist to:
a. give clopidogrel after administering cardioversion.
b. administer cardioversion without using anticoagulants.
c. give warfarin and aspirin before attempting cardioversion.
d. give low-dose aspirin before administering cardioversion.
8. 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?
a. Cilostazol (Pletal)
b. Warfarin (Coumadin)
c. Pentoxifylline (Trental)
d. Low-dose, short-term aspirin
9. 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 which of the following anticoagulant medications?
a. Aspirin
b. Heparin
c. Dabigatran
d. Warfarin
10. A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to:
a. avoid foods that are high in vitamin K for several days.
b. take a double dose of the medication the next morning.
c. refill the prescription and take today’s dose immediately.
d. skip today’s dose and resume a regular dosing schedule in the morning.
