NRS301 EAQ #6

The nurse is working in the emergency department when a patient with a head injury develops increased intracranial pressure. Which drug would the nurse anticipate administering? 1 Mannitol 2 Metolazone 3 Spironolactone 4 Hydrochlorothiazide

1 Intracranial pressure (ICP) that has been elevated by cerebral edema can be reduced with mannitol. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Metolazone and hydrochlorothiazide are thiazide-like diuretics; spironolactone is a potassium-sparing diuretic; they are of little benefit in reducing cerebral edema.

Which assessment is most important for the nurse to obtain before administering digoxin to a patient with heart failure? 1 Pulse 2 Blood pressure 3 Respiratory rate 4 Weight in kilograms

1 It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

The nurse is caring for a patient with bipolar disorder treated with lithium. The patient has a new prescription for captopril for hypertension. The combination of these two drugs makes which assessment particularly important? 1 Lithium level 2 Blood pressure 3 Potassium level 4 Creatinine level

1 Lithium levels should be monitored on a regular basis. Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, can cause lithium accumulation. ACE inhibitors can cause hyperkalemia, renal insufficiency in some patients, and hypotension. However, the combination of lithium and captopril would not increase the risk of these effects.

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine be least appropriate? 1 Atrial fibrillation 2 Angina pectoris 3 Vasospastic angina 4 Essential hypertension

1 Nifedipine produces very little blockade of the calcium channels of the heart; therefore, it is ineffective for treating dysrhythmias, such as atrial fibrillation. Therapeutic uses for nifedipine include the treatment of angina pectoris, essential hypertension, and vasospastic angina.

The nurse is reviewing the chart of a patient with heart failure. Which information would lead the nurse to notify the provider? 1 Hypokalemia 2 Pulse rate 62 beats/min 3 Large amount clear yellow urine 4 Carvedilol 12.5 mg twice/day (bid)

1 The most common cause of dysrhythmias in patients receiving digoxin is hypokalemia secondary to the use of diuretics (in this case furosemide). A pulse rate of 62 beats/min is normal, and the provider should not be notified. Carvedilol is a beta blocker given for heart failure, and the provider should not be notified. The provider should not be notified for the large amount of clear yellow urine because digoxin increases urine production as does furosemide, a loop diuretic.

The nurse is caring for a patient with heart failure who is on digoxin therapy. Assessment findings include a heart rate of 48 bpm, 2+ pedal edema, and orthopnea. Which action would the nurse take first? 1 Hold digoxin 2 Hold diuretics 3 Administer atropine 4 Obtain a serum potassium level

1 The nurse would hold the digoxin if the patient is experiencing bradycardia. Diuretics would not be held when the patient has pedal edema and orthopnea. Atropine would be delivered for significant and symptomatic bradycardia. A potassium level would be indicated if there were signs of hypokalemia or hyperkalemia.

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? 1 Bradypnea 2 Tachycardia 3 Hypotension 4 Hypoglycemia

2 Increased sympathetic activity results in an increased heart rate (tachycardia), increased contractility, increased venous tone, and increased arteriolar tone (elevated blood pressure). Sympathetic stimulation also causes bronchodilation (not bradypnea) and possibly hyperglycemia.

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which structural change occurs with heart failure? 1 Ventricular atrophy 2 Ventricular constriction 3 Ventricular wall thickening 4 Ventricles become more cylindric

3 An increase in ventricular wall thickness, also called ventricular hypertrophy , is characteristic of the remodeling process during the initial phase of heart failure. The ventricles also dilate and become more spherical (less cylindric). This change in cardiac shape typically occurs after cardiac injury under the influence of the neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system.

Which acid-base imbalance is caused by retention of carbon dioxide secondary to hypoventilation? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

3 Respiratory acidosis results from retention of CO 2 secondary to hypoventilation. Reduced CO 2 exhalation raises plasma pCO 2, which in turn causes plasma pH to fall. Retention of CO 2 secondary to hypoventilation does not cause respiratory alkalosis, metabolic acidosis, or metabolic alkalosis.

The patient with diabetes is diagnosed with hypertension. The nurse would instruct the patient to increase frequency of blood glucose monitoring if which medication(s) are prescribed for the patient? Select all that apply. 1 Enalapril 2 Diltiazem 3 Metoprolol 4 Furosemide 5 Hydrochlorothiazide

3, 4, 5 Hydrochlorothiazide and furosemide promote hyperglycemia, and metoprolol suppresses glycogenolysis and can mask signs of hypoglycemia. Therefore, these medications should be administered with caution to patients with diabetes. Diltiazem and enalapril do not cause either of these effects.

Which behavior by a patient indicates more teaching is needed about taking diltiazem? 1 Takes with tea 2 Takes with lemonade 3 Takes with apple juice 4 Takes with grapefruit juice

4 If the patient consumes grapefruit juice, it can raise the levels of diltiazem and verapamil. The other drinks (tea, apple juice, lemonade) can be used by the patient when taking diltiazem because they have no significant interaction.

Which assessment should a nurse monitor more frequently in a patient who takes both an alpha blocker for benign prostatic hyperplasia and metoprolol? 1 Urine output 2 Blood pressure 3 Hemoglobin level 4 Blood glucose level

2 Caution must be exercised in combining an alpha blocker—terazosin, doxazosin, tamsulosin, alfuzosin—with an antihypertensive medication such as metoprolol, because severe hypotension could result. Hemoglobin, blood glucose, and urine output are not affected by combining an alpha blocker and a hypertensive medication.

A patient's arterial pressure drops upon standing. How should the nurse report this finding to the oncoming shift? 1 The patient has water retention. 2 The patient has reflex tachycardia. 3 The patient has steady-state control. 4 The patient has orthostatic hypotension.

4 Postural hypotension, also known as orthostatic hypotension, is a reduction in arterial pressure that can occur when we move from a supine or seated position to an upright position. Water retention is mediated in part by aldosterone through retention of sodium; it is water that is not being excreted but being retained in the body. Reflex tachycardia occurs if a vasodilating drug is administered, activating the baroreceptor reflex. Steady-state sympathetic tone provides a moderate level of vasoconstriction.

A nurse is describing the circulatory system to a patient. In which order does blood travel after leaving the left ventricle? 1. Veins 2. Aorta 3. Arteries 4. Venules 5. Arterioles 6. Capillaries

The blood flows into the aorta, large arteries, arterioles, capillaries, venules, veins (muscular and central), and back to the right atrium.

The nurse is preparing to administer an oral dose of digoxin. The apical pulse rate is 64 beats/min. Which nursing action is most appropriate? 1 Give the medication. 2 Obtain a serum digoxin level. 3 Notify the healthcare provider. 4 Assess for signs of digoxin toxicity.

1 Determine heart rate and rhythm before administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

A patient with benign prostatic hyperplasia (BPH) is prescribed finasteride. Which statement by the patient indicates understanding of medication teaching? 1 "Pregnant women should not handle my medication." 2 "This medication will prevent all types of prostate cancer." 3 "I will take this medication when I am having trouble urinating." 4 "I should notice results within two to four weeks after starting the medication."

1 Finasteride can harm a developing fetus, so pregnant women should not handle the medication. The medication takes months to have an effect and prevents only low-grade prostate cancers. The medication should be taken daily as prescribed.

The nurse is caring for a patient who has congestive heart failure. The patient's medical history indicates that the patient has a history of chronic kidney disease with a low glomerular filtration rate (GFR). Which drug would the nurse anticipate being prescribed for the patient? 1 Furosemide 2 Metolazone 3 Methyclothiazide 4 Hydrochlorothiazide

1 Furosemide is especially useful in patients with severe renal impairment, because, unlike the thiazides, the drug can promote diuresis even when renal blood flow and GFR are low. The use of thiazides (metolazone, hydrochlorothiazide, or methyclothiazide) is not effective with a low GFR.

The nurse is administering several different diuretics. Which drug will produce the most diuresis in a patient? 1 Furosemide 2 Triamterene 3 Spironolactone 4 Hydrochlorothiazide

1 Furosemide is the most potent diuretic. Drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. Furosemide works at the loop of Henle; as a result, furosemide produces the greatest diuresis. Hydrochlorothiazide works on the early distal convoluted tubule so does not have the capacity to excrete as much sodium and water as a loop diuretic and is less effective. Triamterene and spironolactone work at the distal nephron so do not have the ability to excrete as much sodium and water as loop diuretics.

A patient with hypertension is receiving spironolactone therapy. The nurse notes that the patient's serum potassium level is 6.2 mEq/L. What would the nurse anticipate to be prescribed for the patient? 1 Insulin 2 Mannitol 3 Amiloride 4 Triamterene

1 If serum potassium rises above 5 mEq/L, or if signs of hyperkalemia develop (eg, abnormal heart rhythm), spironolactone should be discontinued and potassium intake restricted. Injection of insulin can help lower potassium levels by promoting potassium uptake into cells. Amiloride and triamterene are potassium-sparing diuretics, which, on administration, may cause further increase in the serum potassium levels. Mannitol is an osmotic diuretic that does not show any significant effect on potassium levels.

The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? 1 Enalapril 2 Methyldopa 3 Propranolol 4 Hydrochlorothiazide

1 Preferred antihypertensives for patients with diabetes include angiotensin-converting enzyme (ACE) inhibitors, such as enalapril; angiotensin receptor blockers; and calcium channel blockers. ACE inhibitors are particularly useful, because they slow the progression of diabetic nephropathy in addition to lowering blood pressure. Thiazide diuretics promote hyperglycemia and are used with caution.

Which acid-base imbalance is caused by chronic renal failure, loss of bicarbonate during severe diarrhea, or metabolic disorders that result in overproduction of lactic acid? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

1 Principal causes of metabolic acidosis are chronic renal failure, loss of bicarbonate during severe diarrhea, and metabolic disorders that result in overproduction of lactic acid (lactic acidosis) or ketoacids (ketoacidosis). Metabolic acidosis also may result from poisoning by methanol and certain medications (eg, aspirin and other salicylates).

A patient is scheduled to start taking sildenafil. The nurse should recognize that the patient is at risk for developing an adverse cardiac event if the patient's history reveals which condition? 1 Angina 2 Hypertension 3 Varicose veins 4 Prosthetic mitral valve

1 Sildenafil is used in the treatment of erectile dysfunction. It should be used with caution by men with coronary heart disease (CHD), which may be manifested by angina. Research has suggested that in men with CHD, sexual activity, not sildenafil, is the likely cause of adverse cardiac events. Sildenafil is not contraindicated in patients with hypertension, varicose veins, or a prosthetic mitral valve.

A patient in the emergency department reports taking sildenafil and nitroglycerin 1 hour before sexual activity. Which finding should the nurse recognize as the result of this drug interaction? 1 Blood pressure 70/50 mm Hg 2 Respiratory rate 26 breaths/min 3 Body temperature 100.4°F (38°C) 4 White blood cell count 3200 units/L

1 When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension that is unresponsive to treatment. At least 24 hours should elapse between the last dose of sildenafil and a nitrate. A white blood cell count of 3200 units/L, a respiratory rate of 26 breaths/min, and a body temperature of 100.4° F are abnormal findings and must be reported. However, they are not as important to report as the blood pressure of 70/50 mm Hg, which is directly related to sildenafil and nitroglycerin.

A patient with a hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? 1 Minoxidil 2 Hydralazine 3 Sodium nitroprusside 4 Hydralazine and isosorbide dinitrate

3 Intravenous sodium nitroprusside has an immediate effect and is the drug of choice for hypertensive emergencies. Minoxidil is used when all other antihypertensives have failed to lower the patient's blood pressure. Hydralazine is used for essential hypertension.

A patient is ordered furosemide to be given via intravenous push. Which interventions should the nurse perform? Select all that apply. 1 Obtain weight 2 Assess lung sounds 3 Administer slowly over 1 to 2 minutes 4 Monitor electrocardiogram continuously 5 Maintain accurate intake and output record 6 Insert an arterial line for continuous blood pressure monitoring

1, 2, 3, 5 Furosemide can be infused via intravenous push slowly over 1 to 2 minutes. For all patients, obtain baseline values for weight, blood pressure (sitting and supine), pulse, respirations, and electrolytes (sodium, potassium, chloride). It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure. Also, there is no need to continuously monitor an electrocardiogram.

Which assessment findings indicate the patient is experiencing adverse effects from furosemide? Select all that apply. 1 Oliguria 2 Dry mouth 3 Clear lungs 4 Unusual thirst 5 Clear yellow urine

1, 2, 4 Furosemide can produce dehydration. Signs of evolving dehydration include dry mouth, unusual thirst, and oliguria (urine output less than 25 mL/hr). Therapeutic effects of furosemide include clear lungs and an increased amount of clear yellow urine.

The nurse is caring for a patient with heart failure. Which drugs would the nurse typically administer for routine first-line therapy? Select all that apply. 1 Diuretics 2 Beta blockers 3 Cardiac glycosides 4 Sympathomimetics 5 Angiotensin-converting enzyme (ACE) inhibitors

1, 2, 5 For routine therapy, heart failure is treated with three types of drugs: (1) diuretics, (2) beta blockers, and (3) agents that inhibit the renin-angiotensin-aldosterone system, ACE inhibitors, and angiotensin receptor blockers. Other agents such as digoxin (cardiac glycoside) or dopamine (sympathomimetics) may be used as well for second-line drugs or acute heart failure that requires hospitalization.

The nurse is teaching the staff about the therapeutic effects of vasodilators. Which statements indicate a correct understanding of the teaching? Select all that apply. 1 "Preload is decreased." 2 "Vasodilators reduce afterload." 3 "Vasodilators promote sodium and water retention." 4 "Cardiac output and tissue perfusion are increased." 5 "Some vasodilators dilate arteries or veins, whereas others dilate both."

1, 2, 5 Some agents produce selective dilation of arterioles. Others produce selective dilation of veins. Still others dilate arterioles and veins. Vasodilators that dilate resistance vessels (arterioles) cause a decrease in cardiac afterload. In contrast, drugs that dilate capacitance vessels (veins) reduce the force with which blood is returned to the heart, which reduces ventricular contraction, decreasing cardiac preload. Venous dilators cause a decrease in cardiac work, along with a decrease in cardiac output and tissue perfusion. Vasodilators do not work by promoting sodium and water retention.

Which drugs will lead the nurse to monitor a patient closely for reflex tachycardia? Select all that apply. 1 A drug that dilates veins 2 A drug that constricts veins 3 A drug that dilates arterioles 4 A drug that constricts muscles 5 A drug that constricts arterioles

1, 3 As with drugs that reduce arterial pressure by dilating arterioles, drugs that reduce arterial pressure by dilating veins can trigger the baroreceptor reflex and can thereby cause reflex tachycardia. Reflex tachycardia does not occur with constriction of arterioles and veins or with drugs that constrict muscles.

The nurse is teaching the patient why hypertension must be treated. Which complications would be included in the teaching plan? Select all that apply. 1 Stroke 2 Diabetes 3 Heart failure 4 Emphysema 5 Cardiovascular disease

1, 3, 5

The nurse is teaching a patient prescribed captopril for the treatment of hypertension. Which instructions should the nurse include? Select all that apply. 1 Expect a persistent dry cough. 2 Take the medication with food. 3 Expect a sore throat and fever. 4 Avoid potassium salt substitutes. 5 Report difficulty in breathing immediately.

1, 4, 5 Salt substitutes contain potassium and may increase the risk of hyperkalemia with angiotensin-converting enzyme (ACE) inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril must be taken at least 1 hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body's ability to fight an infection. Early signs of infection include fever and sore throat.

The nurse is reviewing a medication history on a patient taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse will contact the health care provider if the patient is also taking which medication? 1 Furosemide 2 Spironolactone 3 Morphine sulfate 4 Docusate sodium

2 ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be administered with an ACE inhibitor. The other medications do not cause side effects with this medication.

The nurse has just administered the initial dose of enalapril to a newly admitted patient. What is the priority nursing intervention related to this medication over the next several hours? 1 Check the heart rate. 2 Monitor blood pressure. 3 Auscultate lung sounds. 4 Draw a potassium level.

2 First-dose hypotension is a serious potential adverse effect of angiotensin-converting enzyme (ACE) inhibitors such as enalapril. Monitoring the blood pressure is the priority nursing intervention. If hypotension develops, the nurse will place the patient in the supine position and possibly increase intravenous fluids. The other interventions may be appropriate for this patient; however, in the hours immediately after the first dose of an ACE inhibitor, monitoring of the blood pressure is most important.

The patient is prescribed hydralazine and propranolol and asks the nurse why he must take both medications. Which response by the nurse is appropriate? 1 "Propranolol prevents you from retaining too much fluid." 2 "Propranolol prevents your heart rate from getting too high." 3 "Propranolol keeps you from developing symptoms of lupus erythematosus." 4 "Propranolol helps your body excrete excess sodium and water."

2 Hydralazine can be combined with a beta blocker to protect against reflex tachycardia and with a diuretic to prevent sodium and water retention and expansion of blood volume. Doses kept below 200 mg/day will help reduce the incidence of systemic lupus erythematosus-like syndrome.

Which acid-base imbalance is characterized by increases in both the pH and bicarbonate content of plasma? 1 Metabolic acidosis 2 Metabolic alkalosis 3 Respiratory acidosis 4 Respiratory alkalosis

2 Metabolic alkalosis is characterized by increases in both the pH and bicarbonate content of plasma. Causes include excessive loss of gastric acid (through vomiting or suctioning) and administration of alkalinizing salts (eg, sodium bicarbonate).

The health care provider prescribes an intravenous (IV) dose of diltiazem for treatment of a patient with atrial fibrillation. What is the prioritynursing intervention? 1 Assist with cardioversion. 2 Monitor electrocardiogram. 3 Obtain baseline coagulation studies. 4 Assess for increased urinary output.

2 Monitor the electrocardiogram (ECG) continuously during intravenous administration of diltiazem for atrioventricular (AV) block, sudden reduction in heart rate, and prolongation of the PR or QT interval. Cardioversion is not necessary; however, the nurse should have equipment for cardioversion available. Baseline laboratory studies are needed for liver and kidney function. Increased urinary output is not an adverse effect of diltiazem.

A patient who has vomiting and diarrhea is ordered an isotonic intravenous fluid. Which intravenous fluid should the nurse prepare to administer? 1 3% sodium chloride 2 0.9% sodium chloride 3 0.45% sodium chloride 4 0.25% sodium chloride

2 Of the fluids listed, the only one that is isotonic is 0.9% sodium chloride. The first answer, 3% sodium chloride, is considered to be a hypertonic solution; 0.45% and 0.25% sodium chloride are considered to be hypotonic solutions.

Which patient finding would cause the nurse to hold the 8 a.m. dose of verapamil? 1 The patient has atrial flutter. 2 The patient has tachycardia. 3 The patient has hypotension. 4 The patient has angina pectoris.

3 A patient who is scheduled to receive verapamil, a calcium channel blocker (CCB), should have blood pressure and pulse assessed prior to administration. Hypotension would be a reason to hold the drug. Verapamil is given for atrial flutter. Patients with angina may receive CCBs for their vasodilating effects. Tachycardia is not a reason to hold the drug; CCBs decrease the heart rate.

The nurse should notify the health care provider immediately about which patient? 1 A patient who takes digoxin 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL 2 A patient who takes oral spironolactone 25 mg daily and enalapril 5 mg daily with a serum potassium level of 5.5 mEq/L 3 A patient who takes oral lisinopril 5 mg daily and digoxin 0.125 mg daily with a serum digoxin level of 0.5 ng/mL 4 A patient who takes digoxin 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L

2 Patients who take an aldosterone antagonist (spironolactone) are at risk for developing hyperkalemia. The risk is increased if an aldosterone antagonist and an angiotensin-converting enzyme inhibitor (enalapril) are used together. The normal serum potassium level ranges from 3.5 to 5.0 mEq/mL. This patient is hyperkalemic, which increases the risk for electrocardiographic changes. The optimal range for the serum digoxin level is 0.5 to 0.8 ng/mL. The risk of digoxin toxicity increases when hypokalemia is present (potassium level below 3.5 mEq/L).

Which patient should the nurse monitor closely for respiratory alkalosis? 1 A patient who is vomiting 2 A patient who is hyperventilating 3 A patient who has status asthmaticus 4 A patient who has nasogastric suctioning

2 Respiratory alkalosis is produced by hyperventilation. Deep and rapid breathing increases CO 2 loss, which in turn lowers the partial pressure of carbon dioxide (pCO 2) of blood and increases pH. Vomiting and nasogastric suctioning increase the risk for metabolic alkalosis. Status asthmaticus increases the risk for respiratory acidosis by retaining CO 2.

The nurse is reviewing the home medication list with the patient. The nurse should recognize that hydrochlorothiazide is used primarily for which condition? 1 Edema 2 Hypertension 3 Diabetes insipidus 4 Protection against postmenopausal osteoporosis

2 The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides also are used for edema, diabetes insipidus, and protection against postmenopausal osteoporosis, but the primary indication is hypertension.

A patient is prescribed lisinopril 40 mg by mouth once a day for hypertension. For which therapeutic effect should the nurse monitor? 1 Slowing of the heart rate 2 Decrease in blood pressure 3 Symptoms such as dizziness and fainting 4 Pulse oximetry oxygen saturation of 100%

2 The therapeutic effect of angiotensin-converting enzyme (ACE) inhibitors is to reduce blood pressure in patients with hypertension. ACE inhibitors do not affect patients' heart rate. Dizziness and fainting are symptoms of hypotension. ACE inhibitors do not affect oxygen saturation.

A patient with hypertension will be started on a diuretic as first-line drug therapy after lifestyle changes have been ineffective. Which type of diuretics does the nurse anticipate will be used? 1 A loop diuretic 2 A thiazide diuretic 3 An osmotic diuretic 4 A potassium-sparing diuretic

2 The thiazide diuretics such as hydrochlorothiazide are the most commonly used diuretics for the treatment of hypertension. Loop, osmotic, and potassium-sparing diuretics are not drugs of first choice for uncomplicated hypertension.

The nurse is administering several medications at 8 a.m. Which medication will decrease blood pressure by blocking angiotensin II receptor sites? 1 Enalapril 2 Valsartan 3 Eplerenone 4 Furosemide

2 Valsartan is an angiotensin II receptor blocker that is indicated for management of hypertension. Furosemide is a loop diuretic. Eplerenone is an aldosterone antagonist. Enalapril is an angiotensin-converting enzyme inhibitor.

A patient has taken a medication that causes the arterioles to dilate. What will likely happen to the cardiac afterload? 1 It will rise. 2 It will decrease. 3 It will stay the same. 4 It will fluctuate wildly.

2 When arterioles dilate, peripheral resistance falls, causing arterial pressure (afterload) to decline. When arterioles constrict, peripheral resistance rises, also causing arterial pressure (afterload) to rise. It will not stay the same, nor will it fluctuate wildly.

A patient is given medication to make the blood vessels constrict. The nurse understands that what occurs with this medication? 1 Blood flow increases. 2 Resistance increases. 3 Vessel diameter enlarges. 4 Blood pressure decreases.

2 When vessels constrict, resistance rises, causing blood flow to decline. To maintain adequate flow when resistance rises, blood pressure must rise as well. When vessels dilate, the diameter enlarges, whereas constriction causes the diameter to become smaller.

Which are actions of angiotensin II? Select all that apply. 1 Dilates vessels 2 Raises blood pressure 3 Causes cardiac remodeling 4 Catalyzes angiotensinogen 5 Stimulates aldosterone release

2, 3, 5 The most prominent actions of angiotensin II are vasoconstriction (not dilation) and stimulation of aldosterone release. Both actions raise blood pressure. In addition, angiotensin II can act on the heart and blood vessels to cause remodeling and hypertrophy. Renin catalyzes angiotensinogen.

The nurse is reviewing medication records of several different patients. Which patients should the nurse closely monitor for hyperkalemia? Select all that apply. 1 A patient taking amiloride and furosemide 2 A patient taking triamterene and a direct renin inhibitor 3 A patient taking spironolactone and hydrochlorothiazide 4 A patient taking spironolactone and angiotensin receptor blocker 5 A patient taking amiloride and an angiotensin-converting enzyme (ACE) inhibitor

2, 3, 5 Three groups of drugs—ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors—can elevate potassium levels and thus should be combined with spironolactone, amiloride, and triamterene only when clearly necessary. Although they can be employed alone as diuretics, spironolactone and amiloride are used primarily to counteract potassium loss caused by more powerful diuretics (thiazides, loop diuretics) and do not have to be monitored as closely.

The nurse is instructing a patient about potential adverse effects of a prescribed angiotensin-converting enzyme (ACE) inhibitor. For which adverse effect should the patient seek immediate medical attention? 1 Fatigue 2 Diarrhea 3 Angioedema 4 Dry, nonproductive cough

3

The nurse knows that which organ is primarily responsible for maintaining fluid volume and osmolality? 1 Liver 2 Heart 3 Kidneys 4 Blood vessels

3

Which statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? 1 "I will change my position slowly to prevent feeling dizzy." 2 "I will not mow my lawn until I see how this medication makes me feel." 3 "I will check my blood pressure daily and take my medication when it is over 140/90." 4 "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."

3 Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates that he will take rest periods and change positions slowly to avoid orthostatic hypotension, he is demonstrating adherence to the treatment regimen.

The nurse is assessing a patient with benign prostatic hyperplasia (BPH). Which condition is associated with BPH? 1 Prostate cancer 2 Sexual dysfunction 3 Difficulty with urination 4 Unusually small prostate gland

3 BPH is a noncancerous overgrowth of the prostate gland which can lead to obstruction of the flow of urine. BPH is benign, not cancerous. BPH does not impact sexual function. The prostate is larger than normal in BPH, not smaller.

The nurse is preparing to administer amlodipine. Which assessment finding would require immediate action? 1 Apical pulse of 80 beats/min 2 Apical pulse of 90 beats/min 3 Blood pressure of 80/60 mm Hg 4 Blood pressure of 158/88 mm Hg

3 Blood pressure of 80/60 mm Hg indicates hypotension and needs to be addressed; administering amlodipine would make the hypotension worse. Although reflex tachycardia can occur with amlodipine, 80 and 90 beats/min are normal. Amlodipine is a calcium channel blocker used for hypertension (blood pressure of 158/88 mm Hg); the nurse should administer the amlodipine.

The nurse is caring for a patient who takes spironolactone and quinapril for treatment of heart failure. Which finding indicates a potential additive effect between these two drugs? 1 Heart rate of 58 beats/min 2 Glucose level of 180 mg/dL 3 Potassium level of 5.7 mEq/L 4 Elevated serum quinapril level

3 Both spironolactone (Aldactone), a potassium-sparing diuretic, and quinapril (Accupril), an angiotensin-converting enzyme inhibitor, can increase potassium levels. These agents together do not increase quinapril levels, lower the heart rate, or raise the blood glucose level.

The nurse is teaching a patient about the reason for the administration of calcium channel blockers (CCBs). Which information should be included in the teaching plan? 1 "This medication will help you get rid of sodium." 2 "This medication will work to cause you to get rid of fluid." 3 "This medication will enlarge the blood vessels to lower your blood pressure." 4 "This medication will lower your blood pressure by promoting weight loss."

3 CCB medication causes vasodilation (widening) and is used in hypertension to lower blood pressure. It causes direct vasodilation by blocking calcium influx in smooth muscles in the blood vessels. This medication class does not help to rid fluids, decrease sodium, or lose weight.

The nurse is performing medication teaching for a patient with heart failure who has been prescribed digoxin. Which statement by the patient indicates a need for further education? 1 "I will limit my use of salt on food." 2 "I will check my pulse rate and rhythm." 3 "I will double the next dose if I miss a dose." 4 "I will call the health care provider's office if I have muscle weakness."

3 Digoxin therapy should include strict adherence to prescribed dosing with no extra or double dosing; this could lead to toxicity. The other statements indicate effective teaching. The patient would limit the use of salt to reduce fluid overload from excess sodium intake. Pulse rate and rhythm should be monitored for a rate less than 60 bpm and irregular rhythm. Muscle weakness should be reported as it may indicate hypokalemia.

A patient's blood pressure is 200/120 mm Hg, and the provider starts the patient on sodium nitroprusside. What is the appropriate action by the nurse? 1 Measure hourly output. 2 Administer with a full glass of water. 3 Monitor blood pressure continuously. 4 Make certain the patient does not crush the pill.

3 During nitroprusside infusion, blood pressure should be monitored continuously with either an arterial line or an electronic monitoring device. Hourly outputs are not required. The drug is administered intravenously, not orally.

The nurse should plan to monitor closely for which clinical manifestation after administering furosemide? 1 Decreased pulse 2 Decreased temperature 3 Decreased blood pressure 4 Decreased respiratory rate

3 High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Furosemide should not affect temperature or respirations. The nurse also should closely monitor the patient's potassium level.

A patient is taking hydrochlorothiazide. On assessment, the nurse notes that the patient has muscle weakness, cramping, and leg discomfort. What should be the nurse's first intervention? 1 Reduce salt in the patient's diet 2 Administer calcium supplements 3 Assess the serum potassium level 4 Give a lower dose of the medication

3 Hydrochlorothiazide can cause hypokalemia, characterized by muscle weakness, cramping, and leg discomfort. The nurse should immediately assess the patient's serum potassium level to determine the course of action. Giving calcium supplements does not reduce the symptoms caused by potassium deficiency. The patient is experiencing hypokalemia, not hypernatremia; reducing salt is for hypernatremia. Reducing the dose of the medication will not help restore the electrolyte balance.

Which is an appropriate nursing intervention for the patient who is taking hydrochlorothiazide? 1 Schedule the dose to be taken in the evening. 2 Monitor serum calcium and sodium levels daily. 3 Encourage the intake of foods rich in potassium. 4 Take the radial pulse for 1 full minute before administering the drug.

3 Hydrochlorothiazide is a potassium-wasting diuretic that can lead to hypokalemia if potassium is not replaced sufficiently to meet losses. For this reason, the nurse should encourage increased intake of foods high in potassium.

The nurse is preparing to administer intravenous (IV) potassium to a patient with hypokalemia. Which prescription is the most appropriate? 1 Potassium chloride 10 mEq IV push over 1 minute 2 Potassium chloride 30 mEq in 100 mL IV over 1 hour 3 Potassium chloride 10 mEq in 100 mL IV over 1 hour 4 Potassium chloride 10 mEq in 100 mL IV over 30 minutes

3 IV potassium must be diluted and infused slowly (never given IV push), at a rate no faster than 10 mEq/hr. Faster infusions of potassium can lead to cardiac toxicity.

The nurse is caring for a patient receiving a nitroprusside intravenous infusion. The patient's wife asks why furosemide is being prescribed along with this drug. The nurse's response should be based on which concept? 1 Furosemide will help reduce reflex tachycardia. 2 Vasodilators can cause serious orthostatic hypotension. 3 Many vasodilators cause retention of sodium and water. 4 Thiocyanate may accumulate in patients receiving nitroprusside.

3 Nitroprusside is a potent vasodilator that can cause retention of sodium and water. Furosemide, a diuretic, is often combined with nitroprusside to reduce the risk of edema and fluid retention. Furosemide does not reduce reflex tachycardia. Thiocyanate can accumulate in patients receiving nitroprusside, but furosemide does not help prevent or treat that. Vasodilators can cause serious orthostatic hypotension, but that is not the rationale for adding furosemide to the regimen.

Complete the equation: Cardiac output = Volume of blood ejected at each heartbeat × ____. 1 Preload 2 Afterload 3 Heart rate 4 Stroke volume

3 The amount of blood ejected with each heartbeat is known as the stroke volume . To determine the cardiac output, multiply the stroke volume by the number of beats per minute.

The nurse is caring for a patient with hyperkalemia. Which assessment is priority? 1 Lung 2 Kidney 3 Cardiac 4 Abdomen

3 The most serious consequence of hyperkalemia is disruption of the electrical activity of the heart. Because hyperkalemia alters the generation and conduction of cardiac impulses, alterations in the electrocardiogram and cardiac rhythm are usually the earliest signs that potassium levels are growing dangerously high. Assessments of lung, kidney, and abdomen are not as critical for hyperkalemia.

An elderly patient reports a feeling of irregular heartbeat, muscle weakness in the legs, and mild confusion. Which question should the nurse ask the patient? 1 "Have you had an anxiety attack?" 2 "Have you had a respiratory infection recently?" 3 "Have you been taking potassium supplements?" 4 "Have you been having normal bowel movements?"

3 When the patient reports an irregular heartbeat and muscle weakness in the legs and mild confusion, the nurse should suspect hyperkalemia. Hyperkalemia may be caused by potassium supplements. An anxiety attack would lead to respiratory alkalosis before hyperkalemia. A respiratory infection would lead to respiratory alkalosis or acidosis before hyperkalemia. Bowel movements would be assessed to understand the extent of fluid loss rather than potassium loss or gain.

A patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. During a review of the patient's list of current medications, which medications alert the nurse to a possible interaction with this new prescription? Select all that apply. 1 Warfarin 2 Lorazepam 3 Spironolactone 4 Naproxen sodium 5 Potassium chloride

3, 4, 5 Potassium supplements (potassium chloride) and potassium-sparing diuretics (spironolactone) can lead to hyperkalemia and should be used with caution. The use of a nonsteroidal anti-inflammatory drug such as naproxen sodium along with angiotensin-converting enzyme (ACE) inhibitors may reduce the antihypertensive effects of ACE inhibitors. There is no interaction between ACE inhibitors and anticoagulants (warfarin) or benzodiazepines (lorazepam).

A nurse is reviewing the medication record of a patient with chronic kidney disease who developed hypertension. Which drugs will the nurse anticipate administering initially? Select all that apply. 1 Beta blocker 2 Aldosterone antagonist 3 Angiotensin II receptor blocker 4 Calcium channel blocker (CCB) 5 Angiotensin-converting enzyme (ACE) inhibitor

3, 5 Recommendations for initial management of hypertension in patients with chronic kidney disease includes ACE inhibitors and angiotensin II receptor blockers. Beta blockers are recommended for patients with cardiac problems or diabetes. Aldosterone antagonists are recommended for heart failure and after myocardial infarction. CCBs are recommended for high coronary disease risk and diabetes.

A patient has been prescribed furosemide for pulmonary edema secondary to congestive heart failure. Which instructions will the nurse include in the patient teaching? Select all that apply. 1 Weigh yourself weekly. 2 Take the medication before bed. 3 Rise slowly from sitting or reclining positions. 4 Monitor your blood glucose diligently for hypoglycemia. 5 Report any irregular heartbeat, muscle weakness, or cramping. 6 Report any tenderness or swelling of the joints to your health care provider.

3, 5, 6 Furosemide, a loop diuretic, can cause dehydration, so the nurse should teach the patient to monitor him or herself for any side effects. The nurse should tell the patient to rise slowly from sitting or reclining positions in order to minimize the risk of falls secondary to orthostatic hypotension that can occur as a side effect of the furosemide. The nurse should teach the patient to report any irregular heartbeat, muscle weakness, or cramping, since these can be signs of hypokalemia caused by the potassium-wasting properties of furosemide. The patient should also report any tenderness or swelling of the joints, because this can indicate gout caused by hyperuricemia that can occur as a side effect of furosemide. The nurse should teach the patient to weigh him or herself daily in order to monitor the therapeutic effects of the drug. The nurse should tell the patient to avoid taking furosemide later in the day, since it increases urine volume and may make the patient have to urinate frequently at night, disrupting sleep and therefore potentially compromising adherence. The patient should be taught to monitor his or her blood glucose regularly, but this is done for signs of hyperglycemia, not hypoglycemia.

A patient is prescribed lisinopril as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? 1 Jugular vein distention 2 Potassium level of 3.5 mEq/L 3 +2 edema of the lower extremities 4 Crackles in the lungs are no longer heard

4 Because angiotensin-converting enzyme inhibitors promote venous dilation, they provide the therapeutic effect of reducing pulmonary congestion and peripheral edema. Absence of previously heard crackles would be an indicator of effectiveness. Edema and jugular vein distention are manifestations of heart failure. A potassium level of 3.5 mEq/L is a normal value.

To which patient did the nurse most likely administer doxazosin? 1 A hypotensive patient with erectile dysfunction 2 A hypertensive patient with erectile dysfunction 3 A hypotensive patient with benign prostatic hyperplasia 4 A hypertensive patient with benign prostatic hyperplasia

4 Because of their impact on blood pressure, the nonselective alpha 1 blockers (doxazosin and terazosin) are especially useful for patients who have hypertension in addition to benign prostatic hyperplasia, but may be dangerous for men with reduced blood pressure. Doxazosin is not used to treat erectile dysfunction.

A patient is taking verapamil. Which instruction should the nurse give the patient to help prevent a common adverse effect of this drug? 1 "Use sunscreen." 2 "Increase calorie intake." 3 "Use a skin barrier cream." 4 "Increase fluid and fiber intake."

4 Constipation may occur with verapamil. Advise patients that constipation can be minimized by increasing dietary fluid and fiber. Verapamil does not cause photosensitivity, so sunscreen is not needed. Verapamil does not cause weight loss, so an increase in calories is not needed. Verapamil does not cause diarrhea, so a skin barrier cream is not needed.

Diltiazem is ordered for a patient. Which condition in the patient's history would cause the nurse to notify the provider? 1 Hypokalemia 2 Hypertension 3 Cardiac dysrhythmias 4 Second-degree atrioventricular block

4 Diltiazem is contraindicated in second- and third-degree atrioventricular block, so the provider must be notified. Diltiazem is indicated for hypertension and selected cardiac dysrhythmias (eg, supraventricular tachycardia). Hypokalemia is not an issue with diltiazem.

Which assessment indicates to the nurse that a therapeutic effect of mannitol has been achieved? 1 Increased calcium 2 Decreased potassium 3 Increased intraocular pressure (IOP) 4 Decreased intracranial pressure (ICP)

4 ICP that has been elevated by cerebral edema can be reduced with mannitol. The drug lowers ICP because its presence in the blood vessels of the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol has no significant effect on the excretion of potassium and other electrolytes. Mannitol will decrease IOP.

The nurse wants to evaluate the cardiac status of a patient with heart failure (HF). Which laboratory result should the nurse check? 1 Sodium 2 Potassium 3 Digoxin level 4 B-natriuretic peptide

4 Levels of circulating B-natriuretic peptide (BNP) are an important index of cardiac status in HF patients and can be a predictor of long-term survival. High levels of BNP indicate poor cardiac health and can predict a lower chance of survival. Conversely, low levels of BNP indicate better cardiac health and can predict a higher chance of survival. Although sodium and potassium can provide information on electrolyte status, they cannot predict cardiac status of heart failure. Digoxin level predicts only levels of digoxin, not cardiac status.

An adult male patient who takes a beta blocker medication for blood pressure management states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? 1 "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss." 2 "It is unfortunate these drugs can cause erectile dysfunction, but managing your blood pressure is more important than your sexual performance." 3 "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." 4 "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect."

4 Many antihypertensive medications can produce adverse sexual side effects, including impotence. It is important for the nurse to listen to the patient's concerns and avoid making value judgments. Other antihypertensive medications may manage this patient's blood pressure without causing adverse sexual effects. Reducing the undesired effects of antihypertensive medication will improve the patient's adherence.

A patient who is taking terazosin for benign prostatic hyperplasia (BPH) reports symptoms of hypotension. Which drug does the nurse expect to be prescribed to the patient as an alternative to terazosin? 1 Sildenafil 2 Doxazosin 3 Finasteride 4 Tamsulosin

4 Tamsulosin has a higher specificity to alpha 1a receptors and is thus known to have fewer hypotensive effects in comparison with terazosin. Thus, the patient should ideally be prescribed this drug in place of terazosin. Doxazosin is also an alpha 1 receptor antagonist drug, but it may also cause hypotensive effects. Finasteride takes a longer time to treat BPH when compared with terazosin, so it should not be used as an alternative to terazosin. Sildenafil is a drug prescribed for erectile dysfunction; it is not used to treat the symptoms associated with BPH.

Which comment by the patient indicates understanding about the use of enalapril for treatment of hypertension? 1 "I cannot go out in the sun while on this therapy." 2 "I should stop the drug if I have ringing in my ears." 3 "If I feel tired, I should call the health care provider." 4 "If I develop a chronic cough, I need to notify my health care provider."

4 The patient on therapy with an angiotensin-converting enzyme inhibitor such as enalapril needs to report a nonproductive chronic cough because this is a potential side effect. There is no treatment other than to change the medication therapy. Enalapril does not cause sun sensitivity, tinnitus, or fatigue.

The nurse is caring for patients receiving vasodilators. Which instruction should the nurse give the patients to combat a common adverse effect? 1 "Wear a hat when outdoors." 2 "Avoid taking with grapefruit juice." 3 "Drink the oral solution through a straw." 4 "Rise slowly from a sitting to standing position."

4 Vasodilators place patients at increased risk of falls. Patients also should be taught that they can minimize postural (orthostatic) hypotension by avoiding abrupt transitions from a supine or seated position to an upright position. Grapefruit does not affect the metabolism of vasodilators. Wearing hats and using a straw are not necessary with vasodilators.