PHARM II CH 43: Drugs Affecting Blood Pressure

A client is admitted to the emergency department with a severe headache, nausea, shortness of breath, and blood pressure of 200/120 mm Hg. Which response should the nurse prioritize? Measure the pulse rate every hour. Take a blood pressure every 30 minutes. Continuously monitor the client's status. Alternate the arms for assessing the blood pressure and pulse.

Continuously monitor the client's status.

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: Decreased heart rate Decreased venous return Increased stroke volume Increased cardiac output

Decreased venous return

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 above 140 mm Hg Systolic blood pressure below 160 mm Hg Diastolic blood pressure below 90 mm Hg Diastolic blood pressure below 100 mm Hg

Diastolic blood pressure below 90 mm Hg

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

Dietary consumption of calories and salt

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia? Enalapril Labetalol Clonidine Diltiazem

Diltiazem

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

Discontinue the drug

A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent: Renal failure Cardiac arrhythmias Excessive hypotension ACE inhibitor toxicity

Excessive hypotension

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 Falls Infection 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? Close monitoring of the client's electrolyte levels Frequent assessment of the client's cardiac status Supervision of the client when performing activities of daily living Checking the client's blood glucose levels before each meal and at bedtime

Frequent assessment of the client's cardiac status

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? Lavender Prune juice St. John's Wort Hawthorn

St. John's Wort

A client is admitted to the emergency department in hypertensive crisis. The nurse will prioritize which assessment(s) to monitor for potential damage as this client receives emergent treatment? Select all that apply. Gallbladder Heart Eyes Kidneys Pancreas

Heart Eyes Kidneys

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? Spironolactone Triamterene Hydrochlorothiazide Amiloride

Hydrochlorothiazide

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 Hydralazine hydrochloride Digoxin Atorvastatin calcium

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 nurse notes a client has a new prescription for fluconazole who has also been administered losartan for several months. The nurse determines the client should be monitored for which result of this combination? Increased risk of hypersensitivity reaction Increased risk of adverse effects of losartan Increased risk of hypoglycemia Decreased hypotensive effect of losartan

Increased risk of adverse effects of losartan

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 directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. It inhibits the movement of calcium ions across cell membranes. 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.

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? "You should talk to the prescriber for clarification about the medications. " "Your diet and exercise are not effective and adding another drug is ideal." "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 for high blood pressure."

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? "Do you eat something when you take your medications?" "When was your last menstrual period?" "Have you always weighed 150 pounds?" "How much physical exercise do you get?"

"When was your last menstrual period?"

The nurse is preparing to teach a group of middle-aged clients ways to reduce hypertension. Which instruction(s) should the nurse point out during this session? Select all that apply. Lose weight. Increase sodium intake. Stop smoking. Reduce stress. Decrease exercise.

*Stop smoking *Reduce stress *Reduce weight

A nurse is analyzing the medical records of several clients who have come to the clinic for a visit. The nurse determines that a client with which blood pressure readings would be identified as prehypertensive? 128/86 mm Hg 112/72 mm Hg 164/102 mm Hg 144/92 mm Hg

128/86 mm Hg

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? 140/90 mm Hg 130/80 mm Hg 150/100 mm Hg 100/70 mm Hg

130/80 mm Hg

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure? Left atrium Right ventricle Left ventricle Right atrium

Left ventricle

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? Until blood pressure is 120/80 mmHg Lifelong 5 years One year

Lifelong

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 Verapamil Furosemide Lisinopril

Lisinopril

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 Losartan Ramipril Quinapril Atenolol

Lisinopril

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? Mark, who is suffering from impaired renal function Angela, who is in her first trimester of pregnancy Karl, who is showing symptoms of angiedema confined to the face and lip Hilda, who is showing symptoms of chronic cough SUBMIT ANSWER

Mark, who is suffering from impaired renal function

Why do clients with impaired renal function require cautious use of epinephrine? Epinephrine increases the pH of urine and constitutes a risk for urosepsis. Epinephrine can cause lysis of Bowman's capsules, further reducing renal function. Metabolites may accumulate and increase the risk of adverse effects. Epinephrine is fully resorbed in the proximate tubules and can accumulate to toxic levels.

Metabolites may accumulate and increase the risk of adverse effects.

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

Monitoring for complications and side effects of treatment

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

Absent reflexes

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? Enalapril Angiotensin Renin Aldosterone

Aldosterone

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

Nitroprusside SUBMIT ANSWER

A client with hypertension has had their ACE inhibitor discontinued and an angiotensin II receptor blocker prescribed. What factor may have contributed to this change in medication? Rebound hypertension Transient ischemic attack Persistent cough Non-adherence to ACE inhibitor treatment

Persistent cough

The nursing instructor has completed a teaching session explaining the various antihypertensive drugs. The instructor determines additional training is needed when the students choose which drugs as an angiotensin-converting enzyme inhibitor? Enalapril Quinapril Benazepril Pindolol

Pindolol

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

By blocking the angiotensin II receptors

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

By blocking the angiotensin II receptors

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

Risk for injury

During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment? Hypertensive emergency Secondary hypertension Essential hypertension Rebound hypertension

Secondary hypertension

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? Causes excess potassium retention. Causes sodium and water retention. Inhibits renin secretion. Promotes angiotensin I conversion.

Causes sodium and water retention.

Both primary and secondary hypertension are disease processes evident across the lifespan. Primary hypertension can be controlled with appropriate therapy. What is considered curative in secondary hypertension? Diet therapy Surgery Exercise Diuretics

Surgery

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 at bedtime. Take the medication with a high-fat meal.

Take the medication at bedtime.

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 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 low hemoglobin levels elevated neutrophil levels elevated potassium levels

elevated potassium levels

The nurse is providing education to the parent of a child who has been recently diagnosed as allergic to bee venom. What medication would the nurse recommend that the parent have available? norepinephrine dopamine epinephrine aspirin

epinephrine

The nurse is providing education regarding lifestyle changes to a client diagnosed with hypertension. What diet should the nurse recommend as most appropriate for this client? grilled chicken, peas, and baked potato lean sausage, baked beans, and coleslaw grilled hamburger, baked french fries, and diet soda ham sandwich, low-fat potato chips, and cookie

grilled chicken, peas, and baked potato

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

monitor the client's blood pressure.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? increased venous tone myocardial hypertrophy arterial lumen dilation hepatic damage

myocardial hypertrophy

The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which? stress reduction techniques and high fat intake. decreased water intake and decreased potassium intake. weight loss and decreased salt intake. increased exercise activity and fat intake.

weight loss and decreased salt intake.