EAQ Chapt 36: HTN and PAD
The primary health care provider prescribes eplerenone to a patient diagnosed with hypertension. Which medication should be checked in the patient's medication history to ensure safe drug administration? 1 "Do you take erythromycin?" 2 "Do you take ketoconazole?" 3 "Do you take fluconazole?" 4 "Do you take saquinavir?
"Do you take ketoconazole?" Eplerenone acts by inhibiting sodium reabsorption by the kidney. Ketoconazole has the potential to interact with eplerenone and increase its potency. Its coadministration with eplerenone may cause life-threatening hyperkalemia, and therefore, must be avoided. Saquinavir, fluconazole, and erythromycin are safe to take with eplerenone; however, they are administered with dose reduced by half to 25 mg daily.
The primary health care provider prescribes spironolactone to a patient with hypertension. Which instruction should the nurse give to the patient to ensure safety?
"Decrease intake of potassium-rich foods." Spironolactone causes potassium retention in the body and increases the risk for hyperkalemia. Therefore, the nurse should instruct the patient to decrease the intake of potassium-rich foods. A patient should avoid grapefruits and grapefruit juice when taking verapamil because grapefruit can enhance the drug's action and cause organ dysfunction or death. A patient taking hydrochlorothiazide should rise slowly from the bed to prevent falls because the drug causes diuresis that can cause orthostatic hypotension. The patient should not take eplerenone with itraconazole because eplerenone interacts with itraconazole.
The nurse teaches foot care measures to a patient diagnosed with peripheral vascular disease. Which statement of the patient indicates the need for further teaching? 1 "I should use a heating pad on my feet." 2 "I should avoid extended pressure on my feet." 3 "I should use a mild soap to wash my feet." 4 "I should keep my toenails clean and filed."
"I should use a heating pad on my feet."
Which chemical in the urine may indicate pheochromocytoma in a patient with hypertension? 1 Catecholamines 2 17-ketosteroids 3 Corticoids 4 Estrogen
Catecholamines
A patient reports diarrhea, headache, and gastrointestinal disturbance. The patient's laboratory report indicates peripheral arterial disease, intermittent claudication, and a serum high-density lipoprotein (HDL-C) level of 80 mg/dL. Which medication does the nurse most likely find in the patient's prescription? 1 Nifedipine 2 Cilostazol 3 Losartan 4 Warfarin
Cilostazol is used to treat peripheral arterial disease and intermittent claudication. It may produce side effects such as diarrhea, headache, and gastrointestinal disturbance and increases HDL-C levels. The normal level of HDL-C is in the range of 40 to 50 mg/dL. An HDL-C level of 80 mg/dL indicates increased HDL-C levels. Warfarin is an anticoagulant that may cause bleeding as an adverse effect. Losartan treats hypertension and may cause hyperkalemia as an adverse effect. Nifedipine treats Buerger's disease and may cause facial flushing and hypotension.
The nurse assesses the patient and records findings such as cold lower extremities bilaterally with loss of hair on the lower calves. The patient's ankle-brachial index is 0.61 and the patient has decreased Doppler pressure. Which complication does the nurse expect in the patient? 1 Peripheral arterial disease 2 Raynaud's phenomenon 3 Buerger's disease 4 Aortic dissection
Cold extremity, loss of hair on the lower calf, muscle atrophy, and mottled skin are the symptoms of peripheral arterial disease. An ankle-brachial index of less than 0.9 and decreased Doppler pressure also indicate peripheral arterial disease. Diaphoresis, pain in the anterior chest, vomiting, and faintness are symptoms of aortic dissection. Claudication in the feet and lower extremities, sensitivity to cold, and ulcerations and gangrene on digits are symptoms of Buerger's disease. Red-white-blue skin color changes on exposure to cold or stress indicates Raynaud's phenomenon.
A patient with acute peripheral arterial occlusion is receiving platelet inhibitor therapy. The nurse observes that the patient shows signs of bleeding and reports it to the primary health care provider. What order should the nurse anticipate? 1 Change the position of the platelet inhibitor infusion catheter. 2 Administer IV fluids along with a platelet inhibitor infusion. 3 Increase the rate of the platelet inhibitor infusion. 4 Discontinue the platelet inhibitor infusion
Discontinue the platelet inhibitor infusion
Which drug does the primary health care provider prescribe with caution for blood pressure (BP) control in the patient with gout who has a BP of 180/96 mm Hg? 1 Hydrochlorothiazide 2 Triamterene 3 Furosemide 4 Torsemide
For managing high BP in a patient with gout, hydrochlorothiazide may be prescribed cautiously. This drug may cause retention of uric acid, which could further aggravate the patient's gout. The other diuretics, such as torsemide and furosemide, are loop diuretics associated with inhibition of sodium reabsorption and potassium excretion. Triamterene is a potassium-sparing diuretic that helps retain sodium and is used in combination with another diuretic.
In which order should the steps of emergency care for a patient with hypertensive crisis be performed? 1. The oxygen is administered to the patient. 2. The patient is placed in the semi-Fowler's position. 3. The administration of beta blocker or nicardipine is begun through the intravenous route. 4. A solution of 0.9% normal saline solution is slowly administered through the intravenous route. 5. Complications associated with the neurological or cardiovascular system including seizures, numbness, weakness, and dysrhythmias are assessed. 6. The blood pressure is monitored every 5 to 15 minutes until the diastolic pressure reaches 75 to 90 mm Hg.
In a hypertensive crisis, a severe elevation in blood pressure (greater than 180/120 mm Hg) occurs. The patient is admitted to the critical care unit. Initially, the patient is placed in a semi-Fowler's position, and oxygen is administered to promote tissue oxygenation. A solution of 0.9% normal saline solution is slowly administered to maintain fluid and electrolyte balance. Beta blocker or nicardipine is administered through the intravenous (IV) route until the patient's diastolic blood pressure reading reaches 75 to 90 mm Hg. The nurse should observe for any neurovascular or cardiovascular complications that may arise.
What could be the rationale behind scheduling plethysmography for a patient?
To evaluate arterial flow in the lower extremities
What should the nurse include while teaching the patient with hypertension who is prescribed hydrochlorothiazide about its adverse effect? 1 "You may experience less desire for sex." 2 "You may develop breast enlargement." 3 "You may experience lower back pain." 4 "You may develop a cough.
"You may experience less desire for sex." Hydrochlorothiazide manages hypertension by promoting potassium, bicarbonate, and magnesium excretion. Male patients who are prescribed hydrochlorothiazide may experience decreased libido. The other adverse effects such as coughing may be observed by using angiotensin-converting enzyme (ACE) inhibitors. Lower back pain and breast enlargement may not be associated with administration of hydrochlorothiazide.
The nurse educates a patient about reducing the risk of peripheral arterial disease. During a follow-up visit, the nurse finds that the patient's condition has improved. Which actions, performed by the patient, led to the improvement in his/her condition? Select all that apply. 1 Avoiding caffeine consumption 2 Applying direct heat to limbs 3 Avoiding exposure to cold 4 Wearing socks at all times 5 Limiting fluid intake
Avoiding caffeine consumption Avoiding exposure to cold Wearing socks at all times Wearing socks at all times will help keep the feet warm and maintain blood circulation. Exposure to cold and caffeine consumption should be avoided to prevent vasoconstriction. The patient should drink adequate fluids to prevent increased blood viscosity. The patient should avoid applying direct heat to the limbs because sensitivity is decreased in the affected limb and may result in burns.
A patient reports numbness, burning, and pain in the forefoot while resting. The nurse finds that the patient's pain is relieved after placing the extremity in a dependent position. Which stage of chronic peripheral arterial disease does the nurse expect in the patient? 1 Stage IV 2 Stage III 3 Stage II 4 Stage I
Numbness, burning, and pain in the forefoot while at rest are symptoms of stage III chronic peripheral arterial disease. In this stage, the patient's pain is relieved by placing the extremity in a dependent position. Aneurysm, absence of claudication, and decreased pedal pulses are symptoms of stage I chronic peripheral arterial disease. Muscle pain and cramping during exercise are symptoms of stage II chronic peripheral arterial disease. Gangrenous odor, ulcers, and blackened tissue of the forefoot are the symptoms of stage IV chronic peripheral arterial disease.
The nurse is evaluating the prescriptions of four patients. Which patient's prescription needs correction? PAD and Bivalirudin HTN and Enalipril Aortic dissection and esmolol Buergers and Nifedipine
Pentoxifylline is used to treat peripheral arterial disease since it increases the flexibility of red blood cells. Bivalirudin is a highly selective direct thrombin inhibitor used to treat patients with a history of heparin-induced thrombocytopenia. Therefore, the prescription of patient A needs correction. Enalapril is an angiotensin-converting enzyme inhibitor used to treat hypertension. Esmolol is used to treat aortic dissection as it lowers the heart rate and blood pressure. Nifedipine is used to treat Buerger's disease through vasodilation.
A patient is diagnosed with acute peripheral arterial occlusion. Which instruction would the health care provider give to the nurse that would be beneficial for the patient? 1 Provide unfractionated heparin therapy to the patient. 2 Place the patient in a semi-Fowler's position. 3 Avoid alteplase treatment in the patient. 4 Avoid cold exposure in the patient
Provide unfractionated heparin therapy to the patient. Heparin is an anticoagulant medication used to prevent clot formation. Unfractionated heparin therapy is recommended for the treatment of acute peripheral arterial occlusion. Avoiding exposure to cold is beneficial to a patient with peripheral vascular disease. Alteplase is recommended for the treatment of acute peripheral arterial occlusion. The nurse should keep the patient in a semi-Fowler's position if the patient has hypertension.
A patient reports calf muscle pain after walking about one or two blocks. The nurse finds a pale ulcer with even edges and little granulation tissue at the end of the toes, atrophy of skin, cold foot, and absence of pulses. What should the nurse interpret from these findings? 1 The patient has a side effect of metoprolol. 2 The patient has a side effect of aliskiren. 3 The patient has diabetic ulcers. 4 The patient has arterial ulcers.
The patient has arterial ulcers.
Which key feature is associated with stage II of chronic peripheral arterial disease? 1 The patient describes the pain as numbness, burning, and toothache-like. 2 The toes, forefoot, and heel have ulcers and blackened tissue. 3 The symptoms are reproducible with exercise. 4 The patient wakes up with pain at night.
The symptoms are reproducible with exercise. Peripheral vascular disease causes change in natural blood flow through the arteries and veins of the peripheral circulation. These conditions may decrease perfusion to the body tissues. Stage II of this disease is characterized by the reproducibility of symptoms when the patient exercises. Waking up with pain at night occurs during stage III of chronic peripheral arterial disease. The occurrence of ulcers and blackened tissue on the toes, forefoot, and heel are manifestations of stage IV of chronic peripheral arterial disease. Describing the pain as numbness, burning, or toothache-like is typical of stage III of chronic peripheral arterial disease.
The clinical findings of a patient with hypertension show elevated levels of serum creatinine and blood urea nitrogen. What may be a cause of secondary hypertension? 1 Cushing's disease 2 Pheochromocytoma 3 Kidney disease 4 Encephalitis
kidney disease The clinical finding of the patient show increased blood levels of creatinine and blood urea nitrogen (BUN). These findings may be associated with kidney disease. Conditions such as encephalitis, pheochromocytoma, and Cushing's disease may not be associated with elevated level of proteins and RBC in urine and increased blood levels of creatinine and BUN.
