Which of the following antihypertensive drug classes is absolutely contraindicated in this woman?

Correct Answer: B

Rationale: The correct answer is B. ACE inhibitors are absolutely contraindicated in this woman due to her history of gouty arthritis, as these drugs can worsen the condition. ACE inhibitors can increase levels of uric acid in the blood, leading to gout attacks. Therefore, it is important to avoid ACE inhibitors in patients with a history of gout.

Correct Answer: D

Rationale: In the context of managing angina pectoris, maximal medical therapy aims to address the underlying mechanisms contributing to myocardial ischemia. The correct answer, option D (Isosorbide, atenolol, diltiazem), represents a comprehensive approach targeting different aspects of angina treatment. Isosorbide is a nitrate that dilates coronary arteries, reducing myocardial oxygen demand. Atenolol, a beta-blocker, decreases heart rate and contractility, reducing myocardial workload. Diltiazem, a calcium channel blocker, dilates coronary arteries and reduces myocardial oxygen demand by decreasing contractility and heart rate. Option A (Diltiazem, verapamil, nitroglycerin) includes two calcium channel blockers which, when combined, can lead to excessive vasodilation and negative inotropic effects. Nitroglycerin provides acute relief but is not part of maximal long-term therapy. Option B (Atenolol, isoproterenol, diltiazem) includes an inappropriate use of isoproterenol, a non-selective beta-agonist, which can worsen angina due to increased myocardial oxygen demand. Option C (Verapamil, nifedipine, propranolol) combines two calcium channel blockers with a beta-blocker, which can lead to excessive negative inotropic effects and bradycardia, potentially worsening angina symptoms. Educationally, understanding the rationale behind maximal medical therapy for angina helps students appreciate the multifactorial approach needed to effectively manage this condition. It underscores the importance of balancing oxygen supply and demand in the ischemic heart to alleviate symptoms and improve patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Verapamil. Propranolol, a beta-blocker, should not be prescribed for a patient with angina pectoris who is already receiving Verapamil, a calcium channel blocker. This combination can cause additive negative effects on the heart, such as excessive slowing of the heart rate and decreased cardiac contractility, potentially leading to serious cardiac complications. Nifedipine (Option A), Felodipine (Option B), and Isosorbide mononitrate (Option D) are not contraindicated with Propranolol in the context of treating angina pectoris. Nifedipine and Felodipine are also calcium channel blockers but belong to the dihydropyridine class, which does not have the same negative interactions with beta-blockers like Propranolol. Isosorbide mononitrate is a nitrate that is commonly used in combination with beta-blockers for managing angina. Educationally, understanding the interactions between different classes of cardiovascular drugs is crucial for safe and effective pharmacological management. It is essential for nurses to be aware of potential drug interactions to prevent adverse outcomes and to ensure optimal patient care. In this case, the rationale emphasizes the importance of knowing which drug combinations to avoid in patients with angina pectoris to prevent harmful effects on the cardiovascular system.

Correct Answer: A

Rationale: In the context of cardiovascular drugs in nursing pharmacology, understanding the effects of different stimulants on the heart is crucial for safe and effective patient care. In this question, the correct answer is A) Adrenaline. Adrenaline, also known as epinephrine, is the most potent stimulant for the heart due to its direct action on beta-1 adrenergic receptors in the heart. When adrenaline binds to these receptors, it increases heart rate, contractility, and conduction velocity, leading to a stronger and faster heartbeat. Noradrenaline (option B) primarily acts on alpha-1 adrenergic receptors, causing vasoconstriction rather than direct stimulation of the heart. Dopamine (option C) can stimulate both beta-1 and alpha-1 receptors depending on the dose used, but it is not as potent a stimulant for the heart as adrenaline. Ephedrine (option D) is a non-selective adrenergic agonist that acts on both alpha and beta receptors, but it is not as specific or potent for cardiac stimulation as adrenaline. Educationally, this question highlights the importance of understanding the pharmacological properties of different stimulants and their specific effects on the cardiovascular system. Nurses need to be able to differentiate between these drugs to make informed decisions in clinical practice, such as in emergency situations where a potent cardiac stimulant like adrenaline may be required. Understanding the mechanisms of action of these drugs also helps nurses anticipate and manage potential side effects and complications.

Correct Answer: A

Rationale: In teaching a client about ACE inhibitors, it is crucial to discuss potential side effects to promote awareness and adherence. The correct answer is A) Cough. ACE inhibitors commonly cause a dry, persistent cough due to increased bradykinin levels. This side effect can be bothersome but is typically not harmful and often resolves upon discontinuation of the medication. Option B) Bradycardia is incorrect because ACE inhibitors do not typically cause a slowing of the heart rate. In fact, they are more likely to have a neutral or even a beneficial effect on heart rate. Option C) Hypokalemia is also incorrect. While ACE inhibitors can lead to hyperkalemia (high potassium levels) in some cases, hypokalemia (low potassium levels) is not a typical side effect. Option D) Weight gain is not associated with ACE inhibitors. In fact, ACE inhibitors are more likely to have a neutral or even a slight diuretic effect that could lead to weight loss or maintenance. Educationally, understanding these side effects helps the client monitor for and report any concerning symptoms while taking ACE inhibitors. It also underscores the importance of medication adherence and the need for open communication with healthcare providers regarding any side effects experienced.