Pharm Exam 2
Non-pharmacological management of HTN
- limit intake of alcohol - restrict sodium consumption & increase potassium intake - reduce intake of saturated fat and cholesterol and increase consumption of fresh fruits and veggies - increase exercise - reduce stress & learn coping strategy - maintain optimal weight
Tx of overdose for spironolactone (Aldactone)
- normal saline - vasopressor (norepinephrine)
Which symptom will the nurse include as a reason to withhold the medication when teaching a client about digoxin therapy? A. Fatigue B. Yellow vision. C. Persistent hiccups. D. Increased urinary output.
B
Which food would the nurse instruct a client taking Losartan (ARBs) to avoid ? Select all that apply A. Cheddar cheese B. Alcohol C. Grapefruit Juice D. Dark green vegetables
B & C
A patient is taking Losartan for HTN. Select all the pharmacological effects of this drug. A. Sodium retention B. Water excretion C. Vasodilation D. Sodium excretion
B, C, D
Which instruction will the nurse include in the teaching plan for a client taking a calcium channel blocker, such as nifedipine? Select all that apply. A. Reduce calcium intake. B. Report peripheral edema. C. Expect temporary hair loss. D. Avoid drinking grapefruit juice. E. Changed to a standing position slowly
B, D, E
Which adverse effects would a nurse monitor for when caring for a client with hypertension who is prescribed metoprolol? A. Hirsutism. B. Bradycardia. C. Restlessness. D. Angina
B.
Which family of drugs are the following medications considered: amlodipine, nifedipine, Dilatazem? A. ACE Inhibitors (ACEI) B. Calcium Channel Blockers (CCBs) C. Angiotensin Receptor Blockers (ARBs) D. Beta blockers (BB)
B. Calcium Channel Blockers (CCBs)
Which of the following systems of the body can be seriously affected by hypertension? A. Brian, musculoskeletal, kidney, cardiovascular. B. Cardiovascular, brain, kidney, and eyes. C. Cardiovascular, gastrointestinal, reproductive, and kidney.
B. Cardiovascular, brain, kidney, and eyes.
What happens to BP if arterioles are constricted ?
BP increases
Which medication requires the nurse to monitor the client for signs of hyperkalemia? A. Furosemide. B. Metolazone C. Spironolactone. D. Hydrochlorothiazide.
C
Digoxin has inotropic effect, what does this mean ?
improves the force of cardiac contraction
Drug-Drug consideration for metoprolol ?
- use with digoxin may result in bradycardia - use with antihypertensives, may result in additive hypotension
contraindications for metoprolol?
- bradycardia - cardiogenic shock - heart block CAUTION FOR - asthma - renal disorders - COPD - diabetes
what are the administration alerts for Metoprolol?
- hold if pulse <60BPM - if pt is hypotensive - don't crush or chew sustained-release tablets - doses reduced for older pts (risk for dizziness and falls)
Officially, hypertension stage one is diagnosed when the Pt demonstrates a systolic blood pressure greater than ________mg Hg and a diastolic BP greater than ______ mm Hg a sustained period.
130/80
Hypertension stage 2
140 or higher/90 or higher
When teaching a relative about hydrochlorothiazide (Microzide), which of the following should you include in your teaching: (Select all that apply) A. It can increase uric acid levels and precipitate, gout attacks. B. Consume, food, rich in potassium. C. It can cause gynecomastia in men. D. Take the drug in the evening time.
A, B
What happens to BP in case of dehydration, bleeding ?
BP decreases
What type of medication is assosciated with "pril" ?
ACE inhibitors
Which data collection assessment would be performed to evaluate the effectiveness of furosemide administered to a client with congestive heart failure? Select all that apply. A. Daily weight B. Intake and output. C. Monitor for edema. D. Daily pulse oximetry. E. Auscultate rest sounds.
All of them
Explain systolic blood pressure
As heart pumps blood into into the aorta --> aortic pressure rises as well as the sistemic arterial pressure
What is the antidote for metoprolol?
Atropine or isoproterenol
Angiotensin II acts on the adrenal gland to secrete what? A. renin B. aldosterone C. angiotensin
B
Which clinical indicator would the nurse monitor to determine if the clients simvastatin is effective? A. Heart rate. B. Triglycerides C. Blood pressure. D. International normalized ratio (INR)
B
Which instruction with the nurse include in the teaching plan for nitroglycerin patches? A. "Apply to patch on a distal extremity" B. "Remove a previous patch before applying the next one" C. "Massage the area gently after applying to pass to the skin" D. "Add a warm compress to the site before attaching the patch"
B
Which nursing action will best evaluate the effectiveness of the furosemide in maintaining a client with heart failure and acute pulmonary edema? A. Performing daily weight. B. Auscultating breath sounds. C. Monitoring, intake and output. D. Assessing for dependent edema.
B
What is the action of aldactone ?
Inhibits aldosterone —> Na+ and water excretion are increased, and the body retains more potassium
Which response with a nurse give to a client who takes furosemide and digoxin and reports that everything looks yellow? A. "This is related to your heart problems, not medication" B. "I will hold the medication until I consult with your healthcare provider" C. "It is a medication that is necessary, and that side effect is only temporary" D. "Take this dose, and when I see your healthcare provider, I will ask about it"
B
Which side of hypokalemia will the nurse monitor for a client receiving furosemide? A. Chvostek sign B. Muscle weakness. C. Anxious behavior. D. Abdominal cramping
B
Which subjective clinical manifestation lead the nurse to suspect that the furosemide is infusing too rapidly? A. Hunger B. Tinnitus C. Excess salivation
B
Black box warning for aldactone
Because Spironolactone is known to cause tumors in animals in studies, should only be used for for specified indications
What kind of medication is associated with "olol"?
Beta Blockers
Angiotensin 1 is converted to angiotensin II by : A. renin B. Aldosterone C Angiotensin converting enzyme
C
The statement that best explains why furosemide (Lasix) is administered to treat HTN is A. It decreases sympathetic stimulation B. It dilates peripheral blood vessels C. It inhibits reabsorption of sodium and water in the kidney
C
Which adverse effect with a nurse monitor for when caring for a client receiving furosemide to relieve edema? A. Hypernatremia. B. Elevated blood urea nitrogen C. Hypokalemia. D. Increase in the urine specific gravity.
C.
The statement that best explains why furosemide (Lasix) is administered to treat HTN is: A. Inhibits the angiotensin-converting enzymes B. It decreases sympathetic stimulation C. It inhibits reabsorbtion of sodium and water in kidney D. It dilates peripheral blood vessels
C. It inhibits reabsorbtion of sodium and water in kidney
Non-pharmacological techniques can help lower BP. Which of the following is not considered one of these types of techniques? A. Limiting caffeine B. Dietary changes C. Multivitamins D. Smoking cessation
C. Multivitamins
"pine" is associated with what drug ?
Calcium channel blockers
What are the classic symptoms of heart failure ?
Dyspnea on exertion fatigue pulmonary congestion Perihperal edema
What are the uses for nifedipine (aldalat CC, Procardia XL)
HTN & Angina
Excessive cardiac workload can cause _________, leading to ___________.
Heart failure ; pulmonary edema
What is Aldactone?
Potassium sparing diuretic
action for nifedipine (aldalat CC, Procardia XL)
SELECTIVELY blocks calcium channels in myocardial and vascular smooth muscle --> coronary artery dilation, less O2 use by the heart, increasing cardiac output and decreasing BP
What is blood pressure?
force of blood against arterial walls
Black box warning for metoprolol
abrupt withdrawal may exacerbate angina or cause MI - should be gradually decreased.
What is metoprolol?
beta blocker= treats HTN, angina and prevents MI
What is BP regulated by ?
- Baroreceptors - Chemoreceptors - Hormones - Emotions - Medications - Activation of renin-angiotensin- aldosterone system
What are the types of adrenergic antagonists ?
- Beta blockers - alpha 1 blockers - alpha 2 blockers - alpha1 and beta blockers combination
What are the administration alerts for Spironolactone (Aldactone) ?
- Give with food to increase absorption - Don't give K+ supplements
What are the side effects of aldactone ?
- If taken with ACE inhibitors, and angiotensin-receptor blockers (ARBs), hyperkalemia may result - watch for hyperkalemia: muscle weakness, palpitations, cramping, nausea and vomiting. - in men: can cause gynecomastia, impotence, and diminished libido - in women: menstrual irregularities. Hirsutism, and breast's
What are reasons of heart failure progression ?
- Non-adherence to sodium and water restrictions - Non-aherence to drug therapy - myocardial infarction or ischemia
What are the uses for aldactone ?
- Used for mild HTN with combination of another antihypertensive - Primary hyperaldosteronism
Where are baroreceptors located? What do they do ?
- aorta and carotid artery - sense pressure within vessels & send signals to brain
Stroke volume is affected by what ?
- contractility - preload - afterload
What are side effects of lisinopril ?
- dry cough (most common) - postural hypotension - taste disturbance - hyperkalemia
Where are chemoreceptors located ? What do they do ?
- located in the aorta and carotid artery - sense level of O2, CO2, and pH of the blood
Match the following 1. _____is the degree of stretch of cardiac myocytes (myocardium) at the end of ventricular filling. 2. _____ is the resistance the ventricles must overcome to eject blood. A. Preload B. After load
1. A 2.B
What are the 3 factors that affect BP
1. Cardiac output 2. Peripheral Resistance (vessels) 3. blood volume
Drug classes for HTN (DAACAD)
1. Diuretics 2. Ace inhibitors 3. Angiotensin II receptor blockers 4. Calcium Channel blockers 5. Adrenergic Antagonist 6. Direct acting vasodilators
Elevated BP
120-129/<80
Hypertension stage 1
130-139/80-89
(Furosemide) Weight loss should be reported when over ____kg/24hr.
1kg (2.2lbs)
What is the action of Aldosterone on the kidney? A. it increases sodium and water absorption B. it increases water excretion C. It stimulates Renin secretion
A
Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema? A. Furosemide. B. Chlorothiazide. C. Spironolactone. D. Acetazolamide
A
Which information will the nurse include when teaching a client with hypertension about Metoprolol? A. Do not abruptly discontinue the medication. B. Consume, alcoholic beverages in moderation. C. Report a heart rate of less than 70 bpm. D. Increase the medication dosage if chest pain occurs.
A
Which instruction with the nurse include when preparing discharge instructions for a client who will take enalapril for hypertension? A. "Changed to a standing position, slowly" B. "This make color of your urine green" C. "The medication may cause a sore throat for the first few days" D. "Schedule blood test weekly for the first two months"
A
Which medication is the likely cause of the symptoms in a client with hypokalemia, reporting nausea, vomiting, and seeing a yellow right around objects? A. Digoxin B. Furosemide. C. Propranolol. D. Spironolactone.
A
Which medication would a nurse suspect is the cause of severe nausea and a heartbeat that is irregular and slow in a client who takes multiple medication's? A. Digoxin. B. Captopril. C. Furosemide. D. Morphine sulfate.
A
Which manifestation in a client with heart failure indicates digoxin toxicity? Select all that apply A. Nausea √ B. Yellow vision. √ C. Irregular pulse. √ D. Increased urine output. E. Heart rate of 64 bpm.
A, B, C
Which of the following should a nurse teach a Pt on furosemide (lasix). Select all that apply A. Rise slowly from sitting position B. Take early in the day C. Report tinnitus or hearing loss D. Restrict the consumption of bananas
A, B, C
Which response with a nurse monitor for when a client is receiving furosemide to relieve edema? Select all that apply. A. Weight loss B. Negative nitrogen balance. C. Increase urine specific gravity. D. Excessive loss of potassium ions. E. Pronounced retention of sodium ions.
A, D
Which diuretic would the nurse anticipate administering to a client admitted with acute pulmonary edema? A. Hydralazine B. Furosemide C. Spironolactone
B. Furosemide
Angiotensin II causes _____ of the vessels and triggers the release of _______. A. Vasodilation-angiotensin I B. Vasoconstriction - aldosterone C. Vasoconstriction - Renin D. Vasodilation - aldosterone
B. Vasoconstriction - aldosterone
Which important nursing action would be taken after healthcare provider prescribes losartan to a client ? A. Assess the client for hypokalemia. B. Administer the medication with food. C. Monitor the clients blood pressure. D. Monitor serum glucose levels.
C
Which information is important for the nurse to include in the teaching plan of a client who will be taking furosemide and digoxin after discharge from hospital? A. Maintenance of a low potassium diet. B. Avoidance of foods high in cholesterol. C. Signs and symptoms of digoxin toxicity. D. Importance of monitoring output
C
Which instructions about the use of nitroglycerin to prevent angina will put the nurse provide to a client? A. "At the point when pain first occurs, place to tablets under the tongue" B. "Place one tablet under the tongue before activity, and swallow another if pain occurs" C. "Before physical activity, place one tablet under the tongue, and repeat the dose in five minutes, if pain occurs" D. "Place one tablet under the tongue, when pain occurs and use an additional tablet after the attack to prevent recurrence"
C
An infant with a diagnosis of heart failure is being given furosemide (bid). Which laboratory value with the nurse report to the healthcare provider? A. Sodium of 140 mEq/L (140 mmol/L) B. Ionized calcium of 2.35 mEq/L (1.2 mmol/L) C. Chloride of 102 mEq/L (102 mmol/L) D. Potassium of 3.0 mEq/L (3.0 mmol/L)
D
Which complication will occur as a result of administering Sildenafil to a client who takes isosorbide dinitrate ? A. Constipation B. Protracted, vomiting. C. Respiratory distress. D. Severe hypotension.
D
Which statement by client who received a prescription for digoxin leads to the nurse to conclude than teaching was effective? A. "I will avoid foods high in potassium" B. "I must increase my intake of vitamin K" C. "I should've just the dosage according to my activities" D. "It will be important to check my pulse rate daily"
D
Which antihypertensive medication class would the nurse identify as a likely cause of the cough in a client taking multiple medication's for hypertension, who develops a persistent, hacking cough? A. Thiazide diuretics B. Calcium channel blockers. C. Direct renin inhibitors. D. Angiotensin converting enzyme (ACE) inhibitors
D.
what happens if nifedipine (aldalat CC, Procardia XL) is taken with grapefruit juice or alchohol ?
Grapefruit: increased absorption (increased hypotension) Alchohol: increases vasodilating action of nifedipine leading to syncope due to severe decrease in BP
*Drug- Drug Interactions (Spironolactone- Aldactone) ACE inhibitors ?
Hyperkalemia
*Drug- Drug Interactions (Spironolactone- Aldactone) ARBS?
Hyperkalemia
*Drug- Drug Interactions (Spironolactone- Aldactone) Potassium?
Hyperkalemia
what kind of management is recommended for stage 1 HTN ?
Non-pharmacological therapy and ONE antihypertensive medication
what kind of management is recommended for stage 2 HTN ?
Non-pharmacological therapy and TWO antihypertensive medications.
Normal BP
Systolic: <120 Diastolic: <80
What is the serious side effect of lisinopril ?
angioedema (swelling around eyes, lips, throat, and other regions)
Contraindications for Spironolactone (Aldactone)
anuria, CKD, hyperkalemia, pregnancy, lactation
what should you avoid when taking lisinopril ?
avoid excess potassium intake
*DRUG-DRUG interaction nifedipine (aldalat CC, Procardia XL) Digoxin?
bradycardia and increased digoxin toxicity
*Drug- Drug Interactions (Spironolactone- Aldactone) Digoxin ?
concurrent use decreases effects of digoxin
What is the black box warning for lisinopril ?
fetal injury or death
what are the side effects of nifedipine (aldalat CC, Procardia XL) related to vasodilation ?
headache, dizziness, peripheral edema, heart burn, nausea, flushing.
Explain diastolic blood pressure
in between heart beats when the ventricles refill, BP falls (relaxation phase)
* drug-drug interaction nifedipine (aldalat CC, Procardia XL) Beta blockers ?
increased risk of HF
what is the action of lisinopril ?
inhibiting ACE and decreasing aldosterone secretion
Which of the following statements best explains why furosemide (lasix) is administered to treat HTN
inhibits reabsorbtion of sodium, chloride and water in kidney
what kind of management is recommended for ELEVATED BP ?
non-pharmacological therapy
what happens if nifedipine (aldalat CC, Procardia XL) is stopped abruptly ?
rebound hypotension
What is afterload?
resistance left ventricle must overcome to circulate blood
Why is furosemide (potent loop diuretic) given early in the day ?
so it works during the day and your sleep is not disturbed by you needing to get up to go to the toilet during the night.
What is preload?
the degree of stretch of he myocardium at the end of ventricular filling (end diastolic volume - EDV)
Tx of overdose for nifedipine (aldalat CC, Procardia XL)
vasopressors calcium infusions
what is cardiac output (CO)?
volume if blood pumper per minute
What is stroke volume (SV) ?
volume of blood pumped out by one ventricle with each beat