MCQs on Coronary Heart Disease (CHD) Pharmacology

1. A 55-year-old man with a history of angina pectoris

experiences chest pain at rest. Which medication class is MOST
appropriate for immediate relief of his symptoms?
(a) Beta-blocker **Can be used long-term, but not for immediate relief**
(b) Calcium channel blocker **Not the first-line choice for immediate
angina relief**
(c) Nitrate (e.g., nitroglycerin) **Correct: Promotes vasodilation
for immediate angina relief**
(d) Angiotensin-converting enzyme (ACE) inhibitor **Works for long-term
management, not immediate relief**
(e) Statin **Lowers cholesterol but doesn't provide immediate relief**
2. A 60-year-old woman with a history of chronic stable angina is
prescribed a beta-blocker medication. What is the PRIMARY
mechanism by which beta-blockers help manage angina pectoris?
(a) Decrease blood pressure by relaxing blood vessels **Can be a
secondary effect, but not primary**
(b) Increase heart rate and contractility to improve blood flow
**Incorrect: Opposing effect**
(c) Reduce heart rate and contractility, decreasing oxygen
demand **Correct: Reduces workload on the heart**
(d) Lower cholesterol levels to improve blood flow to the heart
**Incorrect: Different mechanism**
(e) Directly dilate coronary arteries to increase blood flow **Not the
primary mechanism**
3. A 70-year-old man with a history of myocardial infarction
(heart attack) is prescribed a statin medication. What is the
PRIMARY benefit of statins in managing CHD?
(a) Immediate relief of chest pain **Not the function of statins**
(b) Lowering blood pressure **Can have this effect, but not primary
benefit**
(c) Reducing blood clot formation **Not the primary mechanism for
CHD**
(d) Lowering low-density lipoprotein (LDL) cholesterol **Correct:
Reduces plaque buildup in arteries**
 (e) Increasing high-density lipoprotein (HDL) cholesterol **Not the
primary benefit**
4. A 45-year-old woman with a family history of CHD is at
increased risk for the disease. Her doctor recommends a low-dose
aspirin regimen. Aspirin's mechanism of action in this context is
PRIMARILY to:
(a) Lower blood pressure **Not the primary mechanism**
(b) Reduce inflammation **May have anti-inflammatory effects, but not
primary**
(c) Lower cholesterol levels **Not a function of aspirin**
(d) Inhibit blood clot formation (antiplatelet effect) **Correct:
Reduces risk of clots blocking coronary arteries**
(e) Increase blood flow to the heart **Not a direct effect**
5. A patient with CHD experiences side effects from a medication
used to manage the condition. The nurse should:
(a) Discontinue the medication without consulting the healthcare
provider. **Incorrect: Potentially dangerous**
(b) Reassure the patient the side effects are normal and will go away.
**Not always true**
(c) Document the side effects and report them to the healthcare
provider for further evaluation. **Correct: Allows for potential
medication adjustments**
(d) Encourage the patient to find alternative medications on their own.
**Incorrect: Can be dangerous**
(e) Tell the patient to "tough it out" because the benefits outweigh the
side effects. **Unprofessional and may discourage communication**
Bonus! Matching:
Match the following medication class with its mechanism of action and a
common side effect:

Medication Common Side

Mechanism of Action
Class Effect

A. Beta- 1. Reduce heart rate and

a. Fatigue
blockers contractility
 B. Statins 2. Lower LDL cholesterol b. Muscle aches

C. Nitrates 3. Promote vasodilation c. Headache

## More MCQs on Coronary Heart Disease (CHD) Pharmacology:

**Advanced Considerations:**

1. A 50-year-old woman with CHD is experiencing breakthrough chest pain

despite taking a beta-blocker medication. Which medication class might
be a suitable ADD-ON therapy to consider?

(a) Diuretic **Not typically used for angina**

(b) Calcium channel blocker **Correct: Can improve blood flow
and reduce angina**
(c) ACE inhibitor **May be used for long-term management but not for
immediate angina relief**
(d) Statin **Important for long-term management but doesn't address
immediate angina**
(e) Antibiotic **Not useful for CHD**

2. A 65-year-old man with CHD and a history of heart failure is considering

a new medication for angina. Beta-blockers might be contraindicated in
this case because they can:

(a) Lower blood sugar levels **Incorrect: Not a typical side effect**
(b) Cause weight gain **Possible side effect, but not the main
concern**
(c) Worsen heart failure symptoms by further weakening the
heart **Correct: Can be detrimental for heart failure**
(d) Increase blood pressure **Not a typical effect**
 (e) Reduce cholesterol levels **Not the main mechanism of action**

3. A 70-year-old woman with CHD is prescribed a new antiplatelet

medication (e.g., clopidogrel) in addition to aspirin. This combination
therapy is used because:

(a) Aspirin alone is not effective enough for all CHD patients
**Correct: Provides additional antiplatelet effect**
(b) Statins are not effective for patients already taking aspirin
**Incorrect: Both can be used together**
(c) Beta-blockers lose their effectiveness over time **Not necessarily
true**
(d) Nitrates are not recommended for long-term use **Correct for
some types, but nitrates can be used long-term in certain cases**
(e) Calcium channel blockers can cause kidney problems **Possible
side effect, but not the main reason for combination therapy**

4. A patient with CHD experiences dizziness as a side effect of a new

medication. Dizziness can be a side effect of several CHD medications,
including:

(a) Statins only **Not a typical side effect**

(b) Beta-blockers **Correct**
(c) Nitrates **Correct**
(d) None of the above **Incorrect: Both beta-blockers and nitrates can
cause dizziness**
(e) All of the above **Correct: Statins are less likely to cause dizziness,
but all three can potentially have this side effect**

5. A nurse educating a patient about CHD medications emphasizes the

importance of taking medications as prescribed, even if they feel well.
Why is this important?

(a) To prevent medication withdrawal symptoms **May occur with

some medications, but not the main reason**
 (b) To maintain consistent blood levels of the medication for
optimal effect **Correct: Ensures continuous control of CHD**
(c) To avoid developing a tolerance to the medication **Less common
concern for most CHD medications**
(d) To prevent addiction to the medication **Not a typical concern for
CHD medications**
(e) To reduce the risk of side effects **Incorrect: Taking medications as
prescribed can actually minimize side effects**

Common CHD Pharmacology MCQs:

1. A 50-year-old man with a history of angina experiences chest pain at rest.

Which medication class is MOST appropriate for immediate relief of his
symptoms?
(a) Beta-blocker **Not for immediate relief, but for long-term
management**
(b) Calcium channel blocker **Not the first-line choice for immediate
angina relief**
(c) Nitrate (e.g., nitroglycerin) **Correct: Promotes vasodilation
for immediate relief**
(d) Angiotensin-converting enzyme (ACE) inhibitor **Works for long-
term management, not immediate relief**
(e) Statin **Lowers cholesterol but doesn't provide immediate
relief**

2. A 60-year-old woman with chronic stable angina is prescribed a beta-blocker

medication. What is the PRIMARY mechanism by which beta-blockers help
manage angina pectoris?
(a) Decrease blood pressure by relaxing blood vessels **Can be a
secondary effect, but not primary**
(b) Increase heart rate and contractility to improve blood flow
**Incorrect: Opposing effect**
(c) Reduce heart rate and contractility, decreasing oxygen demand
**Correct: Reduces workload on the heart**
(d) Lower cholesterol levels to improve blood flow to the heart
**Incorrect: Different mechanism**
(e) Directly dilate coronary arteries to increase blood flow **Not
the primary mechanism**

3. A 70-year-old man with a history of myocardial infarction (heart attack) is

prescribed a statin medication. What is the PRIMARY benefit of statins in
managing CHD?
 (a) Immediate relief of chest pain **Not the function of statins**
(b) Lowering blood pressure **Can have this effect, but not primary
benefit**
(c) Reducing blood clot formation **Not the primary mechanism for
CHD**
(d) Lowering low-density lipoprotein (LDL) cholesterol **Correct:
Reduces plaque buildup in arteries**
(e) Increasing high-density lipoprotein (HDL) cholesterol **Not the
primary benefit**

4. A 45-year-old woman with a family history of CHD is at increased risk for the
disease. Her doctor recommends a low-dose aspirin regimen. Aspirin's
mechanism of action in this context is PRIMARILY to:
(a) Lower blood pressure **Not the primary mechanism**
(b) Reduce inflammation **May have anti-inflammatory effects, but not
primary**
(c) Lower cholesterol levels **Not a function of aspirin**
(d) Inhibit blood clot formation (antiplatelet effect) **Correct:
Reduces risk of clots blocking coronary arteries**
(e) Increase blood flow to the heart **Not a direct effect**

5. A patient with CHD experiences side effects from a medication used to

manage the condition. The nurse should:
(a) Discontinue the medication without consulting the healthcare
provider. **Incorrect: Potentially dangerous**
(b) Reassure the patient the side effects are normal and will go away.
**Not always true**
(c) Document the side effects and report them to the healthcare
provider for further evaluation. **Correct: Allows for potential
medication adjustments**
(d) Encourage the patient to find alternative medications on their
own. **Incorrect: Can be dangerous**
(e) Tell the patient to "tough it out" because the benefits outweigh
the side effects. **Unprofessional and may discourage communication**

Structured Questions with Answers:

Scenario 1: 65-year-old man with a history of CHD experiences breakthrough

chest pain despite taking a beta-blocker medication.
a) What are two additional medication classes that could be considered as
add-on therapy for this patient's angina?
1. Calcium channel blockers: These medications relax blood vessels and
improve blood flow to the heart, which can help reduce angina frequency and
severity.
 2. Short-acting nitrates: While not typically used for long-term control, nitrates
can be helpful for immediate relief of angina symptoms.
b) Why might a healthcare provider be cautious about prescribing a rano-
angiotensin system (RAS) inhibitor in this case?
RAS inhibitors can lower blood pressure. If the patient's blood pressure is already on
the low side, adding another blood pressure-lowering medication could worsen
symptoms like dizziness or fatigue. Additionally, some RAS inhibitors may not be
ideal for patients with certain heart failure presentations.
**Scenario 2: 70-year-old woman with CHD is newly prescribed clopidogrel (Plavix)
in addition to her
## Common CHD Pharmacology MCQs (continued):

**Advanced Considerations:**

1. A 40-year-old woman with controlled CHD experiences significant

fatigue as a side effect of her beta-blocker medication. What is a potential
alternative medication class the doctor might consider?

(a) Diuretic **Not typically used for angina or fatigue**

(b) Statin **Not for managing fatigue**
(c) Calcium channel blocker **Can be a good alternative for
some patients with angina and less fatigue as a side effect**
(d) ACE inhibitor **Not the first choice for managing fatigue**
(e) Aspirin **Not for managing fatigue**

2. A 55-year-old man with CHD and a history of heart failure experiences

worsening shortness of breath after starting a new medication. Beta-
blockers can worsen heart failure symptoms. What is the MOST likely
reason for this?

(a) Beta-blockers can increase blood pressure. **Incorrect: They

typically lower blood pressure**
(b) Beta-blockers can cause weight gain. **Possible side effect, but not
the main concern here**
 (c) Beta-blockers weaken the heart muscle, making it harder to pump
blood. **Correct: Can worsen heart failure**
(d) Beta-blockers raise cholesterol levels. **Incorrect**
(e) Beta-blockers directly damage the lungs. **Incorrect**

3. A 60-year-old woman with CHD is prescribed a new medication for

cholesterol management. She asks the nurse if this medication will help
prevent future heart attacks. The most accurate response is:

(a) Yes, this medication will definitely prevent future heart attacks.
**Overly optimistic, other factors contribute to risk**
(b) No, medication cannot prevent heart attacks. **Too negative,
medications can help reduce risk**
(c) This medication can significantly lower your risk of heart
attack, but it's not a guarantee. **Correct: Risk reduction, not
absolute prevention**
(d) It depends on the severity of your CHD. **True, but doesn't address
the medication's role**
(e) We won't know for sure until you start taking the medication. **Not
helpful, medications have established benefits**

4. A patient with CHD forgets to take their medication one day. The best
course of action depends on the specific medication. The nurse should
advise the patient to:

(a) Take a double dose the next day. **Incorrect: Can be dangerous for
some medications**
(b) Stop taking the medication altogether. **Incorrect: Disrupts
treatment plan**
(c) Call their doctor for specific instructions. **Correct: Ensures safe
approach**
(d) Take two doses of the medication immediately. **Can be dangerous
for some medications**
(e) It doesn't matter if they miss one dose. **Incorrect: Consistency is
important**
5. A nurse educating a patient about CHD medications emphasizes the
importance of taking medications as prescribed, even if they feel well.
Why is this important?

(a) To prevent medication withdrawal symptoms. **May be a concern

for some medications, but not the main reason here**
(b) To maintain consistent blood levels of the medication for
optimal effect. **Correct: Ensures continuous control of CHD**
(c) To develop a tolerance to the medication more slowly. **Less
common for most CHD medications**
(d) To avoid a rebound effect of worsening symptoms if the medication is
stopped. **Can be true for some medications, but not the main reason
here**
(e) Because stopping medications can cause addiction. **Incorrect: Not
typical for CHD medications**