Blood Pressure Medications

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. Which concern would prompt the nurse to ask the health care provider about potassium supplements? Digoxin causes significant potassium depletion. The liver destroys potassium as digoxin is detoxified. Lasix requires adequate serum potassium to promote diuresis. Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Digoxin toxicity occurs rapidly in the presence of hypokalemia. Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

After consistently obtaining a blood pressure of 140/76 mm Hg for a client, which stage of hypertension will the nurse document? Normal Elevated Stage 1 Stage 2

Stage 2 According to the current American College of Cardiology guidelines, systolic blood pressure greater than or equal to 140 mm Hg is classified as stage 2 hypertension. Although the diastolic pressure of 76 mm Hg is normal, elevation of either the systolic or diastolic pressure results in a hypertension diagnosis. Normal blood pressure would be less than 120/80 mm Hg. Systolic pressures between 120 to 129 mm Hg and a diastolic pressure less than 80 mm Hg would be classified as elevated blood pressure. Stage 1 hypertension would be documented for systolic pressures between 130 to 139 mm Hg or diastolic between 80 to 89 mm Hg. Hypertensive crisis would be diagnosed for systolic pressures over 180 mm Hg and/or diastolic pressures over 120 mm Hg.

A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." Which response would the nurse provide? "This is related to your illness rather than to your medication." "This is an expected side effect; you will become accustomed to it over time." "This side effect is only temporary. You should continue the medication." "The medication may need to be discontinued. Come to the clinic this afternoon."

"The medication may need to be discontinued. Come to the clinic this afternoon." Yellow vision indicates digoxin toxicity; the medication should be withheld until the health care provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.

Which of these clients seen at a health fair will be most at risk for hypertension? 23-year-old white man 44-year-old white woman 50-year-old Mexican-American woman 62-year-old African American man

62-year-old African American man African Americans have the highest risk for hypertension; before the age of 45, men are at higher risk than women. A 23-year-old white man would be a low risk for hypertension. A 44-year-old white woman would be a somewhat higher risk, but still much less than an African American man or woman. Mexican-American clients are less likely to seek treatment for hypertension, but they are not at higher risk than African Americans.

Which lifestyle advice does the nurse give to a client when oral digoxin therapy is initiated? Select all that apply. One, some, or all responses may be correct. A. Bran can decrease digoxin absorption. B. Digoxin should not be taken with hawthorn supplements. C. Ginseng may cause a dangerous increase in digoxin levels in the blood. D. St. John's Wort can increase digoxin levels in the blood. E. Medications that lower serum potassium or magnesium can cause digoxin toxicity.

A, B, C, E Consuming large amounts of bran can decrease the absorption of digoxin. Hawthorn may potentiate the effects of digoxin and should be avoided. Ginseng might increase levels of digoxin. St. John's Wort can reduce levels of digoxin in the blood.

A client has been taking the prescribed dose of clozapine. The nurse will assess the client for which adverse effect of this medication? Polycythemia Agranulocytosis Hypertensive crisis Depressed atrioventricular conduction

Agranulocytosis Agranulocytosis occurs in 1% to 2% of clients receiving clozapine and is potentially fatal; weekly blood counts are necessary. Polycythemia is not a side effect of clozapine. Clozapine may cause either hypotension or hypertension, but not to the degree of a hypertensive crisis; this is a side effect of monoamine oxidase inhibitors. Tachycardia may occur, reflecting enhanced, not depressed, conduction.

Which instruction will the nurse include in a teaching plan for a client taking a calcium channel blocker such as nifedipine? Select all that apply A. Reduce calcium intake. B. Report peripheral edema. C. Expect temporary hair loss. D. Avoid drinking grapefruit juice. E. Change to a standing position slowly.

B,D,E Changing positions slowly helps reduce orthostatic hypotension. Peripheral edema may occur as a result of heart failure and must be reported. Grapefruit juice affects the metabolism of calcium channel blockers and should be avoided. Reducing calcium intake is unnecessary because calcium levels are not affected. Hair loss does not occur.

Metoprolol is prescribed for a client with hypertension. The nurse monitors the client for which adverse effect? Hirsutism Bradycardia Restlessness Angina

Bradycardia Beta-blockers block stimulation of beta 1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest. Excessive growth of hair or the presence of hair in unusual places does not occur with this medication; however, absence or loss of hair (alopecia) may occur. A side effect of this medication is fatigue, not restlessness. Metoprolol is indicated for treatment of angina, so angina will be decreased.

A beta blocker is prescribed for the client with persistent ventricular tachycardia. Which response indicates that the beta blocker is working effectively? Decreased anxiety Reduced chest pain Decreased heart rate Increased blood pressure

Decreased heart rate A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta blocker is not an anxiolytic and does not reduce anxiety. A beta blocker is not an analgesic and does not reduce chest pain. Beta blockers reduce blood pressure.

When the health care provider prescribes verapamil to be administered intravenously to a 70-year-old client with hypertension, which nursing intervention will be implemented? Monitor the electrocardiogram for reflex tachycardia. Keep the client in bed for an hour after giving the medication. Dilute the dose in 50 mL of normal saline and administer it over 15 minutes. Assess the client for wheezes and history of asthma before administering the medication.

Keep the client in bed for an hour after giving the medication. Hypotension is a common side effect of intravenously administered verapamil. Keeping the client in bed for an hour after administration provides for the safety of the client. Verapamil slows cardiac conduction as well as causing arterial dilation, so reflex tachycardia does not occur. Reflex tachycardia does occur with the dihydropyridine calcium channel blockers such as nifedipine. Verapamil should be administered undiluted when given intravenously. It is administered over 2 minutes for adults and over 3 minutes for older adults. Asthma history and wheezing would be assessed before administration of beta-receptor blockers, whereas heart rate and blood pressure would be checked before giving calcium channel blockers.