NR 508 Week 2 Quiz, Chamberlain College of Nursing

Question 1.1. 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: (Points : 2)

amlodipine (Norvasc). isradipine (DynaCirc). verapamil HCl (Calan).

short-acting nifedipine (Procardia).

Verapamil and diltiazem are less likely to cause hypotension than

nifedipine and related drugs, such as isradipine and amlodipine.

Question 2.2. A patient who will begin using nitroglycerin for angina

asks the primary care NP how the medication works to relieve pain.

The NP should tell the patient that nitroglycerin acts to: (Points : 2)

dissolve atheromatous lesions. relax vascular smooth muscle.

prevent catecholamine release. reduce C-reactive protein levels.

Nitrates relax vascular smooth muscle via stimulation of intracellular

cyclic guanosine monophosphate production with the major effect being

to reduce myocardial oxygen demand. Nitrates do not dissolve atheromatous

lesions, prevent catecholamine release, or reduce C-reactive protein levels.

Question 3.3. A patient with Graves’ disease is taking methimazole.

After 6 months of therapy, the primary care NP notes normal T3 and T4

and elevated TSH. The NP should: (Points : 2)

Question 4.4. The primary care nurse practitioner (NP) sees a

patient in the clinic who has a blood pressure of 130/85 mm Hg.

The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL.

The NP calculates a body mass index of

Thepatient has a positive family history for cardiovascular disease.
The NP should: (Points : 2) prescribe a thiazide diuretic.

consider treatment with an angiotensin-converting enzyme inhibitor. reassure the patient that these findings are normal.

counsel the patient about dietary and lifestyle changes.

The patient’s blood pressure indicates prehypertension, but the patient

does not have cardiovascular risk factors such as hyperlipidemia or

hyperinsulinemia. The body mass index indicates that the patient is

overweight but not obese. Pharmacologic treatment is not recommended

for prehypertension unless compelling reasons are present. The findings

are not normal, so it is appropriate to counsel the patient about diet and exercise.

Question 5.5. A 45-year-old patient who has a positive family history

but no personal history of coronary artery disease is seen by the primary

care NP for a physical examination. The patient has a body mass index of 27

and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density

lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides,

120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP

should recommend: (Points : 2)

30 minutes of aerobic exercise daily. taking 81 to 325 mg of aspirin daily.

beginning therapy with a statin medication. starting a thiazide diuretic to treat

hypertension.

This patient is overweight but not obese, and blood lipids are within normal limits.

Blood pressure is not elevated. Exercise is recommended as an initial risk reduction

strategy because of its positive effects on blood pressure and blood lipids. Aspirin is generally given to patients older than 55 to

65 who are at risk. Statin medications and thiazide diuretics are not indicated.

Question 6.6. A patient has three consecutive blood pressure readings of

140/95 mm Hg. The patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL.

Creatinine clearance and cholesterol tests are normal. The primary care NP should order:

(Points : 2)

a b-blocker.

an angiotensin-converting enzyme inhibitor.

a thiazide diuretic.

dietary and lifestyle changes.

The patient has stage I hypertension. Because there are no compelling

indications for other treatment, a thiazide diuretic should be used initially

to treat the hypertension. Dietary and lifestyle changes should also be

recommended but are not sufficient for patients with stage I hypertension.

Other drugs may be added later if thiazide diuretic therapy fails

Question 7.7. An 80-year-old male patient will begin taking an b-antiadrenergic

medication. The primary care NP should teach this patient to: (Points : 2)

ask for assistance while bathing. restrict fluids to aid with diuresis.

take the medication in the morning with food. be aware that priapism is a

common side effect.

askforassistance while bathing.

All antihypertensives can cause orthostatic hypotension, so patients

should be cautioned to avoid sudden changes in position and to use

caution when bathing because a hot bath or shower may aggravate dizziness.

Older patients are at increased risk for falls and should be cautioned to ask for

assistance. Patients taking a-antiadrenergics should consume extra fluids

because dehydration can increase the risk of orthostatic hypotension. Patients

should take the medication

at bedtime because drowsiness is a common side effect. Priapism is not a side

effect of these drugs.

Question 8.8. A patient who is taking nifedipine develops mild edema of both feet.

The primary care NP should contact the patient’s cardiologist to discuss: (Points : 2)

Mild to moderate peripheral edema occurs in the lower extremities in about

10% of patients; this is caused by arterial dilation, not by left ventricular dysfunction.

Amlodipine

is less likely to have this effect. Renal function tests are not indicated. Increasing the

nifedipine dose would worsen the symptoms.

Question 9.9. 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: (Points : 2)

atorvastatin (Lipitor). gemfibrozil (Lopid). cholestyramine (Questran).

lovastatin/niacin (Advicor).

HMG-CoA reductase inhibitors are used to treat hyperlipidemia when

the LDL is the primary lipid elevation. This patient has risk factors of being

a man older than 45 years, with a positive family history of coronary heart

disease before age 55 in a male first-degree relative. Gemfibrozil is used for patient

with elevated triglycerides and low HDL. Bile acid sequestrants are

used as adjunctive and not first-line therapy for reducing LDL.

A combination product is not indicated for first-line therapy.

Question 10.10. A patient with type 2 diabetes mellitus takes metformin

(Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily.

At an annual physical examination, the BMI is 29 and hemoglobin

A1c is 7.3%. The NP should: (Points : 2)

change to therapy with colesevelam (Welchol).

add a third oral antidiabetic agent to this patient’s drug regimen.

enroll the patient in a weight loss program to achieve better glycemic control.

Question 11.11. A patient who is newly diagnosed with type 2 diabetes

mellitus has not responded to changes in diet or exercise. The patient is mildly obese and has a

fasting blood glucose of 130 mg/dL. The patient has normal renal function tests.

(SOLVED) NR508 Week 2 Quiz Full – 100%

NR 508 Week 2 Quiz, Chamberlain College of Nursing

Question 1.1. 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: (Points : 2)

amlodipine (Norvasc). isradipine (DynaCirc). verapamil HCl (Calan).

short-acting nifedipine (Procardia).

Verapamil and diltiazem are less likely to cause hypotension than

nifedipine and related drugs, such as isradipine and amlodipine.

Question 2.2. A patient who will begin using nitroglycerin for angina

asks the primary care NP how the medication works to relieve pain.

The NP should tell the patient that nitroglycerin acts to: (Points : 2)

dissolve atheromatous lesions. relax vascular smooth muscle.

prevent catecholamine release. reduce C-reactive protein levels.

Nitrates relax vascular smooth muscle via stimulation of intracellular

cyclic guanosine monophosphate production with the major effect being

to reduce myocardial oxygen demand. Nitrates do not dissolve atheromatous

lesions, prevent catecholamine release, or reduce C-reactive protein levels.

Question 3.3. A patient with Graves’ disease is taking methimazole.

After 6 months of therapy, the primary care NP notes normal T3 and T4

and elevated TSH. The NP should: (Points : 2)

Question 4.4. The primary care nurse practitioner (NP) sees a

patient in the clinic who has a blood pressure of 130/85 mm Hg.

The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL.

The NP calculates a body mass index of

Thepatient has a positive family history for cardiovascular disease.

The NP should: (Points : 2) prescribe a thiazide diuretic.

consider treatment with an angiotensin-converting enzyme inhibitor. reassure the patient that these findings are normal.

counsel the patient about dietary and lifestyle changes.

The patient’s blood pressure indicates prehypertension, but the patient

does not have cardiovascular risk factors such as hyperlipidemia or

hyperinsulinemia. The body mass index indicates that the patient is

overweight but not obese. Pharmacologic treatment is not recommended

for prehypertension unless compelling reasons are present. The findings

are not normal, so it is appropriate to counsel the patient about diet and exercise.

Question 5.5. A 45-year-old patient who has a positive family history

but no personal history of coronary artery disease is seen by the primary

care NP for a physical examination. The patient has a body mass index of 27

and a blood pressure of 130/78 mm Hg. Laboratory tests reveal low-density

lipoprotein, 110 mg/dL; high-density lipoprotein, 70 mg/dL; and triglycerides,

120 mg/dL. The patient does not smoke but has a sedentary lifestyle. The NP

should recommend: (Points : 2)

30 minutes of aerobic exercise daily. taking 81 to 325 mg of aspirin daily.

beginning therapy with a statin medication. starting a thiazide diuretic to treat

hypertension.

This patient is overweight but not obese, and blood lipids are within normal limits.

Blood pressure is not elevated. Exercise is recommended as an initial risk reduction

strategy because of its positive effects on blood pressure and blood lipids. Aspirin is generally given to patients older than 55 to

65 who are at risk. Statin medications and thiazide diuretics are not indicated.

Question 6.6. A patient has three consecutive blood pressure readings of

140/95 mm Hg. The patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL.

Creatinine clearance and cholesterol tests are normal. The primary care NP should order:

(Points : 2)

a b-blocker.

an angiotensin-converting enzyme inhibitor.

a thiazide diuretic.

dietary and lifestyle changes.

The patient has stage I hypertension. Because there are no compelling

indications for other treatment, a thiazide diuretic should be used initially

to treat the hypertension. Dietary and lifestyle changes should also be

recommended but are not sufficient for patients with stage I hypertension.

Other drugs may be added later if thiazide diuretic therapy fails

Question 7.7. An 80-year-old male patient will begin taking an b-antiadrenergic

medication. The primary care NP should teach this patient to: (Points : 2)

ask for assistance while bathing. restrict fluids to aid with diuresis.

take the medication in the morning with food. be aware that priapism is a

common side effect.

askforassistance while bathing.

All antihypertensives can cause orthostatic hypotension, so patients

should be cautioned to avoid sudden changes in position and to use

caution when bathing because a hot bath or shower may aggravate dizziness.

Older patients are at increased risk for falls and should be cautioned to ask for

assistance. Patients taking a-antiadrenergics should consume extra fluids

because dehydration can increase the risk of orthostatic hypotension. Patients

should take the medication

at bedtime because drowsiness is a common side effect. Priapism is not a side

effect of these drugs.