Pharm 201 CH35

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

The client has been taking atenolol for 2 years. The nurse teaches the client to not stop taking his antihypertensives abruptly because what may occur?

Rebound hypertension

A client is taking a sustained release antihypertensive. The nurse knows that the client teaching about this medication needs to include to:

swallow the drug whole and do not cut, crush, or chew it.

How is hypertension defined with regard to blood pressure readings?

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

An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client's blood pressure be classified?

isolated systolic hypertension

A client is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n):

Alpha- and beta-blocker

A patient is receiving a vasodilator that is available only in oral form. Which agent would the nurse most likely identify as being used?

Minoxidil

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

Potassium

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

Stage 2

Which antihypertensive medication can be administered by transdermal patch?

clonidine

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia?

Diltiazem

The nurse is caring for a client with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug would both treat the client's hypertension and reduce myocardial oxygen consumption?

Diltiazem

What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?

Diltiazem (Cardizem)

he nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy?

Dry cough

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:

monitor the client's blood pressure.

A 37-year-old client presents with a blood pressure of 118/86 mm Hg. What advice should the nurse provide to this client?

"Be aware of your salt intake and limit hidden salt."

The health care provider prescribes captopril (Capoten) for a client, and the nurse provides the client with the appropriate client education. What statement by the client tells the nurse that teaching has been effective?

"I will make sure that I rise slowly from a supine position."

The client has been diagnosed as having hypertension. The nurse is responsible for teaching the client about managing the condition with his newly prescribed medication (lisinopril) and nonpharmacologic methods. What statement by the client suggests that teaching has been effective?

"I will make sure that I rise to a standing position slowly."

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."

An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for further health education?

"I'll only need to take these drugs on days when my blood pressure is particularly high."

The nurse cares for several clients in the acute care setting. Which client is most likely to be diagnosed with secondary hypertension?

A client who is being treated for pheochromocytoma

When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a client with hypertension?

Grilled chicken, green salad, and apple

You are caring for a 53-year-old client being treated for hypertension. The nurse is teaching the client about nonpharmacologic methods of managing hypertension. While discussing dietary management, which might be an example of an appropriate meal?

Grilled chicken, green salad, and iced tea

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?

Ham sandwich with mustard, carrots and cheesy dip

A client is receiving an antihypertensive medication that is only available in oral form. Which agent would the nurse identify as most likely being used?

Carvedilol

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

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 90 mm Hg

A client is newly diagnosed with hypertension. When explaining this diagnosis, the nurse would include information that hypertension increases the person's risk for which conditions? Select all that apply.

Heart failure Stroke Blindness Kidney disease

The classification of blood pressures published in 2003 offers new "stages" of blood pressures, ranging from normal to stage 2 hypertension. The client, an 80-year-old retired teacher, consistently has blood pressure readings of 146/86 mm Hg. In the 2003 guidelines, what would the client's blood pressure be designated?

Isolated systolic hypertension

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?

Lifelong

The incidence of hypertension in the United States is staggering. It is estimated that at least 20% of the people in the United States have hypertension, and many are unaware of it. What does hypertension increase the risk of? (Mark all that apply.)

Renal disease Cerebral infarction Heart failure

A provider chooses to treat an African American client with hypertension with a beta blocker and diuretic instead of an ACE inhibitor. The nurse knows that the provider did this for what reason?

Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors.

The pediatric nurse examines an 11 year-old client with mildly elevated blood pressure who is 15% above the upper age-based weight limits. What is the nurse's priority teaching point?

Strategize with the client and family about ways to increase the child's activity level

A client has been admitted to a health care facility for hypertension management. The health care provider has prescribed a transdermal patch of clonidine. The nurse applies the patch to a hairless area at which location?

Upper arm

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

The client taking antihypertensive medications is taught to notify the healthcare provider when which findings occur?

Weight gain of five pounds over a 2-day period

A client has been prescribed metoprolol. The nurse should caution the client against abrupt cessation of treatment to avoid which undesired result? Select all that apply.

angina myocardial infarction

The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy?

dry cough

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?

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?

falls

What statement should underlie the nurse's response when asked if ACE inhibitor therapy can be continued during pregnancy?

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

The client is diagnosed with pulmonary hypertension. The health care provider orders ambrisentan (Letairis). What assessment would be the nurse's priority in monitoring the effectiveness of this medication?

Assess the client's exercise tolerance

A client experienced an MI 10 years ago. He is a 48-year-old man who has frequent episodes of angina. He is tachycardic. What is the first drug of choice for treatment of his condition?

Beta-blockers

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

Bradycardia

The nurse is caring for an obese child with hypertension and slightly elevated serum glucose levels. Lifestyle changes have not returned blood pressure to acceptable limits. What would the nurse anticipate will be ordered?

Diuretic

A client has been prescribed transdermal clonidine therapy. What potential adverse effects should the nurse warn the client about?

Dry mouth and dizziness

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?

Explain that drugs like ramipril often cause a cough.

A client is started on trandolapril (Mavik). The client should be instructed that what is a common adverse effect of ACE inhibitor therapy?

Persistent cough

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?

Persistent cough

Ms. Tacey, a 65-year-old woman, is treated with eplerenone for hypertension. In addition to monitoring blood pressure, what other important assessment needs to be prioritized in her care?

Potassium levels

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?

prehypertension

The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which?

weight loss and decreased salt intake.

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."

The nursing instructor is talking about clients who take an angiotensin II receptor blocker for hypertension. In assessing a female client who has been given a prescription for an ARB, what would the instructor tell the students it would be important for the nurse to ascertain?

"When was your last menstrual period (LMP)?"

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?

"When was your last menstrual period?"

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

The client was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2 of the stepped-care management of hypertension plan, monotherapy with an angiotensin-converting enzyme inhibitor was ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the provider will order what?

A diuretic

A nurse is educating a group of nursing students on the adverse effects of antihypertensive drugs. The nurse explains that orthostatic hypotension occurs initially in the therapy. Which of the following pressure changes in an upright position would indicate orthostatic hypotension?

A fall in the systolic pressure by 10 mm Hg

The nurse works in a clinic that has many African American clients. What would the nurse need to consider when caring for the clients with hypertension? Select all that apply.

African American men are at highest risk for hypertension. African Americans respond best to single-drug therapy. African Americans have increased adverse effects when using thiazide and thiazide-like diuretics.

A nurse is educating a group of nursing students about the uses of hawthorn, a natural agent used in the treatment of hypertension. Which conditions should the nurse explain as the other indications for hawthorn use? Select all that apply.

Angina Arrhythmia Heart failure

Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. What are vasoconstrictive substances? (Select all that apply.)

Angiotensin II Endothelin-1

A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?

Angiotensin II receptor blockers

A client has been diagnosed with hypertension and prescribed ramipril. What outcome would the nurse identify in the planning of this client's care?

Close adherence to the prescribed regimen

When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.)

Constipation Proteinuria Photosensitivity Cough

A client is receiving fosinopril. Which adverse effect would the nurse caution the cliient about to help to promote compliance?

Cough

A client has been started on losartan (Cozaar), an ARB (angiotensin II receptor blocker), for hypertension. After 6 weeks of therapy, it is decided that the Cozaar alone is not controlling the client's hypertension. What can be added to the Cozaar regimen for better control of this client's hypertension?

Hydrochlorothiazide (Hyzaar)

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?

Hyperkalemia

A community health nurse is facilitating a health promotion session to a group of seniors. Which topic related to hypertension is most important to include in the information?

Hypertension will increase the risk of heart disease.

The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a client being brought to the hospital in an ambulance. What is this client's most likely diagnosis?

Hypertensive crisis

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?

Implement interventions to lower blood pressure.

A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands?

Losartan Olmesartan

A nurse is reviewing the function of the renin-angiotensin-aldosterone system before before administering medication to a client with hypertension. Place these events in the function of the renin-angiotensin-aldosterone system in the order that they occur.

Low blood pressure is detected. Renin is released by juxtaglomerular cells. Angiotensinogen is converted to angiotensin I. Angiotensin II reacts with blood vessel receptors. Blood pressure increases due to vasoconstriction.

The nurse recognizes that which medication may be used to treat a hypertensive crisis?

Nitroprusside

The client is to start on lisinopril for hypertension. Prior to administration of the medication, the blood pressure is 112/76 mm Hg. What is the nurse's most appropriate action?

Notify the healthcare provider.

A client taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the client for?

Peripheral edema and bradycardia

A nurse is caring for a client who has been diagnosed with hypertension and will be taking eplerenone (Inspra). Which would be an appropriate nursing diagnosis for this client?

Risk for Injury related to the adverse effect of dizziness

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?

Risk for injury

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 potassium levels

The nurse cares for a client with diabetes and uncontrolled hypertension who has been prescribed losartan (Cozaar). The healthcare provider changes this client's prescription to losartan with hydrochlorothiazide (Hyzaar). What benefits will this client will receive from this change in drug therapy? Select all that apply.

Slowed progression of diabetic nephropathy in type 2 diabetes. Increased excretion of fluid and sodium resulting in lower blood volume. Improved control of blood pressure due to combination therapy.

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:

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

A 51-year-old client has been diagnosed with hypertension following several elevated blood pressure readings. The nurse should prepare to educate the client regarding which likely drug regimen?

a thiazide diuretic combined with a beta-blocker

How does captopril contribute to a reduction of a client's blood pressure?

blocking the conversion of angiotensin I to angiotensin II

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:

falls.

Which dietary choice is most appropriate and should be encouraged by the nurse for a client diagnosed with hypertension?

grilled chicken, green salad, and apple

What additional medication will best increase the effectiveness of blood pressure control in a client prescribed losartan?

hydrochlorothiazide

A client, prescribed a potassium-sparing diuretic, is at a risk for developing which electrolyte imbalance?

hyperkalemia

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

persistent cough

Which outcome is most important for a client recently diagnosed with hypertension?

multiple diastolic blood pressure readings less than 90 mm Hg

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition?

myocardial hypertrophy

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

The goal of therapy for a client taking antihypertensive medication is to maintain:

the blood pressure within normal limits.

A nurse is providing medication teaching to a client prescribed captopril. Which statements should be included to describe potential adverse effects? Select all that apply.

"A decrease of blood pressure is expected." "If you develop a cough, call the prescriber."

The client taking bisoprolol-hydrochlorothiazide (Ziac) states that he is sure the medication is not decreasing his blood pressure. He tells the nurse he is urinating all the time and he does not like this side effect of the medication. What is the nurse's best response?

"Bisoprolol-hydrochlorothiazide (Ziac) works by decreasing the workload of your heart and increasing the excretion of fluid."

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?

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

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 inhibiting the transformation of angiotensin I to angiotensin II

A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?

Frequent assessment of the client's cardiac status

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

A clinic nurse is assessing a new client prior to the client seeing the health care provider. The client has a history of hypertension and takes benazepril (Lotensin) to control the disease process. A priority nursing assessment in this client would be to assess the client for a history of:

renal disease.