Karch Focus on Pharmacology Chapter 43- Drugs Affecting Blood Pressure

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." "Explore the possible use of a calcium channel blocker with your health care provider." "Be aware of your salt intake and limit hidden salt." "Try to increase your intake of potassium-rich foods."

"Be aware of your salt intake and limit hidden salt." This client may reduce the likelihood of developing hypertension with a reduction in salt intake. There is no need for this client to be placed on a calcium channel blocker or to increase potassium intake. Adequate sleep is important, but this is not directly related to blood pressure control.

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? "We need to obtain a sputum sample to see whether you have developed a respiratory infection." "Coughing is an adverse effect of the medication that may lead to pneumonitis." "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."

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

Risk for injury Risk for injury is appropriate because the changes in blood pressure with position changes increases the client's risk for falls. -Ineffective airway clearance would be appropriate if the client has copious respiratory secretions or the unrelenting cough of ACE inhibitors. -Impaired peripheral tissue perfusion would be appropriate if the client was experiencing changes in the color or circulation to his extremities. -Fluid volume deficit would be appropriate if the client was dehydrated.

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

Increased heart rate

When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition? Activity Intolerance Social Isolation Excess Fluid Volume Ineffective Tissue Perfusion

Ineffective tissue perfusion Hypovolemic shock is caused by the loss of intravascular fluids, including blood. Therefore, of the four options, the only choice relevant to hypovolemic shock is Ineffective Tissue Perfusion.

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? Sweating Sedation Hypokalemia Persistent cough

Persistent cough A persistent, nonproductive cough develops in approximately 10% to 20% of clients using ACE inhibitors and may lead to stopping the drug. Hyperkalemia can occur in some clients, such as those who have diabetes mellitus or renal impairment or who are taking nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics.

A nurse is caring for a patient who is on a drug regimen of midodrine to treat hypotension. What would be an appropriate nursing diagnosis to include in the care plan of this patient? Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen Impaired skin integrity related to dermatological effects Acute pain related to GI distress, cough, skin effects, and headache

Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects Nursing diagnoses related to drug therapy with might include ineffective tissue perfusion (total body) related to changes in cardiac output and disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects. Acute pain is a nursing diagnosis appropriate to a patient receiving an ARB. Support and encouragement is an implementation, not a nursing diagnosis. Impaired skin integrity is a nursing diagnosis for a patient taking an ACE inhibitor.

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? Renin Aldosterone Enalapril Angiotensin

Aldosterone The nurse should explain that aldosterone is the hormone produced by the adrenal cortex. Renin and angiotensin are hormones produced in the kidneys, and not by the adrenal cortex. Enalapril is not a hormone; it is an ACEI antihypertensive drug.

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? Calcium channel blockers Angiotensin II receptor blockers Antihyperlipidemic drugs Selective aldosterone blockers

Angiotensin II receptor blockers Losartan is an angiotensin II receptor blocker (ARB) and is recommended for clients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease. Antihyperlipidemic drugs help to reduce cholesterol. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls, these are recommended with caution in pregnant women. Selective aldosterone blockers do not show reduction of end-stage renal disease but are effective in treating severe CHF.

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? Falls Impaired oxygenation Acute confusion Infection

Falls Initiation of antihypertensive therapy creates a risk of acute hypotension and consequent falls. Infection, confusion, or impaired oxygenation is much less likely.

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

Potassium Aliskiren is associated with hyperkalemia. Therefore, the nurse would need to closely monitor potassium levels. Diuretics can lead to hyponatremia, hypomagnesemia, and hypokalemia.

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. Focus on finding a different job Diet with more fruits and vegetables Regular aerobic exercise Decreased alcohol consumption Smoking cessation

Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation 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 student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond? Replace fluids the patient has lost. Restore and maintain adequate tissue perfusion. Resuscitate the client. Restore life to the patient.

Restore and maintain adequate tissue perfusion. The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.

Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure? Thiazide diuretics Potassium-sparing diuretics Osmotic diuretics Loop diuretics

Thiazide diuretics ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. ACE inhibitors are not routinely combined with loop, osmotic, or potassium-sparing diuretics.

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

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.

Why are the small arterioles considered one of the most important factors when determining peripheral resistance?

Because small arterioles have the smallest diameter, they are able to almost stop blood flow into capillary beds when they constrict, building up tremendous pressure in the arteries behind them as they prevent the blood from flowing through.

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

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 blocking the angiotensin II receptors By preventing the conversion of angiotensin I By blocking the aldosterone receptors By preventing renin secretion

By blocking the angiotensin II receptors Losartan brings about an antihypertensive effect by blocking the angiotensin II receptors. Losartan is an angiotensin II receptor antagonist. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors.

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent? Hydrochlorothiazide Spironolactone Amiloride Triamterene

Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body. Subsequently, the client is at risk for hypokalemia. Amiloride, spironolactone, and triamterene are potassium-sparing diuretics. The client using these diuretics would need to be monitored for hyperkalemia because potassium is not lost along with sodium.

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? Diabetes mellitus Asthma Unstable angina pectoris Glaucoma

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 71-year-old male client is being treated for hypertension. Which measurement is a partial indication of effective treatment and management? Systolic blood pressure below 160 mm Hg Diastolic blood pressure below 90 mm Hg Diastolic blood pressure below 100 mm Hg Systolic blood pressure above 140 mm Hg

Diastolic blood pressure below 90 mm Hg Successful treatment involves reducing blood pressure below hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.

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

Dietary consumption of calories and salt Key behavioral determinants of blood pressure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.

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? Maintain the current dosage of the drug Decrease the dosage of the drug Increase the dosage of the drug Discontinue 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.

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? Hypokalemia Hypermagnesemia Hyperkalemia Hypernatremia

Hyperkalemia By blocking production of angiotensin II, the ACE inhibitors decrease aldosterone production (thus reducing retention of sodium and water and increasing the retention of potassium). Hyperkalemia may develop in clients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in clients with diabetes mellitus. Hypernatremia is not a major risk in clients with diabetes who are taking captopril. Hypermagnesemia is not a risk in clients with diabetes who are taking captopril.

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

Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart Plaque, stroke, and increased workload are consequences of hypertension. Increased risk of kidney disease, heart failure, and blindness are also consequences of hypertension.

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? Temperature Increased blood pressure Activation of infectious response Hypoperfusion of tissues

Hypoperfusion of tissues Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response

A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? Thromboembolism Hypotensive crisis Blindness Stroke

Hypotensive crisis Hypotensive crisis may be seen in older patients on nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Thromboembolism, stroke, and blindness will not occur during nitroprusside therapy.

An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client's blood pressure be classified? stage 2 hypertension isolated systolic hypertension stage 1 hypertension normal

isolated systolic hypertension A systolic pressure of 140 or above, with a diastolic pressure below 90, is called isolated systolic hypertension and is more common in older adults. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. More severe hypertension, stage 2 hypertension, is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher. Normal blood pressure is more than 120 over 80 and less than 140 over 90 (120/80-140/90).

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: monitor the client's respiratory rate. monitor the client's blood pressure. question the client about her dietary intake. weigh the client.

monitor the client's blood pressure. Monitoring of blood pressure would be the priority assessment in the care of this client. Questioning the client about her dietary intake and weighing her would be appropriate, but secondary in importance. It is unnecessary to monitor the client's respiratory rate.

Baroreceptor

pressure receptor; located in the arch of the aorta and in the carotid artery; responds to changes in pressure and influences the medulla to stimulate the sympathetic system to increase or decrease blood pressure

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? venous ulcers palpitations pulmonary edema chest pain

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.

shock

severe hypotension that can lead to accumulation of waste products and cell death

Angiotensin II receptors

specific receptors found in blood vessels and in the adrenal gland that react with angiotensin II to cause vasoconstriction and release of aldosterone

essential hypertension

sustained blood pressure above normal limits with no discernible underlying cause

hypotension

sustained blood pressure that is lower than that required to adequately perfuse all of the body's tissues

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? Monitoring for complications and side effects of treatment Safely administering prescribed fluids Documenting the administration of medications Reporting adverse effects of treatment

Monitoring for complications and side effects of treatment General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. -The other options are correct but not more important functions of nursing care than 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.) Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Modification of drug dosage Providing financial assistance with daily expenses Monitoring for drug effects

Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Whether the client or another member of the household is taking antihypertensive medications, the home care nurse may be helpful in teaching about the drugs, monitoring for drug effects, and promoting compliance with the prescribed regimen (pharmacologic and lifestyle modifications). -The nurse would not provide financial assistant with daily expenses though the nurse would help the client and family discover resources that might provide what is needed.

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 your splitting or crushing your pills?" "Are you taking any over-the-counter pain relievers like ibuprofen?" "Have you been drinking any grapefruit juice lately?" "When did you take the last dose of the drug?"

"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 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 increasing his heart rate significantly." "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 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? "Increases client's perception of pain and decreases the heart rate." "Blocks conversion of angiotensin I to angiotensin II." "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." "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." Amlodipine inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation. This leads to lowered blood pressure. Diuretics decrease the cardiac output by diuresis of sodium and water. This medication does not increase pain or affect the heart rate. ACE inhibitors block the conversion of angiotensin I to angiotensin II.

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? "The prescriber has not read the current guidelines and needs an update." "Many clients require two or more drugs for high blood pressure." "You should talk to the prescriber for clarification about the medications. " "Your diet and exercise are not effective and adding another drug is ideal."

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

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.

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? Candesartan Clonidine Enalapril Amlodipine

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

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way? By inhibiting the transformation of angiotensin I to angiotensin II By blocking the movement of calcium ions into arterial smooth muscles By directly relaxing vascular smooth muscle By blocking aldosterone from binding to mineralocorticoid receptors

By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.

The blood in ____________________________ system flows from areas of higher pressure to areas of lower pressure.

Cardiovascular

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 cardiac output Decreased heart rate Decreased venous return Increased stroke volume

Decreased venous return Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. The heart rate increases in an attempt to meet the demands of the body

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

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 client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea Baked fish, broccoli, and oranges Salad with a grilled chicken; unsweetened tea Ham sandwich with mustard, carrots and cheesy dip

Ham sandwich with mustard, carrots and cheesy dip Dietitians usually recommend the Dietary Approaches to Stop Hypertension (DASH) diet. Studies indicate that blood pressure can be reduced by eating a diet low in saturated fat, total fat, and cholesterol and rich in fruits, vegetables, and low-fat dairy foods. The DASH diet includes whole grains, poultry, fish, and nuts and has reduced amounts of fats, red meats, sweets, and sugared beverages. A ham sandwich with mustard and a cheesy dip has increased fat and sodium. The other answer options are in compliance with the DASH diet.

The pressure in the CV system is determined by three elements:

Heart rate Stroke volume, or the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by the volume of blood in the system) Total peripheral resistance, or the resistance of the muscular arteries to the blood being pumped through

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 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. 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 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? Lifelong One year 5 years 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? Diltiazem Lisinopril Verapamil Furosemide

Lisinopril Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response

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? Amlodipine Losartan 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

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 Lower blood pressure gradually Obtain complete medical history Assess for a cause of hypertension before proceeding

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 Discontinued Lowered Increased

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.

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 Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. -There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy.

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? Obtain an order for naloxone Give the nitroprusside at the ordered rate Ask the prescriber to reduce the dose Slow the rate of the infusion

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 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. Assess urine output, and report to prescriber if less than 30 mL/h. Stop the infusion and administer diluted phentolamine. 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? Take the medication at bedtime. Take the medication with a high-fat meal. Increase fluid intake for 48 hours before taking the first dose. Start with a low dose and increase gradually over 2 to 3 weeks.

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.

stroke volume

The amount of blood pumped out of the ventricles with each beat; important in determining blood pressure

The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important point(s) when educating the client on taking the new medication? Select all that apply. Taking ibuprofen can make the drug more potent and decrease your blood pressure, so take acetaminophen instead. Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. Take the medication one hour before meals or two hours after meals to enhance absorption of antihypertensives.

Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. A reliable birth control method, such as barrier contraception, should be used by a peri-menopausal woman to prevent pregnancy as severe birth defects can occur while taking the angiotensin converting inhibitor (ACEI). Before the woman received the prescription, a negative pregnancy test should have been performed. -Only captopril and moexipril must be administered 1 hour before or 2 hours after a meal to enhance absorption. Benazepril may be taken with or without food. -The client beginning an ACEI needs to be taught about the symptoms of angioedema and to not take the next dose, but call the primary care provider (PCP) immediately for further instructions. If the client would have problems breathing, the PCP would instruct the client to call "911". -The client taking ACEIs should not take NSAIDs, such as ibuprofen, because they decrease the effectiveness of the ACEI. -A side effect of ACEIs is a dry cough, which if bothersome may be treated by the PCP with agents such as cromolyn or a local anesthetic.

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? Nicardipine Verapamil Diltiazem Valsartan

Valsartan Valsartan is an angiotensin II receptor blocker.

Cardiovascular center

area of the medulla at which stimulation will activate the sympathetic nervous system to increase blood pressure, heart rate, and so forth

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

bronchiole Epinephrine is the adrenergic drug of choice for relieving the acute bronchospasm and laryngeal edema of anaphylactic shock. The medication has no effect on the muscles suggested by the other options.

renin-angiotensin-aldosterone system (RAAS)

compensatory process that leads to increased blood pressure and blood volume to ensure perfusion of the kidneys; important in the continual regulation of blood pressure

Angiotensin-converting enzyme (ACE) inhibitor

drug that blocks ACE, the enzyme responsible for converting angiotensin I to angiotensin II in the lungs; this blocking prevents the vasoconstriction and aldosterone release related to angiotensin II

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? low sodium levels elevated neutrophil levels low hemoglobin levels elevated potassium 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.

peripheral resistance

force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure