Ch 43: Blood pressure meds

A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor? Aliskiren Candesartan Captopril Mecamylamine

Aliskiren

Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause? Valsartan Azilsartan Olmesartan Aliskiren

Aliskiren

Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure? bronchiole gastrointestinal sphincter intestinal wall superficial blood vessel

bronchiole

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker? Losartan Amlodipine Minoxidil Moexipril

Losartan Losartan is an example of an angiotensin II receptor blocker. Moexipril is an ACE inhibitor. Minoxidil is a vasodilator. Amlodipine is a calcium channel blocker.

A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Serum potassium levels Serum magnesium levels Blood glucose levels Serum calcium levels

Serum potassium levels

A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? Angiotensin II receptor blockers Selective aldosterone blockers Antihyperlipidemic drugs Calcium channel blockers

Angiotensin II receptor blockers

A 37-year-old client presents with a blood pressure of 128/78 mm Hg. What lifestyle change should the nurse suggest related to this assessment finding? "Get 7 to 8 hours of sleep each night." "Try to increase your intake of potassium-rich foods." "Be aware of your salt intake and limit hidden salt." "Explore the possible use of a calcium channel blocker with your health care provider."

"Be aware of your salt intake and limit hidden salt."

A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement? "Drugs like ramipril often cause a cough in clients; we should speak to the health care provider." "We should speak to the health care provider about immediately discontinuing the medication." "Coughing is an adverse effect of the medication that may lead to pneumonitis." "We need to obtain a sputum sample to see whether you have developed a respiratory infection."

"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider." ACE inhibitors like ramipril may precipitate a cough and may necessitate discontinuation of the drug. This is not, however, an emergency or an indication of lung infection or lung inflammation.

A male client who has been receiving verapamil for several months comes to the clinic reporting significant dizziness, light-headedness, and fatigue. He also reports frequent episodes of nausea and swelling of his ankles. Drug toxicity is suspected. Which question would be critical to ask the client? "Are you taking any over-the-counter pain relievers like ibuprofen?" "When did you take the last dose of the drug?" "Are your splitting or crushing your pills?" "Have you been drinking any grapefruit juice lately?"

"Have you been drinking any grapefruit juice lately?" Verapamil, like other calcium channel blockers, interacts with grapefruit juice, increasing the concentration of calcium channel blockers and leading to toxicity. Calcium channel blockers do not interact with ibuprofen. Splitting or crushing the pills could lead to a release of the drug all at once, but this is more common when the drug is first taken. Asking about the time the client last took the drug might be important, but it would not address the problem associated with the significant adverse effects.

A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question? "He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." "He's in shock because his heart rate is too low. The drug will help by increasing his heart rate significantly." "He's in shock because his heart can't pump effectively. This drug will help by increasing his heart rate significantly." "He's in shock because his blood vessels have dilated so severely. The drug will help by reversing that dilation."

"He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." Cardiogenic shock is caused by the myocardium's inability to contract efficiently and maintain an adequate cardiac output. Dobutamine is prescribed for treatment because it acts mainly on beta1 receptors in the heart to increase the force of myocardial contraction. It is less vasoactive than some other drugs and it causes a minimal increase in heart rate.

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response? "Decreases the cardiac output by diuresis of sodium and water." "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." "Blocks conversion of angiotensin I to angiotensin II." "Increases client's perception of pain and decreases the heart rate."

"It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries."

A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response? "Your diet and exercise are not effective and adding another drug is ideal." "Many clients require two or more drugs for high blood pressure." "You should talk to the prescriber for clarification about the medications. " "The prescriber has not read the current guidelines and needs an update."

"Many clients require two or more drugs for high blood pressure." Many clients require two or more drugs to achieve adequate blood pressure. Current guidelines suggest thiazide diuretic alone or with an angiotensin converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), or calcium channel blocker (CCB).

A nurse is caring for a client who has been prescribed captopril. Which instruction is important to include when teaching the client about the medication? "You can take this medication at different times each day." "The dosage will need to be evaluated each week." "Take this medication on an empty stomach." "This medication will decrease your heart rate."

"Take this medication on an empty stomach." Oral captopril should be taken on an empty stomach because food decreases drug absorption. Captopril is an angiotensin converting enzyme inhibitor (ACE-inhibitor) and will decrease the blood pressure by decreasing the conversion of angiotensin I to angiotensin II in the kidneys. It does not affect the heart rate. Blood pressure medications should be taken at the same time each day to avoid rebound hypertension. Captopril and blood pressure will be evaluated monthly to make sure a decrease in blood pressure is occurring.

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? "How much physical exercise do you get?" "When was your last menstrual period?" "Do you eat something when you take your medications?" "Have you always weighed 150 pounds?"

"When was your last menstrual period?" It would be important to know when the patient's LMP occurred and that the client is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the client who is beginning angiotensin II receptor blocker therapy.

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "Maybe you do not need medication with your history." "We always treat high blood pressure with medicine to prevent further damage to your body." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." "The effects of high blood pressure are different for different people."

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."

A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? 100/70 mm Hg 150/100 mm Hg 140/90 mm Hg 130/80 mm Hg

130/80 mm Hg The blood pressure goal for a client with diabetes or kidney disease is 130/80 mm Hg. Values of 140/90 mm Hg and 150/100 mm Hg indicate the blood pressure is not under good control. Blood pressure of 100/70 mm Hg can increase the risk or orthostatic hypotension.

A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? Another ARB A vasopressor An ACE inhibitor A diuretic

A diuretic When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. The addition of an ACE inhibitor, a vasopressor or another ARB is not appropriate.

A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information? Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced. ACE inhibitor therapy can continue during pregnancy. ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy. ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

ACE inhibitors are contraindicated during pregnancy because they are teratogenic. It is important to instruct women of childbearing age to take measures to prevent pregnancy while taking captopril or other ACE inhibitors because the drugs are teratogenic. This therapy must be discontinued if pregnancy occurs.

A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of: Absent reflexes Chest pain Pupil constriction Increased hair growth

Absent reflexes Manifestations of cyanide toxicity include absent reflexes, dilated pupils, dyspnea, headache, vomiting, dizziness, ataxia, loss of consciousness, imperceptible pulse, pink color, distant heart sounds, and shallow breathing. Hair growth is an adverse effect of minoxidil. Chest pain is an adverse effect associated with vasodilator therapy related to changes in blood pressure.

A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). What should the nurse explain is the hormone produced by the adrenal cortex? Aldosterone Renin Enalapril Angiotensin

Aldosterone

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? Baseline renal function A temporary increase in renal function A sustained decrease in renal function A sustained increase in renal dysfunction

Baseline renal function

The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock? Signs of sympathetic stimulation Hypertension Cool, moist skin Bradycardia

Bradycardia In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions? Tachypnea Bradypnea Bradycardia Tachycardia

Bradycardia When combined with ranitidine, calcium channel blockers can have an enhanced effect. Calcium channel blockers relax blood vessels, increase the supply of oxygen to the heart, and reduce the workflow, which may cause the heart to slow. Neither tachycardia, tachypnea, nor bradypnea are related to combining ranitidine with calcium channel blockers.

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? By preventing renin secretion By blocking the aldosterone receptors By blocking the angiotensin II receptors By preventing the conversion of angiotensin I

By blocking the angiotensin II receptors

When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone? Promotes angiotensin I conversion. Causes sodium and water retention. Causes excess potassium retention. Inhibits renin secretion.

Causes sodium and water retention.

The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Enalapril Clonidine Amlodipine Candesartan

Clonidine Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route.

Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases risk of liver disease Hypertension increases risk of stroke. Hypertension increases the workload of the heart. Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of colorectal carcinoma.

Hypertension increases risk of stroke. Hypertension increases the workload of the heart. Hypertension increases the buildup of atherosclerotic plaque.

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Cough GI irritation Constipation Photosensitivity

Cough Fosinopril is associated with an unrelenting cough that can lead clients to discontinue the drug. Constipation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. GI irritation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. Photosensitivity is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug.

The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock? Hypoperfusion of tissues Increased blood pressure Temperature Activation of infectious response

Hypoperfusion of tissues

A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Decreased alcohol consumption Smoking cessation Regular aerobic exercise Diet with more fruits and vegetables Focus on finding a different job

Decreased alcohol consumption Smoking cessation Regular aerobic exercise Diet with more fruits and vegetables Lifestyle management of a client diagnosed with primary hypertension should focus on aerobic exercise, improved diet, weight loss, decreased alcohol consumption, and decreased cigarette smoking. Client education should focus on stress management techniques, and finding a different job is not appropriate at this time.

A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.) Damage to the eyes Damage to the gall bladder Damage to the heart Damage to the pancreas Damage to the kidneys

Damage to the eyes Damage to the heart Damage to the kidneys

When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to: Increased stroke volume Decreased heart rate Decreased venous return Increased cardiac output

Decreased venous return

Key behavioral determinants of blood pressure are related to what factor? Dietary consumption of sugars and fat Comorbidities Dietary consumption of calories and salt Minimal body mass

Dietary consumption of calories and salt

A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do? Discontinue the drug Increase the dosage of the drug Maintain the current dosage of the drug Decrease the dosage of the drug

Discontinue the drug The FDA has issued a black box warning for ACE inhibitors and ARBs during pregnancy because their use can cause injury and even death to a developing fetus.

Which agent would the nurse anticipate administering intravenously to lower a patient's severely elevated blood pressure? Enalapril Enalaprilat Lisinopril Benazepril

Enalaprilat

Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Cerebral ischemia Stevens-Johnson syndrome Exacerbation of chronic cardiovascular conditions Increased intracranial pressure

Exacerbation of chronic cardiovascular conditions Clinicians use adrenergic agents to treat asthma, hypotension, shock, cardiac arrest, and anaphylaxis in older adults. These drugs stimulate the heart to increase rate and force of contraction and blood pressure. Because older adults often have chronic cardiovascular conditions (e.g., angina, arrhythmias, heart failure, coronary artery disease, hypertension, peripheral vascular disease) that are aggravated by adrenergic drugs, careful monitoring by the nurse is required. The actions of norepinephrine do not pose an increased risk for any of the other mentioned conditions.

An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect? Impaired oxygenation Infection Falls Acute confusion

Falls

A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action? Frequent assessment of the client's cardiac status Checking the client's blood glucose levels before each meal and at bedtime Close monitoring of the client's electrolyte levels Supervision of the client when performing activities of daily living

Frequent assessment of the client's cardiac status Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihy pertensive, but it is unnecessary to supervise all of the client's ADLs.

A client is receiving verapamil. What would be important for the nurse to stress that the client avoid? Apple juice Grapefruit juice Milk Yogurt

Grapefruit juice

A patient newly diagnosed with hypertension has just been given a prescription for medication. What would be the most important outcome for this patient? Having taken the first dose of medication A blood pressure of 120/80 Verbalization of why the client should take blood pressure medication A discussion with the client's insurance company about the cost of the drug

Having taken the first dose of medication All of the options are realistic outcomes for this patient. However, compliance is a great concern for people who are in need of hypertensive agents. It would be most important for the health care provider to know that the client has filled the prescription and has taken the first dose of medication.

A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe? Hydrochlorothiazide Digoxin Atorvastatin calcium Hydralazine hydrochloride

Hydrochlorothiazide

The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching? Hypernatremia Hyperkalemia Hypokalemia Hypermagnesemia

Hyperkalemia

A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe? Decreased cardiac output Orthostatic hypotension Increased heart rate Decreased heart rate

Increased heart rate Administration of isoproterenol increases heart rate and cardiac output. Although peripheral vascular resistance is always decreased, blood pressure may be increased or decreased.

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Instant bronchodilation Increased level of consciousness within 2 to 5 minutes An immediate increase in respiratory rate Immediate reduction of anxiety

Instant bronchodilation For acute asthma attacks, subcutaneous administration of epinephrine usually produces bronchodilation instantly; maximal effects may occur within 20 minutes helping to eventually decrease the respiratory rate. None of the remaining options identify expected results of subcutaneous epinephrine.

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. It binds selectively to the mineralocorticoid receptors. It inhibits the movement of calcium ions across cell membranes.

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. Nitroprusside, which is used in hypertensive crisis, directly relaxes vascular smooth muscle, allowing the dilation of peripheral arteries and veins. Angiotensin II receptor blockers block the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. Selective aldosterone blockers bind selectively to the mineralocorticoid receptors, thereby blocking aldosterone from binding to these receptors, while calcium channel blockers inhibit the movement of calcium ions across cell membranes.

A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long? 5 years One year Lifelong Until blood pressure is 120/80 mmHg

Lifelong Once primary hypertension develops, management of the disorder becomes a lifetime task. Diet and exercise with weight loss can help to lower blood pressure; however, there are many factors even genetics that contribute to hypertension.

A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Furosemide Diltiazem Lisinopril Verapamil

Lisinopril

The rescue squad brought a 48-year-old client to the ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the client reports severe headache and drowsiness. The client is disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency? Lower blood pressure as quickly as possible Assess for a cause of hypertension before proceeding Lower blood pressure gradually Obtain complete medical history

Lower blood pressure as quickly as possible Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. The cause can be explored after the crisis has been resolved. A medical history, if necessary, can also be postponed.

A client who is malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client? Prescribed according to normal dosages Increased Lowered Discontinued

Lowered Both losartan and the metabolite are highly bound to plasma albumin, and losartan has a shorter duration of action. Due to malnutrition, a low dose of losartan should be prescribed. The dose should not be higher than normal due to possible toxicity. The dose should not be the same as normal due to possible toxicity. The medication will not be combined with a diuretic unless the blood pressure is not controlled.

Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect? Angela, who is in her first trimester of pregnancy Mark, who is suffering from impaired renal function Hilda, who is showing symptoms of chronic cough Karl, who is showing symptoms of angiedema confined to the face and lip

Mark, who is suffering from impaired renal function Because the patient suffers from impaired renal function, the nurse must closely monitor Mark for neutropenia, the most common side effect in such patients. Also at risk are patients with heart failure and collagen vascular diseases. Neutropenia generally resolves quickly after captopril is discontinued. Captopril should be administered cautiously to patients who are showing symptoms of chronic cough or angiedema. If the patient becomes pregnant while taking captopril, therapy should be discontinued as soon as possible. However, such patients do not face as much of a risk of neutropenia as patients with impaired renal function.

A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate? Methyldopa Dopamine Midodrine Clonidine

Midodrine Midodrine is an alpha-specific adrenergic agent that is used to treat orthostatic hypotension. Dopamine is a sympathomimetic agent that is used to treat shock. Methyldopa and clonidine are alpha-2 blockers used to treat hypertension.

The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient? Reporting adverse effects of treatment Documenting the administration of medications Monitoring for complications and side effects of treatment Safely administering prescribed fluids

Monitoring for complications and side effects of treatment

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.) Monitoring for drug effects Modification of drug dosage Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Providing financial assistance with daily expenses

Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications

Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? Luke, age 28, who is suffering from hypertension Judy, age 36, who is pregnant Cole, age 88, who is suffering from hypertension Nick, age 35, who is suffering from hepatic impairment

Nick, age 35, who is suffering from hepatic impairment

The nurse recognizes that which medication may be used to treat a hypertensive crisis? Nitroprusside Hydralazine Amlodipine Minoxidil

Nitroprusside Nitroprusside is administered during a hypertensive crisis intravenously. Hydralazine and minoxidil are used for severe hypertension, and amlodipine is also administered for hypertension.

A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? Select all that apply. Olmesartan Atenolol Ramipril Quinapril Losartan

Olmesartan Losartan

A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Force of myocardial contraction Peripheral vascular resistance Pulse pressure Renal function

Peripheral vascular resistance

A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely? Potassium Sodium Magnesium Chloride

Potassium

Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites? Nadolol Guanabenz Labetalol Prazosin

Prazosin

The nurse is reviewing lab results where the client has elevated BUN and creatinine levels. The nurse would question the administration of which antihypertensive? Quinapril Nifedipine Amlodipine Diltiazem

Quinapril Quinapril is an ACE inhibitor and is contraindicated in clients with renal failure. Nifedipine, diltiazem, and amlodipine are calcium channel blockers and are not contraindicated in renal failure.

A client is prescribed phenylephrine intravenously (IV) to treat paroxysmal atrial tachycardia. What effect is the medication producing? Reflex bradycardia Compensated shock Inotropic effect Chronotropic effect

Reflex bradycardia When given systemically, phenylephrine produces a reflex bradycardia. The vessels vasoconstrict (due to alpha-2 receptors), and blood pressure goes up. The baroreceptors monitor blood pressure, and when they see an increase in blood pressure, they invoke a bradycardia in the heart as a compensatory measure. This effect may be used therapeutically to relieve paroxysmal atrial tachycardia. Compensated shock, also known as preshock, is characterized by compensatory responses activated in an attempt to reverse the condition. Inotropic effect causes a change in myocardial contraction. Chronotropic effect causes a change in heart rate.

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate? Risk for injury Fluid volume deficit Impaired peripheral tissue perfusion Ineffective airway clearance

Risk for injury

A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse? Ask the prescriber to reduce the dose Obtain an order for naloxone Slow the rate of the infusion Give the nitroprusside at the ordered rate

Slow the rate of the infusion Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.

The client has been prescribed amlodipine for hypertension. The client's blood pressure upon a revisit remains elevated. The nurse inquiries about the use of which alternative therapy? St. John's Wort Lavender Hawthorn Prune juice

St. John's Wort When taken with a calcium channel blocker, the herb St. John's wort can cause a decrease in serum levels of the calcium channel blocker. Neither hawthorn, lavender, nor prune juice is known to affect serum levels of calcium channel blockers.

The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client's systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first? Establish a new IV site with at least 20-gauge needle. Stop the infusion and administer diluted phentolamine. Assess urine output, and report to prescriber if less than 30 mL/h. Increase infusion and reassess SBP in 2 minutes.

Stop the infusion and administer diluted phentolamine. Extravasation (infiltration of IV fluids outside of the vein) of the norepinephrine IV site has occurred as noted by redness and edema. The nurse's first action is to stop the infusion and immediately administer diluted phentolamine, the antidote to minimize sloughing and necrosis of the tissue. The nurse can then establish a new patent IV site and titrate the drug to keep SBP greater than 90 mm Hg. After increasing the drip, the nurse would assess the SBP again. The nurse can assess urine output and report if it is less than 30 mL/h.

A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? Start with a low dose and increase gradually over 2 to 3 weeks. Increase fluid intake for 48 hours before taking the first dose. Take the medication with a high-fat meal. Take the medication at bedtime.

Take the medication at bedtime. To prevent the first-dose phenomenon, first doses and first increased doses are taken at bedtime. Increased fluid and fats will not address this risk, and the medication is not typically increased gradually over several weeks.

The pharmacology instructor is discussing hypertension in children and adolescents. What should the instructor tell the class is the reason for the cautious management of childhood hypertension? The treatment of childhood hypertension is only undertaken without a drug regimen. The long-term effects of the antihypertensive agents are not known. The ways to prevent childhood hypertension are not known or understood. The ramifications of overweight and inactivity in childhood are not fully understood.

The long-term effects of the antihypertensive agents are not known. Treatment of childhood hypertension should be done very cautiously because the long-term effects of the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy if at all possible. Weight loss and increased activity may bring an elevated blood pressure back to normal in many children. The treatment of childhood hypertension is based on the guidelines for treating adult hypertension, but the ramifications are well understood. For many children and adolescents the need for antihypertensive medications has become all too necessary.

After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker? Diltiazem Valsartan Nicardipine Verapamil

Valsartan

The client taking antihypertensive medications is taught to notify the healthcare provider when which findings occur? Decreased appetite Blood pressure decrease Fatigue Weight gain of five pounds over a 2-day period

Weight gain of five pounds over a 2-day period A decrease in blood pressure is a desired effect of antihypertensives. Fatigue and anorexia are adverse reactions related to the use of antihypertensives. Weight gain of two pounds or more per day may indicate retention of sodium and water and should be reported to the health care provider.

The clinic nurse is caring for a 39-year-old black, male client who is 25 pounds overweight and has been newly diagnosed with hypertension after three consecutive blood pressure readings above normal. What will be initial drug therapy for this patient? a calcium channel blocker a beta-blocker an ACE inhibitor a diuretic

a diuretic Black clients are at highest risk for developing hypertension with men more likely than women to develop the disease. Black clients have documented differences in response to antihypertensive therapy. They are most responsive to single drug therapy and diuretics. The first line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. Black clients are less responsive to ACE inhibitors and beta-blockers.

The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition? Glaucoma Asthma Diabetes mellitus Unstable angina pectoris

diabetes mellitus ACE inhibitors are considered first-line antihypertensive agents for clients with diabetes mellitus because they reduce proteinuria and slow the progression of renal impairment.

A patient is admitted to the unit with problems controlling their serum glucose levels. The patient has hypertension as a co-morbidity, and the physician has ordered hydralazine for this patient. The nurse caring for this patient knows that hydralazine is a(n): direct vasoconstrictor. indirect vasodilator. direct vasodilator. indirect vasoconstrictor.

direct vasodilator. If other drug therapies do not achieve the desired reduction in blood pressure, it is sometimes necessary to use a direct vasodilator. Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include diazoxide , hydralazine (generic), minoxidil , and nitroprusside .

An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified? normal elevated stage 2 hypertension stage 1 hypertension

elevated

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? elevated potassium levels low hemoglobin levels elevated neutrophil levels low sodium levels

elevated potassium levels ACE inhibitors like ramipril carry a risk of hyperkalemia, and an elevated potassium level may warrant withholding the drug. Elevated neutrophils or low sodium and hemoglobin levels would not likely prompt this action.

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: xerostomia (dry mouth). constipation. falls. depression.

falls

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure? lowering blood pressure increasing heart rate reducing preload increasing stroke volume

lowering blood pressure

A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to: weigh the client. question the client about her dietary intake. monitor the client's blood pressure. monitor the client's respiratory rate.

monitor the client's blood pressure.

A client has been prescribed metoprolol. The nurse should caution the client against abrupt cessation of treatment to avoid which undesired result? Select all that apply. ventricular hyperplasia pulmonary hypertension myocardial infarction a type IV hypersensitivity reaction angina

myocardial infarction angina The FDA has issued a black box warning for beta-adrenergic blocking agents for clients with coronary artery disease. Withdrawing oral forms of the class may result in exacerbation of angina, increased incidence of ventricular arrhythmias, and the occurrence of myocardial infarctions. Withdrawal does not cause pulmonary hypertension, hypersensitivity, or ventricular hyperplasia.

Medications with alpha-adrenergic activity are prescribed during shock to raise blood pressure. The drugs achieve this by acting on what process? peripheral vascular resistance. heart rate. myocardial activity. cardiac stroke volume.

peripheral vascular resistance.

A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? pulmonary edema palpitations chest pain venous ulcers

pulmonary edema Pulmonary edema is one of the cardinal signs of left-sided heart failure. This health problem does not typically cause venous ulcers, chest pain, or palpitations.

A client in cardiac arrest has been prescribed epinephrine. The nurse is aware that the drug promotes oxygenation of the heart and brain by what means? promoting the binding of oxygen to hemoglobin simultaneously slowing the heart rate and increasing the force of contraction promoting vasodilation both in the myocardium and in the brain redirecting blood flow away from the peripheral circulation

redirecting blood flow away from the peripheral circulation The most important action of epinephrine during cardiac arrest is the constriction of peripheral blood vessels, which shunts blood to the central circulation and increases blood flow to the heart and brain. The drug increases the heart rate and does not impact oxygen binding.