Cardiac Vascular Nursing Exam Cardiac Vascular Nursing Exam Pharmacology & Medications 2 — Questions and Answers
Question 1: Which antiplatelet medication's mechanism involves irreversible inhibition of the P2Y12 receptor on platelets?
- Clopidogrel (Plavix) (Correct answer)
- Aspirin
- Eptifibatide (Integrilin)
- Abciximab (ReoPro)
Correct answer: Clopidogrel (Plavix)
Clopidogrel is an irreversible P2Y12 ADP receptor antagonist; its active metabolite permanently blocks the receptor, preventing ADP-mediated platelet activation for the platelet's 7–10 day lifespan.
Question 2: A nurse prepares to administer IV alteplase (tPA) for acute ischemic stroke. Which cardiac history represents an absolute contraindication?
- Any prior intracranial hemorrhage (Correct answer)
- Remote history of stable angina
- Prior coronary artery bypass graft (CABG) more than 3 months ago
- Controlled hypertension on antihypertensive medications
Correct answer: Any prior intracranial hemorrhage
Prior intracranial hemorrhage is an absolute contraindication to tPA because the fibrinolytic activity dramatically increases risk of re-bleeding into the previous hemorrhage site.
Question 3: Spironolactone improves outcomes in HFrEF through which pharmacological mechanism beyond its diuretic effect?
- Blocking aldosterone receptors reduces cardiac fibrosis and maladaptive remodeling (Correct answer)
- Increasing potassium excretion prevents arrhythmias
- Direct inhibition of angiotensin II at cardiac receptors
- Blocking beta receptors in addition to aldosterone receptors
Correct answer: Blocking aldosterone receptors reduces cardiac fibrosis and maladaptive remodeling
Aldosterone promotes cardiac and vascular fibrosis; spironolactone's blockade of myocardial aldosterone receptors reduces interstitial fibrosis and sympathetic activation independent of its diuretic effect.
Question 4: A patient receiving IV vasopressin for vasodilatory shock develops chest pain. The nurse suspects which complication related to vasopressin's mechanism?
- Coronary vasoconstriction causing myocardial ischemia (Correct answer)
- Vasopressin-induced pulmonary edema
- Aortic dissection from acute hypertension
- Allergic reaction to the synthetic peptide
Correct answer: Coronary vasoconstriction causing myocardial ischemia
Vasopressin (V1 receptor agonist) causes non-selective vasoconstriction including coronary arteries, potentially reducing myocardial perfusion and causing ischemia, especially in patients with CAD.
Question 5: Which monitoring parameter is most critical for a patient starting sacubitril/valsartan (Entresto) for heart failure?
- Blood pressure and renal function, as hypotension and worsening renal function are primary concerns (Correct answer)
- Liver enzymes, as hepatotoxicity is the primary adverse effect
- QT interval, as Entresto commonly causes ventricular arrhythmias
- Thyroid function, as neprilysin inhibition affects thyroid hormone metabolism
Correct answer: Blood pressure and renal function, as hypotension and worsening renal function are primary concerns
Sacubitril/valsartan lowers blood pressure significantly and can reduce renal perfusion; blood pressure and creatinine/potassium levels must be monitored at initiation and dose titration.
Question 6: Heparin-induced thrombocytopenia (HIT) requires immediate discontinuation of heparin and initiation of which alternative anticoagulant?
- A direct thrombin inhibitor such as argatroban or bivalirudin (Correct answer)
- Warfarin initiated immediately as monotherapy
- Low-molecular-weight heparin such as enoxaparin
- No anticoagulation until platelet count normalizes
Correct answer: A direct thrombin inhibitor such as argatroban or bivalirudin
HIT causes a prothrombotic state; all heparin products must be stopped and a non-heparin anticoagulant (direct thrombin inhibitor) started immediately to prevent thrombosis despite low platelets.
Cardiac Vascular Nursing Exam Cardiac Vascular Nursing Exam Pharmacology & Medications 2
Which antiplatelet medication's mechanism involves irreversible inhibition of the P2Y12 receptor on platelets?