Pharm CH. 34
A client with hypertension is also diagnosed with type 2 diabetes mellitus. The client asks why the health care provider has prescribed an ACE inhibitor. Which response by the nurse is the most appropriate? 1. "It protects the kidneys." 2. "It protects the eyes." 3. "It protects the heart." 4. "It protects the nerves."
Correct Answer: 1 Global Rationale: ACE inhibitors protect the kidneys in clients with diabetes. By treating the client with an ACE inhibitor, the health care provider is dealing with the hypertension and diabetes at the same time. Any antihypertensive will protect the eyes from hypertension. ACE inhibitors can protect the heart from hypertension, but so can other drug classes. Nerves are typically damaged by hypertension, and ACE inhibitors do not protect the nerves.
The client begins taking enalapril (Vasotec) for hypertension. Which adverse effect should the nurse teach the client to expect while taking this medication? 1. Persistent cough 2. Rebound hypertension 3. Hyperkalemia 4. Hyperglycemia
Correct Answer: 1 Global Rationale: Adverse effects of ACE inhibitors are usually minor and include a persistent cough, particularly following the first few doses of the drug. Orthostatic hypotension, not rebound hypertension, is expected particularly following the first few doses of the drug. There is no indication that the client has any risk factors for hyperkalemia such as diabetes, renal impairment, or therapy with potassium-sparing diuretics. Hyperglycemia is not an adverse effect associated with ACE inhibitors.
The client is prescribed doxazosin (Cardura) for hypertension and asks the nurse how the medication works. Which response by the nurse is the most appropriate? 1. "It works by making your blood vessels expand." 2. "It works by causing your kidneys to excrete more urine." 3. "It works by decreasing the release of stress hormones." 4. "It works by making your heart work more efficiently."
Correct Answer: 1 Global Rationale: Doxazosin (Cardura) is selective for blocking alpha-1 receptors in vascular smooth muscle, which results in dilation of arteries and veins. Excreting more urine is an effect of diuretic medications. Decreasing the release of stress hormones is not an effect of doxazosin (Cardura). Increasing the efficiency of the heart is not an effect of doxazosin (Cardura).
A client with hypertension has experienced heart failure. The nurse notes that the client is receiving nifedipine (Procardia). Which is a priority assessment for the nurse? 1. Auscultate breath sounds for crackles. 2. Assess level of orientation. 3. Review recent lab results for hypokalemia. 4. Assess urinary output.
Correct Answer: 1 Global Rationale: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure. Level of orientation could be decreased with heart failure, but it is not a priority assessment at this time. Calcium channel blockers do not cause hypokalemia. Urinary output could be decreased with heart failure, but it is not a priority assessment at this time.
The nurse completes medication education with a client prescribed hydrochlorothiazide. The nurse determines that teaching has been effective when the client makes which statement? 1. "I take my medication early in the morning." 2. "I really need to avoid grapefruit juice when I take this medication." 3. "If I develop a cough, I should call my doctor." 4. "I need to avoid salt substitutes and potassium-rich foods."
Correct Answer: 1 Global Rationale: Taking hydrochlorothiazide early in the day will help prevent nocturia. Grapefruit juice inhibits the metabolism of the calcium channel blockers. Development of a cough occurs with ACE inhibitors, not with diuretics. Hydrochlorothiazide is a potassium-excreting diuretic, and potassium supplementation is often necessary.
The nurse is caring for an African American male recently diagnosed with hypertension. The nurse anticipates that this client will be started on which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A thiazide diuretic 2. A calcium channel blocker 3. An ACE inhibitor 4. A beta-adrenergic antagonist 5. An angiotensin II receptor blocker
Correct Answer: 1,2 Global Rationale: Thiazide diuretics and calcium channel blockers seem to provide the greatest blood pressure reduction in this population. Monotherapy with ACE inhibitors, beta-adrenergic antagonists, and angiotensin II receptor blockers do not reduce blood pressure as effectively in African Americans as in other groups.
The nurse is caring for a client recently diagnosed with hypertension. The client asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include which medications? Standard Text: Select all that apply. 1. Diuretics 2. Angiotensin II receptor blockers (ARBs) 3. Beta-adrenergic antagonists 4. Direct-acting vasodilators 5. Peripheral adrenergic antagonists
Correct Answer: 1,2,3 Global Rationale: Diuretics, ARBs, and beta-adrenergic antagonists are considered primary antihypertensive agents and should be discussed with this client. Direct-acting vasodilators and peripheral adrenergic antagonists are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response.
The nurse is caring for a client with a history of uncontrolled hypertension. The client's family asks the nurse the consequences of this condition. Which conditions will the nurse include in the teaching session regarding the consequences of uncontrolled hypertension? Standard Text: Select all that apply. 1. Stroke 2. Congestive heart failure 3. Myocardial infarction 4. Depression 5. Hyperbilirubinemia
Correct Answer: 1,2,3 Global Rationale: Uncontrolled hypertension places the client at an increased risk for stroke, heart failure, and heart attack. Uncontrolled hypertension does not place a client at an increased risk for depression or hyperbilirubinemia.
The nurse is providing care to a client recently diagnosed with hypertension. The client's sustained blood pressure is 144/90 mmHg and expressed concern about possible effects on the body. When educating this client, which conditions affected by hypertension are appropriate to discuss? Standard Text: Select all that apply. 1. Stroke 2. Kidney damage 3. Heart failure 4. Blindness 5. Liver failure
Correct Answer: 1,2,3,4 Global Rationale: Hypertension increases the risk of both hemorrhagic and thrombotic stroke by weakening arteries and promoting atherosclerosis. Hypertension damages the arteries of the glomerulus, leading to kidney disease. Hypertension increases the risk of heart failure due to the strain of increased peripheral vascular resistance. By damaging the retinal arteries, hypertension can lead to blindness. Liver failure is not caused by systemic hypertension.
The nurse is discussing the long-term consequences of uncontrolled hypertension with a group of clients. Place in order the pathological changes that occur as a result of uncontrolled hypertension. Standard Text: Click on the down arrow for each response in the right column and select the correct choice from the list. Response 1. Damage to the blood vessels occurs, particularly the small arteries and arterioles. Response 2. Damage to the blood vessels continues with thickening of the arterial walls. Response 3. The blood vessels become inflamed. Response 4. The lumen of the arteries narrows. Response 5. Blood flow to the vital organs decreases.
Correct Answer: 1,2,3,4,5 Global Rationale: The damage from untreated hypertension begins in the blood vessels, particularly the small arteries and arterioles. The second consequence of uncontrolled hypertension is a thickening of the arterial walls. The third consequence of uncontrolled hypertension is the blood vessels becoming inflamed. The fourth consequence of uncontrolled hypertension is the narrowing of the lumen of the arteries. The fifth consequence of uncontrolled hypertension is decreased blood flow to the vital organs. This can lead to strokes, heart failure, and myocardial infarction
The nurse is administering nitroprusside sodium in the treatment of a hypertensive crisis. The nurse will assess the client for which signs and symptoms of thiocyanate poisoning? Standard Text: Select all that apply. 1. Hypotension 2. Blurred vision 3. Flushing of the skin 4. Metabolic acidosis 5. Dizziness
Correct Answer: 1,2,4 Global Rationale: Hypotension, blurred vision, and metabolic acidosis are symptoms of thiocyanate toxicity that may manifest with extended therapy. Flushing of the skin and dizziness are expected side effects of therapy and do not indicate thiocyanate toxicity.
The nurse is educating a client diagnosed with hypertension and explains that which criteria will be used to determine medication management for the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Risk factors 2. Comorbid medical conditions 3. Age 4. Degree of blood pressure elevation 5. Occupational status
Correct Answer: 1,2,4 Global Rationale: The client's risk factors, comorbiditis, and the degree of hypertension guide the pharmacotherapy to treat hypertension. The client's age and occupation are not factors in the pharmacotherapy of hypertension.
A client is newly diagnosed with hypertension and diabetes. Which classes of drugs are likely to be prescribed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. ACE inhibitors 2. Beta blockers 3. Thiazide diuretics 4. Calcium channel blockers 5. Angiotensin receptor blockers (ARBs)
Correct Answer: 1,5 Global Rationale: ACE inhibitors and ARBs protect the kidneys in clients with diabetes. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the "other" factors. Beta blockers treat hypertension but do not help diabetes and can mask signs of hypoglycemia. Thiazide diuretics and calcium channel blockers treat hypertension, but do not help diabetes.
When reviewing the medical record of a client admitted for hypertensive emergency, the nurse realizes the client's actual admitting diagnosis should have been hypertensive crisis, as the diastolic blood pressure was greater than_____ mmHg and the client was experiencing oliguria. Standard Text: Record your answer rounding to the nearest whole number.
Correct Answer: 120 Global Rationale: A hypertensive emergency (HTN-E), also called hypertensive crisis, is defined as a diastolic pressure greater than 120 mmHg, with evidence of target-organ system damage. This client should have been diagnosed with hypertensive crisis.
Which is a priority nursing intervention for a client who is prescribed enalapril (Vasotec) for antihypertensive treatment? 1. Monitor the client for headaches. 2. Take the client's blood pressure. 3. Review the client's lab results for hypokalemia. 4. Order a sodium-restricted diet for the client.
Correct Answer: 2 Global Rationale: Enalapril (Vasotec) might produce a first-dose phenomenon, resulting in profound hypotension, which could result in syncope. Although headache is a side effect, it is not as important a priority as is another condition. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia. Enalapril (Vasotec) does not affect sodium levels.
The nurse is caring for a client with a new diagnosis of hypertension and no other conditions. Which medication prescription should the nurse anticipate as the first treatment option? 1. A calcium channel blocker 2. A thiazide-type diuretic 3. An ACE inhibitor 4. A beta blocker
Correct Answer: 2 Global Rationale: JNC VI recommends a thiazide-type diuretic as the first drug of choice for clients without other underlying conditions. Calcium channel blockers are not normally recommended as first-line drugs for hypertension alone. ACE inhibitors are recommended first-line drugs for clients with diabetes. Beta blockers are recommended first-line drugs for clients with hypertension and heart disease.
The nurse is caring for a client who is prescribed hydralazine for the treatment of high blood pressure. Which medication should the client avoid taking because of the risk of severe hypotension? 1. Beta blockers 2. Monoamine oxidase inhibitors (MAOIs) 3. Acetaminophen 4. Potassium supplements
Correct Answer: 2 Global Rationale: MAOIs should not be administered with hydralazine as the combination can cause severe hypotension. Beta blockers are often administered with hydralazine to treat the reflex tachycardia that can occur with the medication. Acetaminophen and potassium supplements can be taken safely with hydralazine.
The health care provider asks the nurse to monitor a client with hypertension for signs of kidney damage. Which clinical manifestation would indicate kidney damage? 1. Urine output of 30 mL/hr 2. Proteinuria 3. Dysuria 4. Estimated glomerular filtration rate of 105
Correct Answer: 2 Global Rationale: Proteinuria is a very common sign of kidney damage due to hypertension. Urine output of 30 mL/hour and a GFR of 105 are both considered normal. Dysuria is not a sign of kidney damage.
The nurse is administering nitroprusside in the treatment of a hypertensive crisis. The nurse will assess the client's blood pressure after 1 to ____ minutes to assess for the therapeutic effects of the medication.
Correct Answer: 2 Global Rationale: The onset of action for this medication is 1 to 2 minutes. The nurse would assess the client for the therapeutic effects of the medication at this time.
The nurse is taking the initial history of a client admitted to the hospital for hypertension. The health care provider has ordered a beta-adrenergic blocker. Which statement by the client does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "I have always had problems with my asthma." 3. "When I have a migraine headache, I need to have the room darkened." 4. "My father died of a heart attack when he was 48 years old."
Correct Answer: 2 Global Rationale: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in clients with asthma. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant, but has no correlation to the use of beta-adrenergic blockers in this client.
The nurse is educating a client whose blood pressure is 140/90 mmHg on ways to lower blood pressure. Which lifestyle choices may eliminate the need for pharmacotherapy in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking
Correct Answer: 2,4,5 Global Rationale: Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Increasing the intake of alcohol, including wine, is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The client should be encouraged to decrease the intake of alcohol. Increasing the intake of saturated fat is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The client should be encouraged to decrease the intake of red meat and other sources of saturated fat.
The nurse is educating a client with hypertension on the importance of maintaining an optimal weight. The client asks the nurse how much weight loss is needed. The nurse's response is based on the knowledge that a weight loss of 11 to _____ lb produces a measurable decrease in blood pressure.
Correct Answer: 20 Global Rationale: Therapeutic lifestyle changes should be recommended for all clients with prehypertension or HTN. Of greatest importance is maintaining optimum weight, since obesity is closely associated with dyslipidemia (abnormal serum lipid levels) and HTN. A 5- to 9-kg (11- to 20-lb) weight loss often produces a measurable decrease in blood pressure, even in clients who are obese. Combining a medically supervised weight loss program with proper nutrition can delay the progression from prehypertension to HTN.
The client recently diagnosed with hypertension presents with the following assessment data: weight, 200 lb; height, 5'4"; diet, mostly starches; alcohol intake, three beers/week; stressors, works 60 hours/week. In planning care with this client, what is the priority outcome? 1. The client will eliminate alcohol from the diet. 2. The client will decrease stress by limiting work to 40 hours/week. 3. The client will achieve and maintain optimum weight. 4. The client will balance diet according to the food pyramid.
Correct Answer: 3 Global Rationale: Achieving and maintaining optimum weight is of greatest importance when a client has hypertension. For obese clients, a 10- to 20-lb weight loss can produce a measurable change in blood pressure. Eliminating alcohol, decreasing stress, and a balanced diet are all important, but they are not the priority outcome.
A client with a history of heart disease has been diagnosed with hypertension. Which class of drugs is likely to be prescribed? 1. Calcium channel blockers 2. Thiazide diuretics 3. ACE inhibitors 4. Beta blockers
Correct Answer: 4 Global Rationale: Beta blockers are typically given to clients with heart disease to protect the heart. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the "other" factors. Calcium channel blockers, thiazide diuretics, and ACE inhibitors protect the heart from hypertension, but do not specifically help protect the heart from heart disease.
A client comes to the emergency department with a blood pressure of 200/120 mmHg. The health care provider orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and tachypnea 3. Hypotension and hyperthermia 4. Hypotension and tachycardia
Correct Answer: 4 Global Rationale: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators produce hypotension and tachycardia, not bradycardia. Direct vasodilators do not affect respiratory rate or body temperature.
A client presents with a blood pressure of 210/124 mmHg. The nurse documents this finding in which way? 1. Prehypertension 2. Stage 1 hypertension 3. Stage 2 hypertension 4. Hypertensive crisis
Correct Answer: 4 Global Rationale: Hypertensive emergencies are characterized by diastolic readings greater than 120 mmHg. Prehypertension is characterized by blood pressure between 120/80 and 139/89 mmHg. Stage 1 hypertension is characterized by blood pressure between 140/90 and 159/99 mmHg. Stage 2 hypertension is characterized by blood pressure greater than 160/100 mmHg.
The nurse is teaching a client diagnosed with hypertension about lifestyle modifications. The nurse determines that teaching has been effective when the client makes which statement? 1. "My father had hypertension, did nothing, and lived to be 90 years old." 2. "I won't be able to run the marathon anymore." 3. "I need to get started on my medications right away." 4. "I know I need to give up my cigarettes and alcohol."
Correct Answer: 4 Global Rationale: Limiting intake of alcohol and discontinuing the use of tobacco products are important nonpharmacologic methods for controlling hypertension. The fact that the client's father had hypertension and lived to be 90 years old does not mean that the client will have the same experience; the client is in denial. Increasing physical activity is an important lifestyle modification for controlling hypertension. Implementing lifestyle modifications might eliminate the need for pharmacotherapy, so the client might not have to take medication right away.
The nurse is teaching the client about lifestyle modifications to help manage hypertension. The nurse determines that teaching has been effective when the client makes which statement? 1. "Lifestyle changes always get blood pressure down to normal levels." 2. "Lifestyle changes are just a way to make you feel like you're doing something." 3. "As long as I take my medications, I don't need to make any lifestyle changes." 4. "I will probably need to change my lifestyle and take medications."
Correct Answer: 4 Global Rationale: Most clients with hypertension do best with a combination of drug therapy and lifestyle changes. While lifestyle changes are an important part of hypertension treatment, many clients also require pharmacologic therapy. Weight loss and dietary changes both have shown to yield substantial blood pressure changes. Most hypertensive clients require multiple drugs. Lifestyle changes can reduce the number of drugs and the dose required to control blood pressure. In some clients, lifestyle changes alone can control blood pressure.
A client is treated in the emergency department for hypertensive emergency. The nurse anticipates treatment with which drug? 1. Metoprolol 2. Lisinopril 3. Clonidine 4. Nitroprusside
Correct Answer: 4 Global Rationale: Nitroprusside is a direct vasodilator, and is typically used to lower blood pressure immediately during hypertensive emergencies. Metoprolol, lisinopril, and clonodine are not used for hypertensive emergencies.
A client does not want to take hypertension medication, and asks why it is needed, as the client feels fine. Which response by the nurse is the most appropriate? 1. "You're right; there is no need for these medications." 2. "The medications can prevent worsening of the hypertension." 3. "If the hypertension is severe, symptoms could arise." 4. "The medications can prevent complications from hypertension."
Correct Answer: 4 Global Rationale: The primary goal of hypertension treatment is to prevent complications of hypertension, such as stroke and blindness. Hypertension should always be treated. While medications can prevent worsening of the hypertension, this is not the primary goal. While symptoms can occur if hypertension is severe, this statement does not address the primary goal of hypertension treatment
