NUR 2092 Pharm Ch 43- Drugs affecting blood pressure

A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement?

"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider."

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."

The nurse is teaching a client how to take his diltiazem. Which instruction would be most appropriate?

"Swallow the drug whole with a large glass of water."

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?

A diuretic

A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume?

Changes in heart contraction

A client appears to be in hypovolemic shock with a significant loss of blood. What assessment findings might help confirm the diagnosis? Select all that apply.

Clammy skin Nausea Weak pulse

The nurse is caring for a client who is being treated for opioid withdrawal. The nurse notes that the health care provider has ordered which medication that is also used as an antihypertensive?

Clonidine

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance?

Cough

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 venous return

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

Diltiazem

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

When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?

Ineffective Tissue Perfusion

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

Prazosin

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

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.

What are the indications for captopril?

The indications for captopril are treatment of hypertension, HF, diabetic nephropathy, or left ventricular dysfunction after an MI.

The pharmacology instructor is discussing hypertension in children and adolescents. What should the instructor tell the class is the reason for the cautious management of childhood hypertension?

The long-term effects of the antihypertensive agents are not known.

What are the most common adverse effects for nitroprusside? The most common adverse effects for nitroprusside are apprehension, headache, retrosternal pressure, palpitations, cyanide toxicity, diaphoresis, nausea, vomiting, abdominal pain, and irritation at the injection site.

The most common adverse effects for nitroprusside are apprehension, headache, retrosternal pressure, palpitations, cyanide toxicity, diaphoresis, nausea, vomiting, abdominal pain, and irritation at the injection site.

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:

a persistent, dry cough may occur; however, it is not serious.

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?

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

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response?

"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?

"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?

"When was your last menstrual period?"

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?

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

A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following?

130/80 mm Hg

A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?

2

A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information?

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

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

Aldosterone

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

Aliskiren

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment?

Baseline renal function

A 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

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

When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.)

Constipation Proteinuria Photosensitivity Cough

A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.)

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

The mechanism of action of an ACE inhibitor is the blocking of ACE from converting angiotensin I to angiotensin II. What does this cause?

Decrease in aldosterone production

A client with which diagnosis should be prescribed captopril as the first-line treatment?

Diabetes mellitus

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

A 71-year-old male client is being treated for hypertension. Which measurement is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

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.

Diet with more fruits and vegetables Smoking cessation Regular aerobic exercise Decreased alcohol consumption

Key behavioral determinants of blood pressure are related to what factor?

Dietary consumption of calories and salt

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

Discontinue the drug

Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect?

Exacerbation of chronic cardiovascular conditions

The use of a loop diuretic is the first drug used in the Step Care Management program to treat hypertension.

False A somewhat controversial study, the ALLHAT study, reported in 2002 that patients taking the less expensive, less toxic diuretics did better and had better blood pressure control than patients using other antihypertensive agents. Replications of this study have supported its findings and the use of a thiazide diuretic is currently considered the first drug used in the Step Care Management of Hypertension.

A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?

Frequent assessment of the client's cardiac status

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

The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock?

Hypoperfusion of tissues

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

Hypotensive crisis

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?

Implement interventions to lower blood pressure.

A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe?

Increased heart rate

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?

Instant bronchodilation

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

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 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?

Lifelong

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

Losartan

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.

Losartan Olmesartan

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

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?

Lowered

Why do clients with impaired renal function require cautious use of epinephrine?

Metabolites may accumulate and increase the risk of adverse effects.

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

Midodrine

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)

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

The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse's best response?

Myocardium hypertrophy

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?

Persistent cough

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

Potassium

The nurse is leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following is appropriate for managing hypertension in children? Select all that apply.

Preventing obesity Promoting exercise Reducing dietary sodium

A client is prescribed phenylephrine intravenously (IV) to treat paroxysmal atrial tachycardia. What effect is the medication producing?

Reflex bradycardia

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?

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?

Secondary hypertension

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?

Slow the rate of the infusion

A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension?

Stage 2

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?

Stop the infusion and administer diluted phentolamine.

What are the therapeutic actions for diltiazem?

The therapeutic action for diltiazem is to inhibit the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption.

The nurse is caring for a 27-year-old African American woman who was just prescribed an ACE inhibitor for management of her hypertension. What should be advised related to contraception?

Use barrier contraceptives to prevent pregnancy while taking these drugs.

A client has been prescribed metoprolol. The nurse should caution the client against abrupt cessation of treatment to avoid which undesired result? Select all that apply.

angina myocardial infarction

How does captopril contribute to a reduction of a client's blood pressure?

blocking the conversion of angiotensin I to angiotensin II

Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure?

bronchiole

A client has been newly diagnosed with primary hypertension. Which medication classification represented in the client's current medication regime should the nurse question when considering the treatment for this new diagnosis?

direct vasoconstrictors

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

direct vasodilator.

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

elevated potassium levels

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

falls.

Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure?

lowering blood pressure

A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:

monitor the client's blood pressure.

What are the nursing implementation considerations for a patient receiving nitroprusside for blood pressure?

• Encourage the patient to implement lifestyle changes, including weight loss, smoking cessation, decreased alcohol and salt in the diet, and increased exercise, to increase the effectiveness of antihypertensive therapy. • Monitor blood pressure closely during administration to evaluate for effectiveness and to ensure quick response if blood pressure falls rapidly or too much. • Monitor blood glucose and serum electrolytes to avoid potentially serious adverse effects. • Monitor the patient carefully in any situation that might lead to a drop in fluid volume (e.g., excessive sweating, vomiting, diarrhea, dehydration) to detect and treat excessive hypotension that may occur. • Provide comfort measures to help the patient tolerate drug effects, including small, frequent meals; access to bathroom facilities; safety precautions if CNS effects occur; environmental controls; appropriate skin care as needed; and analgesics as needed. • Provide thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance. • Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen.

What are the lifespan considerations in the older adult for the use of drugs that affect blood pressure?

• Older adults frequently are prescribed one of these drugs. Older adults are more susceptible to the toxic effects of the drugs and are more likely to have underlying conditions that could interfere with drug metabolism and excretion. Renal or hepatic impairment can lead to accumulation of the drugs in the body. If renal or hepatic dysfunction is present, the dosage should be reduced and the patient monitored very closely. • The total drug regimen of the older patient should be coordinated with careful attention to interactions among drugs and alternative therapies. • Older adults need to use special caution in any situation that could lead to a fall in blood pressure, such as loss of fluids from diarrhea or vomiting, lack of fluid intake, or excessive heat with decreased sweating that comes with age. Dizziness falls, or syncope can occur if the blood pressure falls too far in these situations. The blood pressure should always be taken immediately before an antihypertensive is administered to an older adult in an institutional setting to avoid excessive lowering of blood pressure. • Older patients should be especially cautioned about sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for excessive dosing if these drugs are inappropriately cut.