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ESPIRITU, MELODY MAE D.

BSN 2-2

Cardiovascular System:

1. Which side effect of the calcium channel blocker nicardine hydrochloride (Cardene) would be
of concern to the nurse?
a. “My mouth is so dry”
b. “I haven’t had a BM in 4 days”
c. BP 200/100
d. BP 80/50
Answer: D
Rationale: Hypotension with bradycardia are the primary features seen in calcium
channel antagonist poisoning. These findings are due to peripheral vasodilatation and
reduced cardiac contractility. Hypotension may be profound and life-threatening; it
results from peripheral vasodilation, bradycardia, and decreased ionotropy. Cardiac
conduction may also suffer impairment with AV conduction abnormalities, complete
heart block, and idioventricular rhythms.
 Option A: Dry mouth is one of the normal side effects of calcium channel blockers.
 Option B: Constipation is one of the normal side effects of calcium channel blockers.
 Option C: Nicardipine is used to treat high blood pressure and control angina, thus
cannot cause a blood pressure of 200/100.

2. What is the initial treatment for a client with essential hypertension?

a. A diuretic agent
b. A diuretic, low fat diet, and exercise
c. Low-sodium diet, weight reduction, and an exercise program
d. Adrenergic blocking agent
Answer: B
Rationale: Initial management of hypertension uses a two-pronged approach, with
emphasis on lifestyle measures and add-on drug management. Lifestyle changes should
include dietary interventions such as a low-fat diet and exercise. While drug management
such as water pills (diuretics) helps remove sodium and water from the body. They are
often the first medicines used to treat high blood pressure.
 Option A: Diuretic agents helps diminish blood pressure, however, are not the initial
management for essential hypertension. Medications are usually supplementary with
lifestyle modifications as treatments.
 Option C:
 Option D:

3. How should the nurse respond when a client asks how a beta blocker lower his/her BP?
a. “The drug increases the amount of O2 demanded by the heart”
b. “The drug dilates veins, which increases the workload of the heart”
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c. “You’ll have to discuss this with your doctor”

d. “The drug slows the HR and decreases cardiac output, thereby lowering BP”
Answer: D
Rationale: Beta blockers work by blocking the effects of the hormone epinephrine, also
known as adrenaline. Beta blockers cause the heart to beat more slowly and with less
force, which lowers blood pressure.
 Option A: By slowing the heart rate, beta blockers reduce the oxygen demand of the
heart and not increase its demand.
 Option B: Beta blockers dilates veins and arteries to improve blood flow which cause
the heart to beat more slowly and with less force. Thus, do not increase workload but
rather decrease workload of the heart.
 Option C:

4. The drugs of choice in reducing triglycerides in clients who do not respond to dietary
management are
a. Bile-sequestering agents
b. Febric acid derivatives
c. Cholesterol synthesis inhibitors
d. Bile-sequestering agents and cholesterol synthesis inhibitors
Answer: B
Rationale: Fibric acid derivatives or fibrates are regarded as broad-spectrum lipid
lowering drugs. Their main action is to decrease triglyceride levels but they also tend to
reduce low density lipoprotein (LDL) cholesterol levels and help to raise high density
lipoprotein (HDL) cholesterol.
 Option A:
 Option C:
 Option D:

5. A loading dose of digoxin (Lanoxin) 0.5 mg PO is administered and followed by 0.25 mg PO

daily. The positive inotropic and negative chronotropic effect is reflected in which of the
following sets of data?
a. BP 157/70, P.92, R.24, decrease in urine output
b. BP 130/80, P.60, R.22, increase in urine output
c. BP 80/50, P.60, R.22, no effect on urine output
d. BP 80/50, P.92, R.24, decrease in urine output
Answer: B
Rationale:
 Option
 Option
 Option

6. The nurse should suspect digoxin (Lanoxin) toxicity if a client states:

a. “I can’t have a BM” –
b. “The light seem very bright”
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c. “I have no appetite”
d. “My BP has been elevated today”
Answer: C
Rationale: Loss of appetite is the first sign of toxicity in Lanoxin. This is caused by
anorexia, nausea, vomiting and neurological symptoms.
 Option A: Early warning signs of Lanoxin overdose includes diarrhea and not
constipation.
 Option B:
 Option C: Blood pressure is not affected during Lanoxin toxicity.

7. Which of the following should alert the nurse to consider digoxin (Lanoxin) toxicity?
a. K level 5.5 mEq/L
b. Na level 146 mWq/L
c. Magnesium level 1.5 mEq/L
d. K level 2.3 mEq/L
Answer: D
Rationale: The most common trigger of digoxin toxicity is hypokalemia, which may occur
because of diuretic therapy.
 Option A
 Option B
 Option C

8. After administering a client his first nitroglycerin (Nitrostat) sublingual (SL), the nurse checks
his blood pressure and gets 80/50. He still complains of chest pain. The nurse should:
a. Give the SL nitroglycerin (Nitrostat) tablet anyway and notify the physician
b. Hold the SL nitroglycerin (Nitrostat) tablet and notify the physician
c. Apply a nitroglycerin (Transderm-Nitro) transdermal patch instead
d. Wait 5 minutes, recheck the BP, and if elevated give the NTG (Nitrostat)
Answer: B
Rationale: A person's blood pressure can drop significantly after using nitroglycerin.
Nitroglycerin works by relaxing smooth muscle within the walls of blood vessels
(particularly veins) which dilates (widens) them. This helps to relieve chest pain that is
caused by a narrowing of the blood vessels, and also reduces how hard the heart has to
work to pump blood around the body, reducing blood pressure. With a documented low
blood pressure, it is better to hold second dose and notify the physician first, as the
patient is still complaining of chest pain even after the second dose.
 Option A:
 Option B:
 Option C:

9. After application of a nitroglycerin (Nitrodur) patch, which of the following would be

considered a common side effect?
a. “My skin itches all over”
b. “I see halos around everything”
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c. “My head is pounding”

d. “I feel tired”
Answer: C
Rationale: Dizziness, lightheadedness, or fainting may occur, especially when you get up
quickly from a lying or sitting position. Getting up slowly may help. Also, lying down for
a while may relieve dizziness or lightheadedness.
 Option A
 Option B
 Option D

10. A client is admitted with ventricular tachycardia in an emergency situation. The physician
orders a bolus of lidocaine hydrochloride (Xylocaine) followed by an IV infusion of lidocaine
hydrochloride (Xylocaine), Class I-B antidysrhytmic. Which of the following is true about this
medication?
a. Lidocaine is the drug of choice for ventricular dysrhythmias
b. It seldom causes drowsiness and/or confusion
c. It is indicated in the above dysrhythmia and heart blocks
d. It can be mixed with epinephrine (Adrenalin) to slow the absorption
Answer: A
Rationale: Lidocaine is also a class 1b antiarrhythmic agent that is primarily used for the
treatment of ventricular arrhythmias. Lidocaine blocks cardiac sodium channels
shortening the action potential and is used intravenously only for arrhythmia.
 Option B
 Option C
 Option D

11. After several bolus doses of lidocaine hydrochloride (Xylocaine), a Class I-B drug, the
ventricular tachycardia does not stop. The physician would probably try:
a. Class I-C, encainide hydrochloride (Enkaid)
b. Class I-A quinidine sulfate
c. Class II, esmolal hydrochloride (Brivibloc)
d. Class IV, verapamil hydrochloride (Isoptin)
Answer: A
Rationale:
 Option B
 Option C
 Option D

12. Which of the following is true of beta blockers?

a. They have adverse effects as orthostatic hypotension
b. They are the drug of choice in angina
c. They increase the rate and contractility of the heart
d. They are Step 3 drugs in treating hypertension
Answer: A
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Rationale:
 Option B
 Option C
 Option D

13. If a client who experiences angina abruptly stops taking a beta blocker, which of the
following might be experienced?
a. Hypertension
b. Nausea
c. Lethargy
d. Acute myocardial infarction
Answer: D
Rationale: Abrupt withdrawal of long-term beta-blocker therapy in patients with
angina may be associated with unstable angina and myocardial infarction. It appears that
an "overshoot" in heart rate from pretreatment values occurs, which increases
myocardial oxygen demand.
 Option A: Hypertension may be experienced by the client, however, this is just a
withdrawal symptom that the client may experience which then leads to acute
myocardial infarction.
 Option B:
 Option C:

14. By interrupting the conversion of angiotensin I to angiotensin II, ACE inhibitors act in which
of the following ways?
a. Inhibit the autonomic nervous system
b. Increase PVR
c. Increase the effect of angiotensin I
d. Decrease aldosterone release
Answer: D
Rationale:
 Option A
 Option B
 Option C

15. A client on a routine office visit complains of chest pain every time he cuts the grass, yet he
refuses to hire someone else to perform this task. The nurse should instruct the client to:
a. Stop every 15 minutes while cutting the grass
b. Take a NTG (Nitrostat) if chest pain occurs
c. Take a NTG (Nitostat) before cutting the grass and rest periodically
d. Take three NTG (Nitrostat) 5 minutes apart and then cut the grass
Answer: C
Rationale: NTG (Nitrostat) is used to treat episodes of angina (chest pain). It is also used
just before activities that may cause episodes of angina to prevent the angina from
occurring.
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 Option A: If a client feels a chest pain, he should halt whatever he is doing in order to
protect his health.
 Option B: NGT (Nitrostat) is typically used before to activities rather than when a client
is experiencing chest pain.
 Option D: NTG (Nitrostat should not be taken more than 3 tablets in 15 minutes.