Pharm Exam 4 Practice ?s

A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake and increased potassium intake c. Stress reduction and increased protein intake d. Weight reduction and decreased sodium intake ANS: D Weight loss decreases the stress on the heart and the afterload. Decreasing salt intake decreases the amount of retained fluid. Changing to yoga from weight-bearing exercise, limiting fluids, and increasing potassium are not indicated. Stress reduction is recommended, but increasing protein is not. A patient has a blood pressure of 135/85 mm Hg on three separate occasions. The nurse understands that this patient should be treated with a. a beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes. ANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a diastolic pressure between 80 and 89. Drug therapy is recommended if the blood pressure is greater than 20/10 over the goal, which would be140/90. Prehypertension is generally treated first with lifestyle changes. A patient has a blood pressure of 155/95 mm Hg. The nurse understands that this patient's risk of cardiovascular disease is _____ greater than normal. a. two times b. three times c. four times d. six times ANS: C Cardiovascular disease (CVD) risk doubles with each increase of 20/10 mm Hg above normal, starting at 115/75 mm Hg. This patient's blood pressure is 40/20 above normal, which increases the risk four times. A blood pressure of 135/85 would be two times greater. The patient's risk would still be four times greater with a blood pressure of 155/70 or 130/95, since systolic and diastolic blood hypertension are each powerful predictors of CVD. The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss a. adding a diuretic medication. b. changing to an ACE inhibitor. c. decreasing the beta blocker dose. d. doubling the beta blocker dose. ANS: A African Americans do not respond well to beta blockers and ACE inhibitors, but do tend to respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or altering the beta blocker dose are not indicated. Hypertension in African-American patients can be controlled by combining beta blockers with diuretics. The nurse understands that a medication such as carvedilol (Coreg) may not be effective in an African-American patient because of its effects on a. cardiac contractility. b. heart rate. c. renin release. d. vascular resistance. ANS: C African Americans are more likely to be susceptible to low-renin hypertension. Beta blockers reduce heart rate, contractility, and renin release, and there is a greater hypotensive response in patients with higher renin levels. Changes in heart rate, contractility, and vascular resistance explain why there is some response in this group. The nurse is preparing to care for a Native-American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient? a. Acebutolol (Sectral) b. Captopril (Capoten) c. Carteolol HCl (Cartrol) d. Metoprolol (Lopressor) ANS: B Captopril is an angiotensin II inhibitor. Native-American patients do not respond well to beta blockers. Acebutolol, carteolol, and metoprolol are all beta blockers. The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet ANS: C Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated. The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action? a. Administer the medication and monitor the patient's serum glucose. b. Contact the provider to discuss another type antihypertensive medication. c. Request an order for renal function tests prior to administering this drug. d. Teach the patient about the risks of combining herbal medications with this drug. ANS: B Patients with chronic lung disease are at risk for bronchospasm with beta blockers, especially those like propranolol which are non-selective. Beta blockers, with the exception of carvedilol, also decrease the efficacy of many oral antidiabetic medications. The nurse should discuss a change in medications to one that does not carry this risk. The nurse is admitting a patient who has been taking minoxidil (Loniten) to treat hypertension. Prior to beginning therapy with this medication, the patient had a blood pressure of 170/95 mm Hg and a heart rate of 72 beats per minute. The nurse assesses the patient and notes a blood pressure of 130/72 mm Hg and a heart rate of 78 beats per minute, and also notes a 2.2-kg weight gain since the previous hospitalization and edema of the hands and feet. The nurse will contact the provider to discuss which intervention? a. Adding hydrochlorothiazide to help increase urine output b. Adding metoprolol (Lopressor) to help decrease the heart rate c. Increasing the dose of minoxidil to lower the blood pressure d. Restricting fluids to help with weight reduction ANS: A Minoxidil is a direct-acting vasodilator which can cause sodium and water retention. Combining this drug with a diuretic can help reduce edema by increasing urine output. If the patient were tachycardic, a beta blocker might be added. It is not necessary to increase the minoxidil dose or to restrict fluids. The nurse is teaching a patient who has hypertension about long-term management of the disease and a beta blocker. The patient reports typically consuming 1 to 2 glasses of wine each evening with meals. How will the nurse respond? a. "Beta blockers and wine cause a reflex hypertension." b. "Four to 6 ounces of wine is considered safe with these medications." c. "Wine in moderation helps you relax and get better blood pressure control." d. "Wine increases the hypotensive effects of the beta blocker." ANS: D Patients who take beta blockers should avoid all alcohol because it increases the hypotensive effects. It does not cause reflex hypertension. A patient who has recently begun taking captopril (Capoten) to treat hypertension calls a clinic to report a persistent cough. The nurse will perform which action? a. Instruct the patient to go to an emergency department because this is a hypersensitivity reaction. b. Reassure the patient that this side effect is nothing to worry about and will diminish over time. c. Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB). d. Tell the patient to stop taking the drug immediately since this is a serious side effect of this drug. ANS: C An angiotensin-converting enzyme (ACE) inhibitor, such as captopril, can cause a constant, irritated cough. The cough will stop with discontinuation of the drug, and many patients can switch to an ARB medication. It does not indicate a hypersensitivity reaction. The cough will not diminish while still taking the drug. The patient does not need to stop taking the drug immediately. The nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor to a patient who has hypertension. The nurse notes peripheral edema and swelling of the patient's lips. The patient has a blood pressure of 160/80 mm Hg and a heart rate of 76 beats per minute. What is the nurse's next action? a. Administer the dose and observe carefully for hypotension. b. Hold the dose and notify the provider of a hypersensitivity reaction. c. Notify the provider and request an order for a diuretic medication. d. Request an order for serum electrolytes and renal function tests. ANS: B The patient has signs of angioedema which indicates a hypersensitivity reaction. The nurse should hold the dose and notify the provider. Giving the dose will make the reaction more serious. These are not signs of edema, so a diuretic is not indicated. Electrolytes and renal function tests are not indicated. The nurse is caring for a patient who will begin taking captopril (Capoten) for hypertension. The nurse reviews the patient's laboratory test results and notes increased BUN and creatinine. Which action will the nurse take? a. Administer the captopril and monitor vital signs. b. Contact the provider to discuss changing to fosinopril (Monopril). c. Obtain an order for intravenous fluids to improve urine output. d. Request an order to add hydrochlorothiazide (HydroDIURIL). ANS: B Patients who have renal insufficiency will not require a decrease in dose with fosinopril, as they would with other angiotensin-converting enzyme (ACE) inhibitors. If captopril is given, it should be given in a reduced dose. Increased IV fluids are not indicated. The nurse is caring for a patient who experiences a rapid rise in blood pressure. The nurse will contact the provider to discuss administering which medication? a. Amlodipine (Norvasc) b. Nifedipine (Procardia) c. Nifedipine extended release (Procardia XL) d. Verapamil (Calan) ANS: B The short-acting nifedipine is used to treat rapid rises in blood pressure but cannot be used for out-patient treatment at high dosages because of an increased risk for sudden cardiac death. The other drugs are not used for rapid rise in BP. The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patient's ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and a. ask to decrease the dose to 2.5 mg/day. b. discuss twice daily dosing. c. request an order for a diuretic. d. suggest adding propranolol to the regimen. ANS: A This patient is experiencing side effects of the medication. Elderly patients often require lower doses, so the nurse should ask about a dose reduction. Older adults generally require 2.5 to 5.0 mg/day. Twice daily dosing is not recommended. Unless edema persists, a diuretic is not indicated. The nurse teaches a patient about antihypertensive medication. Which statements by the patient indicate understanding of the teaching? (Select all that apply.) a. "I should be careful when I stand up from a chair." b. "I should not add extra salt to my foods." c. "If I have side effects, I should stop taking the drug immediately." d. "If my blood pressure returns to normal, I can stop taking this drug." e. "I may need to take a combination of drugs, including diuretics." f. "I will not need to make lifestyle changes since I am taking a medication." ANS: A, B, E The patient receiving an antihypertensive medication should be warned to rise slowly to avoid orthostatic hypotension. Patients should be counseled to continue to make lifestyle changes, including decreasing sodium. Often, more than one medication is required. Patients should not stop taking the drug abruptly to avoid rebound hypertension and will not stop the drug when blood pressure returns to normal.

Practice ?s