chapter 43 pharm

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response? "Blocks conversion of angiotensin I to angiotensin II." "Increases client's perception of pain and decreases the heart rate." "Decreases the cardiac output by diuresis of sodium and water." "It dilates peripheral arteries and relaxes vascular smooth muscle."

"It dilates peripheral arteries and relaxes vascular smooth muscle."

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." "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." "You should talk to the prescriber for clarification about the medications. "

"Many clients require two or more drugs for high blood pressure."

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." "Mix the crushed tablet with applesauce to improve the taste." "Cut the tablet in half to make it easier to swallow." "Chew the tablet thoroughly before swallowing."

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

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

"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? "We always treat high blood pressure with medicine to prevent further damage to your body." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." "Maybe you do not need medication with your history." "The effects of high blood pressure are different for different people."

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

Prehypertension

120-139/80-89

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 150/100 mm Hg 130/80 mm Hg 100/70 mm Hg

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? 3 2 4 1

2

Normal

< 120 / < 80

What statement should underlie the nurse's response when asked if ACE inhibitor therapy can be continued during pregnancy? There is no research to support discontinuation of ACE inhibitor therapy during pregnancy. ACE inhibitors are contraindicated during pregnancy because they are teratogenic. Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced. ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy.

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

A diabetic patient with hypertension has come to the clinic with vague reports of "just not feeling well." Physical assessment shows that this patient does not have well-controlled hypertension. The nurse practitioner changes the patient's medication regimen from Lisinopril, 10 mg/qd to Accuretic, 10/12.5 mg/qd. What is the rationale for choosing this drug to better control the patient's hypertension? ARBs, combined with a thiazide diuretic, decreases proteinuria and slows the development of nephropathy in diabetic patients. ACE inhibitors, combined with a thiazide diuretic, decrease glucosuria and slows the development of neuropathy in diabetic patients. Beta-blockers, combined with a thiazide diuretic, decrease diabetic retinopathy. ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients.

ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients.

Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause? Aliskiren Olmesartan Azilsartan Valsartan

Aliskiren

A client has been diagnosed with primary hypertension. Which medications are used to treat primary hypertension? Angiotensin converting enzymes (ACEs) Thiazide diuretics Loop diuretics Beta adrenergic antagonists Angiotensin receptor blockers (ARBs)

Angiotensin converting enzymes (ACEs) Thiazide diuretics Angiotensin receptor blockers (ARBs)

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? A sustained increase in renal dysfunction A temporary increase in renal function Baseline renal function A sustained decrease in renal function

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

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 blocking the movement of calcium ions into arterial smooth muscles By inhibiting the transformation of angiotensin I to angiotensin II By blocking aldosterone from binding to mineralocorticoid receptors By directly relaxing vascular smooth muscle

By inhibiting the transformation of angiotensin I to angiotensin II

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 walking pattern Changes in respiratory rate Changes in heart contraction Changes in heparin dose

Changes in heart contraction

The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Clonidine Candesartan Amlodipine Enalapril

Clonidine

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 Damage to the pancreas Damage to the gall bladder

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

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 Increased stroke volume Decreased venous return Increased cardiac output

Decreased venous return

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? Diastolic blood pressure below 100 mm Hg Systolic blood pressure above 140 mm Hg Diastolic blood pressure below 90 mm Hg Systolic blood pressure below 160 mm Hg

Diastolic blood pressure below 90 mm Hg

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

Dietary consumption of calories and salt

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

Dietary consumption of calories and salt

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? Cerebral ischemia Exacerbation of chronic cardiovascular conditions Stevens-Johnson syndrome Increased intracranial pressure

Exacerbation of chronic cardiovascular conditions

Which tasks should a nurse assist a client with in the ambulatory setting in regards to hypertensive management? (Select all that apply.) Schedules an appointment to see a nephrologist Schedules an appointment to see a cardiologist Schedules regular monitoring of weight and blood pressure Finds local resources in the community for taking blood pressure Teaches client how to properly record weight and blood pressure

Finds local resources in the community for taking blood pressure Teaches client how to properly record weight and blood pressure Schedules regular monitoring of weight and blood pressure

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? Baked fish, broccoli, and oranges Ham sandwich with mustard, carrots and cheesy dip Salad with a grilled chicken; unsweetened tea Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea

Ham sandwich with mustard, carrots and cheesy dip

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? Triamterene Amiloride Hydrochlorothiazide Spironolactone

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? Hypermagnesemia Hyperkalemia Hypernatremia Hypokalemia

Hyperkalemia

A community health nurse is facilitating a health promotion session for a group of older adults. Which topic related to hypertension is most important to include in the information? An increase is sodium is recommended with hypertension. Exercise will increase the risk of hypertension. Hypertension will increase the risk of heart disease. Hypertension will increase the risk of cancer.

Hypertension will increase the risk of heart disease.

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? Activation of infectious response Temperature Hypoperfusion of tissues Increased blood pressure

Hypoperfusion of tissues

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? Administer antiemetic medication. Monitor the client's level of consciousness. Assess the level of head pain. Implement interventions to lower blood pressure.

Implement interventions to lower blood pressure.

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Immediate reduction of anxiety An immediate increase in respiratory rate Increased level of consciousness within 2 to 5 minutes Instant bronchodilation

Instant bronchodilation

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? An immediate increase in respiratory rate Increased level of consciousness within 2 to 5 minutes Immediate reduction of anxiety Instant bronchodilation

Instant bronchodilation

A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Increased level of consciousness within 2 to 5 minutes Immediate reduction of anxiety Instant bronchodilation An immediate increase in respiratory rate

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

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

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

Mark, who is suffering from impaired renal function

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

Monitoring for complications and side effects of treatment

After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply? Myocardium hypertrophy Decreased risk of thrombosis Arterial lumen dilation Increased risk for hepatic damage

Myocardium hypertrophy

A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Pulse pressure Peripheral vascular resistance Force of myocardial contraction Renal function

Peripheral vascular resistance

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? Sweating Persistent cough Hypokalemia Sedation

Persistent cough

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

Prazosin

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.) Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Monitoring for drug effects Providing financial assistance with daily expenses Modification of drug dosage

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

Which risk factors should be the focus of the nursing assessment for a client requiring treatment for primary hypertension? Select all that apply. Family history Medical conditions Current medications Race Prior surgeries

Race Current medications Medical conditions

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. Decreased alcohol consumption Regular aerobic exercise Focus on finding a different job Diet with more fruits and vegetables Smoking cessation

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

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? Rebound hypertension Essential hypertension Hypertensive emergency Secondary hypertension

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 Give the nitroprusside at the ordered rate Obtain an order for naloxone Ask the prescriber to reduce the dose

Slow the rate of the infusion

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? Establish a new IV site with at least 20-gauge needle. Stop the infusion and administer diluted phentolamine. Assess urine output, and report to prescriber if less than 30 mL/h. Increase infusion and reassess SBP in 2 minutes.

Stop the infusion and administer diluted phentolamine.

Stage 2 hypertension

Systolic- >160 Diastolic- >100

Stage 1 hypertension

Systolic: 140-159 Diastolic: 90-99

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.

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? Nicardipine Diltiazem Verapamil Valsartan

Valsartan

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: the first dose of the medication should be taken at breakfast. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. a persistent, dry cough may occur; however, it is not serious. he should use a salt substitute containing potassium to avoid hypokalemia.

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

A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex? Enalapril Aldosterone Angiotensin Renin

aldosterone

A 37-year-old client presents with a blood pressure of 118/86 mm Hg. What advice should the nurse provide to this client? "Explore the possible use of a calcium channel blocker with your care provider." "Try to increase your intake of potassium-rich foods." "Ensure 7 to 8 hours of sleep each night." "Be aware of your salt intake and limit hidden salt."

be aware of your salt intake and limit hidden salt

How does captopril contribute to a reduction of a client's blood pressure? increasing rebel excretion of sodium and water dilating peripheral arteries and relaxing vascular smooth muscle blocking the conversion of angiotensin I to angiotensin II blocking the blood pressure-raising effects of angiotensin II

blocking the conversion of angiotensin I to angiotensin II

The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock? Bradycardia Signs of sympathetic stimulation Cool, moist skin Hypertension

bradycardia

Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure? superficial blood vessel bronchiole gastrointestinal sphincter intestinal wall

bronchiole

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Photosensitivity Constipation Cough GI irritation

cough

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 vasoconstrictor. indirect vasoconstrictor. direct vasodilator. indirect vasodilator.

direct vasodilator

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

discontinue the drug

What antihypertensive agent is the most likely initial drug of choice for a black client? beta-adrenergic blocker calcium channel blocker vasodilator diuretic

diuretic

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. The nurse first reviews the client's most recent blood work and should consider withholding the dose because of what laboratory finding? low hemoglobin levels elevated potassium levels low sodium levels elevated neutrophil levels

elevated potassium levels

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 patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? Thromboembolism Stroke Blindness Hypotensive crisis

hypertensive crisis

When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition? Excess Fluid Volume Ineffective Tissue Perfusion Activity Intolerance Social Isolation

ineffective tissue perfusion

An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client's blood pressure be classified? stage 1 hypertension normal isolated systolic hypertension stage 2 hypertension

isolated systolic hypertension

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? Right ventricle Left ventricle Left atrium 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? One year Lifelong Until blood pressure is 120/80 mmHg 5 years

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? Lisinopril Diltiazem Furosemide Verapamil

lisinopril

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? Amlodipine Losartan Minoxidil Moexipril

losartan

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? Increased Prescribed according to normal dosages Lowered Discontinued

lowered

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

monitor the client's blood pressure.

A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? sedation rash tachycardia persistent cough

persistent cough

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

potassium

A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? chest pain palpitations pulmonary edema venous ulcers

pulmonary edema

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 Impaired peripheral tissue perfusion Fluid volume deficit

risk of injury

After teaching a group of students about nitroprusside and cyanide toxicity, the instructor determines that the teaching was successful when the students identify what as an assessment finding? (Select all that apply.) Shallow breathing Distant heart sounds Dilated pupils Bounding pulse Dyspnea Hyperactive reflexes

shallow breathing dilated pupils dyspnea distant heart beat

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension? Stage 1 Stage 2 Hypertensive urgency Normotensive Prehypertension

stage 2

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. Increase fluid intake for 48 hours before taking the first dose. Start with a low dose and increase gradually over 2 to 3 weeks. Take the medication with a high-fat meal.

take medication at bedtime