Practice Midterm Test

An antibiotic is defined as:

any substance that can kill bacteria
any chemical that can kill microbes
products produced by organisms to inhibit other organisms
a drug used to treat colds and flu

The MIC is the ____ of a drug that is required to inhibit growth of a microbe.
largest concentration
standard dose
smallest concentration
lowest dilution

A 56-year-old patient who has no previous history of hypertension or other health problems suddenly
develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for
the nurse to tell the patient that
a BP recheck should be scheduled in a few weeks.
dietary sodium and fat content should be decreased.
there is an immediate danger of a stroke and hospitalization will be required.
diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.

All of the following are effects of Nitrates except?

Peripheral Artery Vasodilation
Reduction of peripheral arterial resistance
decrease after load
reduced venous load

A primary hypertension/ or essential hypertension is caused by:

Medications such as pain relievers
Diseases such as obesity and kidney disease
Diabetes
no known cause

Which step in RAAS pathway is mediated by Angiotensin Converting Enzyme

Angiotensinogen to Angiotensin 1
Step catalyzed by Renin
Angiotensin 1 to Angiotensin 2
Action of Angiotensin 2 on AT-2 receptors

All of the following are common calcium channel blockers. Which of these are not correctly paired
with its onset of action?
Nifedipine - 20 minutes
Verapamil - 1 to 2 hours
Diltiazem - 1 hour
Nicardifine - 20 minutes
A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril
(Capoten) for the management of heart failure. Which assessment finding by the home health nurse
is a priority to communicate to the health care provider?
Presence of 1 to 2+ edema in the feet and ankles
Palpable liver edge 2 cm below the ribs on the right side
Serum potassium level 3.0 mEq/L after 1 week of therapy
Weight increase from 120 pounds to 122 pounds over 3 days

It is safe to take any over-the-counter medication along with your prescription medication since over-
the-counter drugs do not require a prescription from a doctor.
True
False

A patient has just been diagnosed with hypertension and has been started on captopril (Capoten).
Which information is important to include when teaching the patient about this medication?
Check blood pressure (BP) in both arms before taking the medication.
Increase fluid intake if dryness of the mouth is a problem.
Include high-potassium foods such as bananas in the diet.
Change position slowly to help prevent dizziness and falls.

A nurse is caring for four clients. Which one should the nurse see first?
Client who needs a beta blocker, and has a blood pressure of 92/58 mm Hg
Client who had a first dose of captopril (Capoten) and needs to use the bathroom
Hypertensive client with a blood pressure of 188/92 mm Hg
Client who needs pain medication prior to a dressing change of a surgical wound

The nurse working on the heart failure unit knows that teaching an older female patient with newly
diagnosed heart failure is effective when the patient states that
she will take furosemide (Lasix) every day at bedtime.
the nitroglycerin patch is applied when any chest pain develops.
she will call the clinic if her weight goes from 124 to 128 pounds in a week.
an additional pillow can help her sleep if she is feeling short of breath at night.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF)
requires the most immediate action by the nurse?
Oxygen saturation of 88%
Weight gain of 1 kg (2.2 lb)
Heart rate of 106 beats/minute
Urine output of 50 mL over 2 hours

Osmotic- mannitol
Neptazane
Diamox
Osmitrol

A diastolic pressure of 80 - 89
normal blood pressure
prehypertension
hypertension stage 1
hypertension stage 2
.is hypertension inherited mainly?
yes
no

2 ANSWERS. ANSWER ALL THAT APPLIES.

Stable angina is usually caused by obstruction of the coronary arteries. Which of the following
classification of drugs is not correctly paired with its generic drug?
Nitrates - Nitroglycerin
Beta Blockers - Spironolactone
Calcium Channel Blockers - Nifedipine
Calcium Channel Blockers – Propanolol

Patient presents to the ED with chest pain and a BP of 200/120. She has a history of HTN and she's
pregnant. What would be the best agent to initiate?
Labetalol
Nitroprusside
Nicardipine
Captopril

Decreases heart rate, blood pressure, and cardiac contractility without appreciable decrease in
cardiac output
Alpha Blockers
Nitrates
Calcium Channel Blockers
Beta Blockers

Crosses the BBB

timolol
propranolol
metoprolol
carvedilol

Usual dosage for Nitroglycerin tablets.

0.5 to 1.5 mg
0.5 to 1.2 grams
0.7 to 1.5 mg
0.5 to 1.2 mg

Which of the following is false about angina pectoris?

principal symptom of patients with ischemic heart disease
sudden, severe, substernal pain
radiates along the right shoulder most of the time and to the flexor group of muscles
usually caused by exercise or heavy meal

Which of the following is NOT a limitation to use of nitroprusside?

Risk of cyanide accumulation
Development of tachyphylaxis
Must be protected from light
Difficult to titrate
Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical
manifestations of heart failure. The nurse anticipates discharge teaching will include information
about
digitalis preparations
b-adrenergic blockers.
calcium channel blockers.
angiotensin-converting enzyme (ACE) inhibitors.

An antimicrobial drug with a _____ therapeutic index is a better choice that one with a _____
therapeutic index.
low, high
high, low

what is the natural pacemaker of the heart?

The SA node in the right atrium
the AED
The SA node in the left atrium
the AV node and Bundle of His

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with
acute shortness of breath has heart failure?
Serum troponin
Arterial blood gases
B-type natriuretic peptide
12-lead electrocardiogram

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess
first?
A patient who is cool and clammy, with new-onset confusion and restlessness
A patient who has crackles bilaterally in the lung bases and is receiving oxygen.
A patient who had dizziness after receiving the first dose of captopril (Capoten)
A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on
the left lower leg?
Need to increase carbohydrate intake
Methods of keeping the wound area dry
Purpose of prophylactic antibiotic therapy
Application of elastic compression stockings

Prescription drug abuse and prescription drug misuse mean the exact same thing.
True
False

All of these antibiotics inhibit protein synthesis EXCEPT:

Erythromycin
Streptomycin
Tetracyclin
Vancomycin

2 ANSWERS. CHOOSE ALL THAT APPLIES.

Combination of drugs that are useful in severe vasospastic or exertional angina with congestive
heart failure and sick sinus syndrome.
Beta Blockers
Nitrates
Calcium Channel Blockers
NOTA

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should
consult with the health care provider before giving this medication when the patient reveals a history
of
asthma.
daily alcohol use
peptic ulcer disease.
myocardial infarction (MI).
Which agent is effective across multiple comorbidities (ACS, ARF, eclampsia, etc.)
Nicardipine
Phentolamine
Hydralazine
Fenoldopam

The following route of administration will provide the highest concentration of drugs in the blood
Intavascular
Intradermal
Intramuscular
Oral

Thiazide-hydrochlorothiazide
HCTZ, Microzide
Diamox
Lasix

What happens in the body when the blood pressure is high?

Walls of arteries get stretched and damaging
The body suffers a series of mild heart attacks

ACEI mainly causes

Hyperakalemia
Hypokalemia
Hypoglycemia
Sepsis

Which of the following modes of action would be most selectively toxic?

interrupting ribosomal function
dissolving the cell membrane
preventing cell wall synthesis
inhibiting DNA replication
Adverse effects of Nitrates are all of the following except?
throbbing headache
flushing of the face
dizziness at the end of the treatment
postural hypotension

A patient at the clinic says, “I have always taken a walk after dinner, but lately my leg cramps and
hurts after just a few minutes of starting. The pain goes away after I stop walking, though.” The
nurse should
check for the presence of tortuous veins bilaterally on the legs.
ask about any skin color changes that occur in response to cold.
assess for unilateral swelling, redness, and tenderness of either leg.
assess for the presence of the dorsalis pedis and posterior tibial pulses.

Which statement is not an aim in the use of drugs in antimicrobial chemotherapy? The drug should
have selective toxicity
be active even in high dilutions
be broken down and excreted rapidly
be microbicidal
Spironolactone works on the ...... of the nephron.
proximal convoluted tubule
distal convoluted tubule
loop of Henle
collecting duct

Select a drug or drugs that can prevent a viral nucleic acid from being replicated.
azidothymidine
acyclovir
amantadine
both a and b

Diuretics can be used for the following conditions EXCEPT

Heart Failure
Edema
Fluid in the lungs
Diabetes

A patient with a hx of HTN presents to the outpatient clinic with a BP of 185/110. ROS and PE
normal other than elevated BP. What is your recommendation?
Send patient to the ER
Initiate clonidine and optimize BP medications
Initiate nifedipine and optimize BP medications
Initiate esmolol IV

Which formulation should not be used for hypertensive crisis because of erratic PK?
IM
IV
PO
SL

Which of the following is a side effect of Spironolactone?

Hypokalemia
Hyperkalemia
Ototoxicity

A relative of an in-patient for stable angina asked you that he is not familiar with the term "stable"
angina. You tried to explain it using other known names for stable angina. Which of the following is
not another term for stable angina?
Exertional
Crescendo
Fixed
Classic

When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery
disease (PAD), which instructions should the nurse include?
Exercise only if you do not experience any pain.”
“It is very important that you stop smoking cigarettes.”
Try to keep your legs elevated whenever you are sitting.”
“Put elastic compression stockings on early in the morning.”

Find out the lysine derivative of enalaprilat using the following emoji
Enalapri
Lisinopril
Captopril
Verapamil

Indapamide acts on the .............. of the nephron.

collecting duct
Loop of Henle
Distal Convoluted Tubule
Proximal Convoluted Tubule

which vessel takes blood from the lower portion of the body and returns it to the heart?
the aorta
the right atrium
the inferior vena cava
the superior vena cava

A method of drug administration used for gradual absorption of the anti-anginal drug for prolonged
prophylactic purpose.
Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure
and an ejection fraction of 33%?
Need to begin an aerobic exercise program several times weekly
Use of salt substitutes to replace table salt when cooking and at the table
Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
Importance of making an annual appointment with the primary care provider

2 ANSWERS. CHOOSE ALL THAT APPLIES.

Mr. P.D was diagnosed with Prinzmetal Angina. Upon checking for his medical history, which of the
following combination of drugs could have been prescribed to him by the doctor?
Nitrates
Calcium Channel Blockers
Beta Blockers
Alpha Blockers

Bacteria would likely obtain the beta-lactamase enzyme via:

mutation of existing genes
horizontal gene transfer
radiation treatment

R factors are _____ that contain a code for ______.

genes, replication
plasmids, drug resistance
transposons, interferon
plasmids, conjugation
Which of the following effects do antiviral drugs not have?
killing extracellular viruses
stopping virus synthesis
inhibiting virus maturation
blocking virus receptors

An unusually rapid heart rate: over 100 bpm

Tachycardia
Tachypnea
Metabolism
A problem

what valve does blood pass through when it's going from the right atrium and ventricle?
The tricuspid valve
the aortic valve
the pulmonary valve
the mitral valve

Nitroglycerin typically isn't recommended except...

As an adjunct agent in acute MI
For pregnant patients
For cocaine overdose
For cyanide overdose

Which of the following is a Levine Sign?

Which of the following is an aldosterone antagonist?

Frusemide
Spironolactone
Mannitol

Fatima has blood pressure 183/81, what is Fatima's systolic pressure?

81
183
183/81
81/183

Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne)
to a patient with hypertension?
Encourage the use of hard candy to prevent dry mouth.
Instruct the patient to ask for help if heart palpitations occur.
Ask the patient to request assistance when getting out of bed.
Teach the patient that headaches may occur with this medication.

It is safer to abuse prescription drugs than street drugs.

True
False

what layer of the heart is damaged in a heart attack?

endocardium
epicardium
pericardium
myocardium

which of these diseases is related to hypertension?

peptic ulcer
diabetes
pneumonia

What is "normal" blood pressure

120/110 mmHg
120/80 mmHg
100/80 mmHg
140/80 mmHg

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with
hypertension. Which result is most important to communicate to the health care provider?
Serum creatinine of 2.8 mg/dL
Serum potassium of 4.5 mEq/L
Serum hemoglobin of 14.7 g/dL
Blood glucose level of 96 mg/dL

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a
hypertensive emergency. Which finding is most important to report to the health care provider?
Urine output over 8 hours is 250 mL less than the fluid intake.
The patient cannot move the left arm and leg when asked to do so.
Tremors are noted in the fingers when the patient extends the arms.
The patient complains of a headache with pain at level 8/10 (0 to 10 scale).

Lopressor
atenolol
metoprolol
Inderal
propranolol

Chronic high BP is called...

Hypertrophy
Atrophy
Hypertension
Hyperatrophy

It is safe to take a prescription medicine that has expired as long as it is your own prescription.
True
False

Low blood pressure

diastolic pressure
systolic pressure
hypotension
hypertension

Prescription drug abuse is against the law.

True
False
A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme
(ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea
and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first?
“Did you take any acetaminophen (Tylenol) today?”
“Have you been consistently taking your medications?”
“Have there been any recent stressful events in your life?”
“Have you recently taken any antihistamine medications?”

How many chambers does your heart have?

1
2
3
NOTA

During change-of-shift report, the nurse obtains the following information about a hypertensive
patient who received the first dose of nadolol (Corgard) during the previous shift. Which information
indicates that the patient needsimmediate intervention?
The patient’s most recent blood pressure (BP) reading is 158/91 mm Hg.
The patient’s pulse has dropped from 68 to 57 beats/minute.
The patient has developed wheezes throughout the lung fields.
The patient complains that the fingers and toes feel quite cold.

Most antihelminthic drugs function by

weakening the worms so they can be flushed out by the intestine
inhibiting worm metabolism
blocking the absorption of nutrients
inhibiting egg production

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess
first?
Patient who is taking carvedilol (Coreg) and has a heart rate of 58
Patient who is taking digoxin and has a potassium level of 3.1 mEq/L
Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache
Patient who is taking captopril (Capoten) and has a frequent nonproductive cough
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be
implemented, which diet choice indicates that the teaching has been effective?
The patient avoids eating nuts or nut butters.
The patient restricts intake of chicken and fish.
The patient has two cups of coffee in the morning.
The patient has a glass of low-fat milk with each meal.

What is a probable reason that tuberculosis therapy must continue for several months?
to prevent drug resistance
to keep the infection from spreading
the TB bacillus grows very slowly
the drugs are slow acting
These are all unwanted effects of Calcium Channel Blockers except?
Nausea
Vomitting
Flushing of the face
Bradycardia

The following processes occur in the nephron EXCEPT

secretion
absorption
filtration
reabsorption

A patient who has chronic heart failure tells the nurse, “I was fine when I went to bed, but I woke up
in the middle of the night feeling like I was suffocating!” The nurse will document this assessment
finding as
orthopnea.
pulsus alternans.
paroxysmal nocturnal dyspnea.
acute bilateral pleural effusion.

An unusually slow heartbeat

Tachycardia
Bradypnea
Tachypnea
Bradycardia

Beta-lactamase is:
an enzyme our cells use to attack the cell walls of bacteria
an enyzyme bacteria use to break down certain antibiotics
an antimicrobial drug that inhibits cell wall synthesis
an antimicrobial drug that inhibits protein synthesis

Prescription drug abuse can lead to addiction.

True
False

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme
(ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight
gain in the last 3 days. The nurse’s priority action will be to
have the patient recall the dietary intake for the last 3 days.
ask the patient about the use of the prescribed medications.
assess the patient for clinical manifestations of acute heart failure.
teach the patient about the importance of restricting dietary sodium.

Loop- furosemide-
Diamox
Lasix
Osmitrol
Which beta-blocker is preferred for critically ill patients because of it's ultra-short acting properties?
Labetalol
Propranolol
Esmolol
Carvedilol

While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD)
with the head of the patient’s bed elevated 45 degrees. The nurse knows this finding indicates
decreased fluid volume.
jugular vein atherosclerosis.
increased right atrial pressure.
incompetent jugular vein valves.

The nurse on the intermediate care unit received change-of-shift report on four patients with
hypertension. Which patient should the nurse assess first?
43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain
52-year-old with a BP of 212/90 who has intermittent claudication
50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL
48-year-old with a BP of 172/98 whose urine shows microalbuminuria

ACEI and ARBs are not used in

Hypertension
Diabetic nephropathy
Myocardial Infarction
B/L Renal Artery stenosis

While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent
claudication. Which statement by the patient would support this information?
When I stand too long, my feet start to swell.”
“I get short of breath when I climb a lot of stairs.”
My fingers hurt when I go outside in cold weather.”
“My legs cramp whenever I walk more than a block.”

Relaxation of the heart

Systole
Asystole
Diastole
Cardiac Arrest

Ototoxicity is a side effect related to this diuretic.

acetazolamide
mannitol
frusemide
thiazide

When a patient's immune system becomes reactive to a drug, this is an example of

superinfection
drug resistance
allergy
toxicity

Frusemide belongs to .....

Loop diuretics
Carbonic anhydrase inhibitor
thiazide diuretics

Plasma half ife of Losartan

24-48 hours
1-2 hours
12-16 hours
9-10 hours

CCB
~olol
~sartan
~pril
~ipine

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD)
of the legs and an ulcer on the right second toe would expect to find
dilated superficial veins.
swollen, dry, scaly ankles.
prolonged capillary refill in all the toes.
a serosanguineous drainage from the ulcer.

Beta blockers
~pril
~olol
~ipine
~sartan

Microbial resistance to drugs is acquired through

conjugation
transformation
transduction
all of these

Vasotec
enalapril
lisinopril
propranolol
nifedipine

Misuse or abuse of prescription drugs can be deadly.

True
False
While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation,
the nurse determines that discharge teaching has been effective when the patient states that it will
be necessary to
take antibiotics before any dental appointments.
limit physical activity to avoid stressing the heart.
take an aspirin a day to prevent clots from forming on the valve.
avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

Antibiotics kill viruses

True
False

What helps prevent High Blood Pressure?

Physical Excersise
Stress Management
All of the Above
Low Sodium Diets

Of the following antibiotics, which inhibit cell wall synthesis--check ALL that apply.
Penicillins
Aldehydes
Tetracyclines
Cephalosporins

Name the agent under the class of carbonic anhydrase inhibitor.

Frusemide
Indapamide
Acetazolamide
Mannitol

can hypertension be completely cured?

yes
no

Why is high blood pressure or hypertension a 'silent' killer?

It has no sound
It has no symptoms
It kills people
It is a leading cause of death in the world

In the hospital, a folk of the patient was having severe chest pains. He said to you that this has been
going on for 15 minutes already. You called the attention of a doctor and knowing the patient's
ACE inhibitor
Vasotec
Lopressor
Cardizem
Coreg

Increased blood pressure over time can cause problems with the heart, blood vessels, kidneys and
even the brain
True
False

A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which
patient statement is most supportive of the diagnosis?
“I can’t get my shoes on at the end of the day.”
“I can’t seem to ever get my feet warm enough.”
“I have burning leg pains after I walk two blocks.”
“I wake up during the night because my legs hurt.”

This hormone is responsible to absorb water from the lumen.

Antidiuretic hormone (ADH)
Parathyroid
Aldosterone

A compound synthesized by bacteria of fungi that destroys or inhibits the growth of other microbes is
a/an
synthetic drug
antibiotic
antimicrobial drug
competitive inhibitor

All of these are common ways in which antimicrobial drugs affect cells except for:
inhibit cell wall synthesis
inhibit 70S ribosomes
inhibit DNA/RNA synthesis
denature proteins