Week 9 Pharmacotherapy of Hypertension
The nurse is discussing the ACE inhibitor lisinopril (Prinivil) with an adult client. Which statement about ACE inhibitors is correct? ACE inhibitors end with "zide" in their name. ACE inhibitors block angiotensin II, which prevents vasoconstriction and decreases peripheral resistance. ACE inhibitors increase blood pressure. ACE inhibitors can decrease the effects of thiazides.
ACE inhibitors block angiotensin II, which prevents vasoconstriction and decreases peripheral resistance. Rational: ACE inhibitors block angiotensin II. This action prevents the vasoconstriction of arterioles. In turn, the vasoconstriction decreases blood pressure by reducing peripheral resistance. ACE inhibitors can increase the effects of thiazides, so dosing must be monitored. ACE inhibitor names end with "pril"; lisinopril (Prinivil) is an example.
Diane Cichowski has come to the clinic complaining of constipation. She is currently taking verapamil (Verelan) for hypertension. What should you tell Mrs. Cichowski? Add more fiber to your diet and drink more fluids. Drink red wine at dinnertime every day. Take an antacid. Stop taking verapamil (Verelan).
Add more fiber to your diet and drink more fluids. Rational: Antihypertensives such as verapamil (Verelan) may cause constipation that can be relieved by maintaining adequate fiber and fluid intake. A client should not abruptly stop taking an antihypertensive drug. If the client needs to stop or change medication, the dose should be tapered off to prevent rebound hypertension. Drinking alcohol should be avoided, as it may cause dehydration and lower blood pressure causing dizziness. Antacids do not relieve constipation.
The nurse is reviewing the mechanisms the body uses to regulate blood pressure. Which hormone helps regulate blood pressure? Antidiuretic hormone (ADH) Insulin Estrogen Serotonin
Antidiuretic hormone (ADH) Rational: Antidiuretic hormone (ADH) causes vasoconstriction and increases blood volume. Serotonin is a natural hormone in the body that affects sleep and brain function, but not blood pressure. Insulin regulates blood sugar. Estrogen is the hormone that helps to regulate menstruation, breast health, and pregnancy; it does not affect blood pressure.
The nurse is reviewing the action of angiotensin II receptor blockers (ARBs) so that she can explain the action to the adult client with hypertension who has an appointment today. What action of ARBs lowers blood pressure in the adult client? Cause the veins to dilate Block angiotensin II in the smooth muscle of the artery wall Slow the movement of calcium into the heart muscle cells Pull water from the extracellular space
Block angiotensin II in the smooth muscle of the artery wall rational: By blocking angiotensin II in the smooth muscle of the artery wall, ARBs decrease peripheral resistance in the arteries and thus lower blood pressure. Alpha1-adrenergic blockers, not ARBs, cause the veins to dilate. Diuretics pull water from the extracellular spaces and encourage excretion, thereby lowering blood volume and blood pressure. Slowing the movement of calcium into the heart muscle cells is an action of calcium channel blockers (CCBs), not ARBs.
The nurse is providing client education on antihypertensive medications. What teaching does the nurse include regarding what may happen if the client suddenly stops taking the medication? Blood pressure may rebound. Blood pressure will not exceed previous high levels. Blood pressure may become dangerously low. Blood pressure will remain within normal limits.
Blood pressure may rebound. Rational: When antihypertensive medication is stopped abruptly, rebound hypertension can occur, sending the blood pressure even higher than it was before medication therapy was started.
The nurse is assessing an adult client for hypertension. Which factors influence blood pressure? Select all that apply. Glucose levels Blood volume Peripheral resistance Cardiac output Lipid levels in the bloodstream
Blood volume Peripheral resistance Cardiac output Rational: The cardiac output (the amount the heart pumps) is responsible for the blood pressure. Low cardiac output will lower pressure, increased cardiac output will increase blood pressure. The pressure inside the arteries will directly affect the blood pressure. The amount of blood volume directly influences blood pressure. Glucose levels do not directly affect blood pressure, but the long-term effects of diabetes can contribute to hypertension. Lipid levels in the blood stream do not affect blood pressure, although high levels contribute to the risk of stroke from hypertension.
How do hormones regulate blood pressure in the body? Select all that apply. Cause vasoconstriction Increase blood volume Receive information from receptors in the carotid arteries Send messages to the arteries Change peripheral resistance
Cause vasoconstriction Increase blood volume Change peripheral resistance Rational: The body uses hormones to help regulate blood pressure. The antidiuretic hormone (ADH) causes vasoconstriction and increases blood volume. The renin-angiotensin-aldosterone system (RAAS) affects blood pressure by changes in both blood volume and peripheral resistance. The vasomotor system in the brain, not hormones, receives information from receptors in the aorta and the carotid arteries. Based on this information, the vasomotor system sends messages to the arteries to either constrict the arterial walls to increase blood pressure, or to vasodilate the arterial walls to decrease blood pressure.
The nurse is educating an adult client on the treatment of hypertension with diuretics. Which statements accurately describe diuretic pharmacologic therapy for hypertension? Select all that apply. Thiazides are not diuretics. Diuretics increase urine output. Diuretics decrease blood volume. Diuretics are not given to clients who are anuric. Diuretics are used in first-line treatment of hypertension.
Diuretics increase urine output. Diuretics decrease blood volume. Diuretics are not given to clients who are anuric. Diuretics are used in first-line treatment of hypertension. Rational: Diuretics are used as the first-line treatment of hypertension because of the success rate with these medications. Diuretics decrease the absorption of sodium and increase the release of water, so urine output increases. When diuretics increase urine output, fluid vascular volume decreases. Clients who do not urinate normally are not given diuretics as a treatment for hypertension. Thiazides are a first-line group of diuretics.
Larry Collins has a family history of hypertension. Mr. Collins is pre-hypertensive with a blood pressure of 130/85 mmHg. What is your primary goal for this client? Asking client to keep a blood pressure diary Asking client to look for symptoms of hypertension Educating client on lifestyle modification Assessing client's breath sounds
Educating client on lifestyle modification Rational: Left untreated, consistent high blood pressure can lead to serious health consequences or death. Your primary goal for pre-hypertensive clients is decreased blood pressure by means of lifestyle changes such as diet modifications, increased exercise, and stress reduction. A client with hypertension, not pre-hypertension, needs to keep a blood pressure diary. Assessing breath sounds is not necessary in this case scenario. Typically, only minimal, if any, symptoms occur initially with hypertension, so the client would not be able to look for symptoms.
What serum laboratory values should you as a nurse assess before administering a diuretic to a client? Select all that apply. Hemoglobin Glucose Hematocrit Electrolytes Uric acid
Glucose Electrolytes Uric acid Rational: Diuretics are often used as a first-line treatment in the management of hypertension. However, they are not given to clients who are anuric. Diuretics increase the excretion of water and electrolytes by the urinary system, thereby causing a potential risk for dehydration and excessive loss of electrolytes. Electrolyte levels should be monitored during therapy, assessing for hypochloremia, hypomagnesmia, hyponatremia, and alterations in potassium levels. Because diuretics can cause hyperglycemia and hyperuricemia, careful assessment of glucose, as well as uric acid levels, is important. The hemoglobin or hematocrit levels have no association with the administration of a diuretic.
The nurse is assessing a client who has been on one type of medication for hypertension and has had a low potassium level for several weeks. Which statements about potassium-sparing diuretics are correct? Select all that apply. Hyperkalemia is not a risk of potassium-sparing diuretic therapy when an ACE inhibitor is taken concurrently. Hyperkalemia is a risk when taking spironolactone (Aldactone) and an ACE inhibitor. All diuretics are potassium sparing. Spironolactone (Aldactone) will prevent the client from becoming hypokalemic by sparing normal potassium. Potassium levels do not diminish with potassium-sparing diuretics.
Hyperkalemia is a risk when taking spironolactone (Aldactone) and an ACE inhibitor. Spironolactone (Aldactone) will prevent the client from becoming hypokalemic by sparing normal potassium. Potassium levels do not diminish with potassium-sparing diuretics. Rational: Potassium-sparing diuretics spare the potassium during diuresis, helping the client to maintain a normal potassium level. Spironolactone (Aldactone) is a potassium-sparing diuretic. Hyperkalemia is a risk of potassium-sparing diuretic therapy if that therapy is used concurrently with ACE inhibitors. Not all diuretics work the same way; thiazides are an example of diuretics that are not potassium sparing.
The nurse is assessing an adult client and discussing the risk factors for primary hypertension in adults. What risk factors can contribute to the adult client's risk for hypertension? Select all that apply. Race The use of oral contraceptives Stress Family history Age
Race Stress Family history Age Rational: Stress can cause an increase in blood pressure. A family history of hypertension increases the risk for hypertension in the adult client. Increasing age also increases the risk for developing hypertension. African Americans are at higher risk for hypertension. The use of oral contraceptives increases the risk for secondary hypertension, not primary hypertension.
Your client abruptly stops her antihypertensive medication. Her blood pressure returns to its previous hypertensive level. What is this known as? Rebound hypertension Secondary hypertension Primary hypertension Return hypertension
Rebound hypertension Rational: Rebound hypertension is the term used when a client's blood pressure "rebounds" to the previous hypertensive level or higher. This can happen if a client abruptly discontinues antihypertensive medication. Return hypertension is a fabricated term. Primary hypertension is hypertension with no identifiable cause. In secondary hypertension, a cause for the high blood pressure can be identified and treated.
One of your clinic's clients, Raymond Chu, has hypertension without angina. Mr. Chu is prescribed amlodipine (Norvasc), a calcium channel blocker. Which should you teach Mr. Chu before he leaves the clinic? Take extra calcium supplements. Listen for bowel sounds. Note if there is an increase in angina. Report constipation.
Report constipation. Rational: Calcium channel blockers (CCBs), such as amlodipine (Norvasc), slow the movement of calcium into the heart's cells. One adverse effect that can occur with CCBs is constipation. CCBs prevent calcium from entering the cardiac cells, which slows the heart rate; taking extra calcium supplements is not indicated. Although CCBs can cause an increase in angina, your client does not have this condition, so he would not be noting an increase. Bowel sounds are not related to hypertension issues.
In the first few days of taking an antihypertensive drug, or after changing dosages, what should your client be instructed to do? Limit alcohol consumption to one drink a day. Weigh herself twice a day. Come to the clinic daily to check her blood pressure and pulse. Rise slowly to prevent dizziness.
Rise slowly to prevent dizziness. Rational: You need to educate your client to rise slowly to prevent dizziness and fainting, a precaution that is especially significant during the first few days of taking a new medication or after changing dosages. The client does not need to weigh herself twice a day, but rather at the same time each day. The client should avoid alcohol consumption because it can lower blood pressure and exacerbate dizziness or faintness. She should learn how to check her own blood pressure and pulse, and recognize the importance of doing and recording this regularly.
The nurse is assessing an adult client with new onset of primary hypertension. Which statements accurately describe primary hypertension in the adult client? Select all that apply. Primary hypertension leads to secondary hypertension. Stage 2 primary hypertension is a blood pressure of 160/100 or higher. Primary hypertension is managed with medications. No specific cause might be found for primary hypertension. Stage 1 primary hypertension is a blood pressure of 140-159/90-99.
Stage 2 primary hypertension is a blood pressure of 160/100 or higher. Primary hypertension is managed with medications. No specific cause might be found for primary hypertension. Stage 1 primary hypertension is a blood pressure of 140-159/90-99. Rational: Primary hypertension is managed with medications and lifestyle changes. Primary hypertension may not have a discernible cause. Stage 1 hypertension is defined as a blood pressure reading of 140-159/90-99 and requires intervention to reduce the numbers. Stage 2 hypertension is a blood pressure reading of 160/100 or higher. Primary hypertension and secondary hypertension have different etiologies; primary hypertension does not lead to secondary hypertension.
The nurse is assessing an adult client for the first time. Which tasks does the nurse perform to assess for appropriate pharmacologic therapy as part of the treatment for hypertension? Select all that apply. The nurse performs an ultrasound. The nurse assesses the client's readiness for learning. The nurse takes a complete health history. The nurse obtains a complete set of vital signs. The nurse obtains the client's history of both prescription and over-the-counter medications.
The nurse assesses the client's readiness for learning. The nurse takes a complete health history. The nurse obtains a complete set of vital signs. The nurse obtains the client's history of both prescription and over-the-counter medications. Rational: The nurse should obtain a complete health history, including any cardiac problems and any recent cardiac events. Baseline vital signs should be taken before medications for hypertension are administered. The nurse should assess the client's readiness for education about medications and lifestyle changes, including any barriers to compliance (such as cost). It is important for the nurse to know all medications the client is taking-both prescription and over-the-counter-before giving treatment for hypertension. The nurse would not perform an ultrasound before administering antihypertensive medication, unless ordered by the health care provider.
The nurse is monitoring an adult client with hypertension who will be given a strong antihypertensive. What is the nurse's role in monitoring this client? Select all that apply. As long as the client has no symptoms, there is no need to monitor. The nurse should monitor the client before and after dosing. The client should be monitored for dizziness. Heart rate should be taken before medication administration and a half-hour thereafter to ensure effectiveness. Blood pressure should be monitored before and after administering medication.
The nurse should monitor the client before and after dosing. The client should be monitored for dizziness. Heart rate should be taken before medication administration and a half-hour thereafter to ensure effectiveness. Blood pressure should be monitored before and after administering medication. Rational: The nurse should monitor the client both before and after medication administration to check for side effects and to see if the medication is working effectively. The client should be monitored for a decrease in heart rate by taking the pulse before medication is administered and a half-hour thereafter. The blood pressure should be measured and recorded before and after medication administration. The client should be monitored for dizziness after taking the medication to prevent the client from falling. It is always important to monitor a client after giving a new medication.
Which conditions would contraindicate the use of direct vasodilators? Select all that apply. Underlying tachycardia Angina Altered skin integrity History of myocardial infarction Low sodium levels
Underlying tachycardia Angina History of myocardial infarction Rational: Direct vasodilators are commonly used in hypertensive emergencies. However, they are not a first-line treatment for hypertension due to their many adverse effects. Direct vasodilators are contraindicated for clients who have angina, a history of myocardial infarction, or an underlying tachycardia, as the medication could worsen these conditions or precipitate another cardiac event. Direct vasodilators are not contraindicated for clients with low sodium levels or altered skin integrity.
What can cause secondary hypertension? Select all that apply. Use of B-complex vitamins Use of oral contraceptives Cushing disease Use of corticosteroids Rheumatoid arthritis
Use of oral contraceptives Cushing disease Use of corticosteroids Rational: Hypertension can be primary, when there is no identifiable cause; or it can be secondary, where the cause or causes can be identified and treated. Some causes of secondary hypertension are use of oral contraceptives, Cushing disease, and use of corticosteroids. Use of B-complex vitamins and rheumatoid arthritis do not cause hypertension.
What instruction should the nurse give a client who is starting a new antihypertensive medication? Rise slowly. Drink alcohol with the medication. Increase salt intake. There is no need to report headaches; they are expected.
rise slowly Rational: Instructing clients to rise slowly to prevent dizziness will help avoid falls. Clients should avoid drinking alcohol with antihypertensive medications, to prevent an increased risk of dizziness. Clients should be instructed to report headaches and any other adverse effects from the medications. Increasing salt intake is not an appropriate instruction for clients who are taking antihypertensive medications.
