Karch: Ch. 43 - Drugs Affecting Blood Pressure

A client is receiving candesartan. The nurse understands that this drug acts in which manner? Selectively binds with angiotensin II receptors in the vascular smooth muscle Prevents angiotensin converting enzyme from converting angiotensin I to angiotension II Inhibits the movement of calcium ions across the heart and arterial muscle cell membranes Increases the excretion of sodium and water from the kidney

Selectively binds with angiotensin II receptors in the vascular smooth muscle

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 calcium levels Serum potassium levels Blood glucose levels Serum magnesium levels

Serum potassium levels

When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.) Constipation Proteinuria Photosensitivity Cough Bradycardia Leukocytosis

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 heart Damage to the kidneys Damage to the gall bladder Damage to the pancreas Damage to the eyes

Damage to the heart Damage to the kidneys 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: Increased stroke volume Increased cardiac output Decreased heart rate Decreased venous return

Decreased venous return

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 Asthma Glaucoma Unstable angina pectoris

Diabetes mellitus

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

Diastolic blood pressure below 90 mm Hg

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

Discontinue the drug

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? Inform the client that the drug should be immediately discontinued. Inform the client that this is an adverse effect of the medication that may lead to pneumonitis. Explain why it will be necessary to obtain a sputum sample. Explain that drugs like ramipril often cause a cough.

Explain that drugs like ramipril often cause a cough.

A patient is receiving verapamil. What would be important for the nurse to stress that the patient avoid? Grapefruit juice Milk Apple juice Yogurt

Grapefruit juice

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

Slow the rate of the infusion

When describing the action of calcium channel blockers, which would be an expected effect? Increased contractility Arterial contraction Increased venous return Slowed impulse formation

Slowed impulse formation

A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension? Stage 2 Stage 1 Prehypertension Normotensive

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 SBP is 88 mm. Which action would the nurse implement first? Increase infusion and re-assess SBP in 2 minutes. Stop the infusion and administer diluted phentolamine. Assess urine output, and report to prescriber if less than 30 mL/h. Establish a new IV site with at least 20-gauge needle.

Stop the infusion and administer diluted phentolamine.

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? Amiloride Spironolactone Triamterene Hydrochlorothiazide

Hydrochlorothiazide

Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases risk of colorectal carcinoma. Hypertension increases risk of liver disease Hypertension increases the workload of the heart.

Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart.

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 Increased blood pressure Hypoperfusion of tissues Temperature

Hypoperfusion of tissues

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

Hypotensive crisis

A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe? Increased heart rate Orthostatic hypotension Decreased cardiac output Decreased heart rate

Increased heart rate

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 Activity Intolerance Social Isolation Excess Fluid Volume

Ineffective Tissue Perfusion

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

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

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 rate is too low. The drug will help by increasing his heart rate significantly." "He's in shock because his blood vessels have dilated so severely. The drug will help by reversing that dilation." "He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." "He's in shock because his heart can't pump effectively. This drug will help by increasing his heart rate significantly."

"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 has emphasized the importance of not exceeding the recommended frequency of administration for a prescription for a metered-dose inhaler of epinephrine. Which statement by the client indicates an understanding of the possibility of adverse effects? "I could develop a tolerance to the drug." "I'd be at a greater risk for developing upper respiratory infections." "I'm told it could cause something called rebound bronchoconstriction." "A dangerous heart block can result from overuse of this medication."

"I could develop a tolerance to the drug."

Which statement made by a client prescribed hydrochloride indicates effective teaching about beta-blocker therapy? "I'll make sure not to stop taking my propranolol suddenly." "I will take my propranolol whenever I develop chest pain." "I know that this drug will tend to make me urinate more often." "I'll supplement this drug with my usual regimen of herbs."

"I'll make sure not to stop taking my propranolol suddenly."

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

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

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

"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? "Maybe you do not need medication with your history." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." "The effects of high blood pressure are different for different people." "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."

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 140/90 mm Hg 150/100 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? 2 1 3 4

2

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

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

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 Verapamil Diltiazem Furosemide

Lisinopril

What should a client with newly diagnosed hypertension be counseled to do? Select all that apply. Lose weight Stop smoking Reduce stress Decrease exercise Increase sodium intake

Lose weight Stop smoking Reduce stress

The squad brought a 48-year-old man 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. He becomes disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency? Lower blood pressure as quickly as possible Obtain complete medical history Lower blood pressure gradually Observe for signs and symptoms of cause of hypertension before proceeding

Lower blood pressure as quickly as possible

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 Mark, who is suffering from impaired renal function Hilda, who is showing symptoms of chronic cough Karl, who is showing symptoms of angioedema confined to the face and lip

Mark, who is suffering from impaired renal function

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

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

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 Increased risk for hepatic damage Arterial lumen dilation

Myocardium hypertrophy

A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of: Increased hair growth Absent reflexes Pupil constriction Chest pain

Absent reflexes

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? Angiotensin Aldosterone Renin Enalapril

Aldosterone

Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? Judy, age 36, who is pregnant Luke, age 28, who is suffering from hypertension Nick, age 35, who is suffering from hepatic impairment Cole, age 88, who is suffering from hypertension

Nick, age 35, who is suffering from hepatic impairment

The nurse recognizes that which medication may be used to treat a hypertensive crisis? Minoxidil Nitroprusside Hydralazine Amlodipine

Nitroprusside

On several occasions, the nurse checks a client's blood pressure. The readings are 130/82 mm Hg, 136/84 mm Hg, and 128/88 mm Hg. The nurse would expect this client to be classified as having which stage of hypertension? Prehypertension Stage 1 hypertension Stage 2 hypertension Normotensive

Prehypertension

A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions? Bradycardia Tachycardia Tachypnea Bradypnea

Bradycardia

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 blocking the angiotensin II receptors By preventing renin secretion

By blocking the angiotensin II receptors

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

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

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

What does the administration of a calcium channel blocker result in? (Select all that apply.) Relaxation of blood vessels Increase oxygen supply to the heart Reduce the workload on the heart Decrease blood pressure Increase workload on the kidneys

Relaxation of blood vessels Increase oxygen supply to the heart Reduce the workload on the heart Decrease blood pressure

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond? Restore life to the patient. Replace fluids the patient has lost. Restore and maintain adequate tissue perfusion. Resuscitate the client.

Restore and maintain adequate tissue perfusion.

When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone? Inhibits renin secretion. Causes sodium and water retention. Causes excess potassium retention. Promotes angiotensin I conversion.

Causes sodium and water retention.

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

Changes in heart contraction

How can the nurse minimize the risk for extravasation when administering norepinephrine? Warm the medication before administration. Use a central line to administer the medication. Administer phentolamine just prior to the induction of the medication. In older adults, administer medication into a large vein in a lower extremity.

Use a central line to administer the medication.

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? Valsartan Nicardipine Diltiazem Verapamil

Valsartan

Nonpharmacologic management should be tried alone or with drug therapy. What methods of nonpharmacologic management are used in the treatment of hypertension? (Select all that apply.) Weight reduction Limited alcohol intake Moderate sodium restriction Diet including no concentrated sweets Hot tub soaks

Weight reduction Limited alcohol intake Moderate sodium restriction

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

bronchiole

Which antihypertensive medication can be administered by transdermal patch? amlodipine candesartan enalapril clonidine

clonidine

A client with which diagnosis should be prescribed captopril as the first-line treatment? diabetes mellitus asthma glaucoma angina pectoris

diabetes mellitus

The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy? rhinitis dry cough photosensitivity rash to the trunk and extremities

dry cough

Anaphylaxis kits for clients allergic to bee stings would contain which medication? dopamine aspirin epinephrine norepinephrine

epinephrine

Norepinephrine should be used with caution in an elderly client because of the increased risk of which side effect? exacerbation of chronic cardiovascular conditions cerebral ischemia intracranial pressure Stevens-Johnson's syndrome

exacerbation of chronic cardiovascular conditions

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 infection acute confusion impaired oxygenation

falls

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: constipation. falls. xerostomia (dry mouth). depression.

falls.

What additional medication will best increase the effectiveness of blood pressure control in a client prescribed losartan? atorvastatin calcium hydrochlorothiazide hydralazine hydrochloride digoxin

hydrochlorothiazide

What electrolyte imbalance might a diabetic client be prone to develop when prescribed captopril? hyperkalemia hypokalemia hypernatremia hypermagnesemia

hyperkalemia

A teenage 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 an immediate increase in respiratory rate instant bronchodilation

instant bronchodilation

A 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 lowered prescribed according to normal dosages discontinued

lowered Both losartan and the metabolite are highly bound to plasma albumin, and losartan has a shorter duration of action. Due to malnutrition, a low-dose of losartan should be prescribed.

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 blood pressure. weigh the client. monitor the client's respiratory rate.

monitor the client's blood pressure.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? arterial lumen dilation myocardial hypertrophy increased venous tone hepatic damage

myocardial hypertrophy

A need for additional education on the administration of epinephrine is needed when a new nursing graduate indicates that epinephrine can be effectively administered by what route? oral topical intravenous subcutaneous

oral

Primary medications used in the management of shock are adrenergic drugs. Medications with alpha-adrenergic activity raise blood pressure via increasing: peripheral vascular resistance. myocardial activity. heart rate. cardiac stroke volume.

peripheral vascular resistance.

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

persistent cough

An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified? normal prehypertension stage 1 hypertension stage 2 hypertension

prehypertension

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? pulmonary edema venous ulcers chest pain palpitations

pulmonary edema

How is hypertension defined with regard to blood pressure readings? systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg systolic pressure above 160 mm Hg or diastolic pressure above 110 mm Hg systolic pressure above 130 mm Hg or diastolic pressure above 88 mm Hg systolic pressure above 150 mm Hg or diastolic pressure above 100 mm Hg

systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg

Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure? loop diuretics osmotic diuretics potassium-sparing diuretics thiazide diuretics

thiazide diuretics