pharm exam 3- antihypertensives evolve
Which information would the nurse provide the patient to ensure patient understanding of pharmacologic therapy for hypertension? "Urinary output determines blood pressure." "Blood pressure is determined by heart contraction." "Sympathetic stimulation causes blood pressure to decrease." "Blood pressure is a product of cardiac output and vascular resistance."
"Blood pressure is a product of cardiac output and vascular resistance." Blood pressure is determined by cardiac output (4 to 8 L/min) and systemic vascular resistance (SVR). Cardiac output is the amount of blood that is ejected from the left ventricle and is measured in liters/min. SVR is the resistance to blood flow that is determined by the diameter of the blood vessel and the vascular musculature. It is calculated by the blood pressure divided by the cardiac output.
The nurse demonstrates knowledge of use of calcium channel blockers (CCBs) for management of hypertension by making which statement to the patient? "CCBs promote excretion of water." "CCBs block reabsorption of sodium." "CCBs increase blood return to heart." "CCBs relax vascular smooth muscle."
"CCBs relax vascular smooth muscle." By blocking calcium channels, CCBs inhibit muscle contraction in the coronary arteries and peripheral arteries, resulting in vasodilation, improved blood flow to the myocardium, and decreased blood pressure. CCBs have no direct role in sodium or water activity. Because CCBs decrease blood return to the heart, preload is reduced.
The nurse is providing teaching to an elderly patient who has been prescribed extended-release doxazosin. Which information would the nurse include? Select all that apply. "A glass of wine a few times a week should not be a problem." "You may develop a nonproductive, dry cough from this medication." "Do not be concerned if you see the matrix of the capsule in your stool." "Be especially careful when changing position after your first dose of the medication." "The medication is contraindicated if you develop benign prostatic hypertrophy (BPH)."
"Do not be concerned if you see the matrix of the capsule in your stool." "Be especially careful when changing position after your first dose of the medication." Doxazosin is a commonly used alpha1 blocker that is available in immediate- and extended-release formulations. When the drug is released from the extended-release form, the matrix of the capsule is expelled in the stool. The patient should be informed that this will happen and should be reassured that the active drug has been absorbed.
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. Which information would the nurse provide to the patient? "Change the patch daily at the same time." "Remove the patch before taking a shower or bath." "Get up slowly from a sitting to a standing position." "Do not take other antihypertensive medications while using this patch."
"Get up slowly from a sitting to a standing position." Clonidine can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs that may aid in the reduction of blood pressure.
The nursing instructor determines that the student nurse understands the rationale for administration of an angiotensin converting enzyme (ACE) inhibitor for treatment of hypertension when the student makes which statement(s)? Select all that apply. "They reduce afterload." "Angiotensin II is a potent vasodilator." "They promote sodium and water retention." "Systemic vascular resistance (SVR) is decreased." "ACE inhibitors modify the function of the sympathetic nervous system (SNS)."
"They reduce afterload." "Systemic vascular resistance (SVR) is decreased."
The nurse is teaching a patient about the reason for the administration of calcium channel blockers. Which statement should be included in the teaching plan? "This medication will help your body to get rid of sodium." "This medication will work to cause your body to get rid of fluid." "This medication will help you to lose weight to lower your blood pressure." "This medication will vasodilate your blood vessels to lower your blood pressure."
"This medication will vasodilate your blood vessels to lower your blood pressure." Calcium channel blockers cause vasodilation and are used for hypertension to lower blood pressure. They cause direct vasodilation by blocking calcium influx in smooth muscles in the blood vessels. This medication class does not help to rid the body of fluids, decrease sodium, or help the patient to lose weight.
Which effect indicates that a patient is experiencing a side effect of enalapril? Persistent dry mouth A dry, hacking cough Serum potassium of 4.2 mEq/L Serum sodium of 147 mEq/L
A dry, hacking cough One of the major side effects of angiotensin converting enzyme (ACE) inhibitors such as enalapril is a dry, irritating, nonproductive cough. This cough is a major reason for the discontinuation of ACE inhibitors.
Which patient receiving losartan needs to be monitored closely while receiving this therapy? A patient with constipation A patient with a heart rate of 90 beats/min A patient with an elevated creatinine level A patient with a potassium level of 3.4 mEq/L
A patient with an elevated creatinine level Losartan has been shown to be beneficial in patients with hypertension and heart failure. Patients with renal or hepatic dysfunction need to be assessed carefully because of the potential for toxicity and increased side effects. An elevated creatinine level is an indication of renal dysfunction.
Which patient with hypertension would benefit most from receiving an alpha 1 blocker? A pregnant patient A patient with asthma A patient with an increased heart rate A patient with benign prostatic hyperplasia
A patient with benign prostatic hyperplasia
The nurse administers lisinopril to a hypertensive patient with heart failure. Which parameter would the nurse evaluate to determine the therapeutic effectiveness of lisinopril in this patient? Mental status Breath sounds Peripheral pulses Serum potassium
Breath sounds Angiotensin converting enzyme (ACE) inhibitors are the medications of choice for hypertensive patients with heart failure. The nurse assesses the patient's breath sounds as a means of evaluating therapeutic effectiveness of ACE inhibitors, because in heart failure, the lungs fill with fluid.
The nurse is caring for a patient who is hypertensive and has liver dysfunction. The nurse would anticipate that the patient will most likely be placed on which antihypertensive drug? Losartan Ramipril Enalapril Captopril
Captopril Captopril and lisinopril are the only two angiotensin converting enzyme inhibitors that are not prodrugs. A prodrug is a drug that is inactive in its administered form and must be metabolized to its active form in the body, generally by the liver, to be effective. If liver dysfunction is present, there is a decreased ability to convert medications to their active form, which would be required for losartan, ramipril, and enalapril.
A patient has been prescribed an angiotensin II receptor blocker to treat hypertension. The patient is also being treated with rifampin. What result would the nurse anticipate from the interaction of these drugs? Increased effect of the rifampin Decreased effect of the rifampin Increased effect of the angiotensin II receptor blocker drug Decreased effect of the angiotensin II receptor blocker drug
Decreased effect of the angiotensin II receptor blocker drug The interaction of rifampin and the angiotensin II receptor blocker will result in a decreased, not increased, effect of the angiotensin II receptor blocker drug. The combination of these two medications will not cause changes in rifampin effectiveness.
A patient has been prescribed an angiotensin II receptor blocker to treat hypertension. The patient is also being treated with a nonsteroidal antiinflammatory drug. Which result would the nurse anticipate from the interaction of these drugs? Increased effect of the nonsteroidal antiinflammatory drug Increased effect of the angiotensin II receptor blocker drug Decreased effect of the nonsteroidal antiinflammatory drug Decreased effect of the angiotensin II receptor blocker drug
Decreased effect of the angiotensin II receptor blocker drug The interaction of the angiotensin II receptor blocker and the nonsteroidal antiinflammatory drug will result in a decreased effect of the angiotensin II receptor blocker drug.
Which antihypertensive medications are most likely to cause tachycardia? Select all that apply. Aliskiren Valsartan Lisinopril Diazoxide Eplerenone Hydralazine
Diazoxide Hydralazine
A patient has been receiving hydralazine. Which findings indicate the patient is experiencing adverse effects of this medication therapy? Select all that apply. Constipation Dizziness Headache Vomiting and diarrhea Disorientation to person, place, and time Difficulty walking to the bathroom
Dizziness Headache Vomiting and diarrhea Adverse effects of hydralazine include dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, and rash. Constipation, disorientation, and difficulty walking are not reported side effects.
Which is an appropriate nursing intervention for a patient who is taking hydrochlorothiazide? Encourage intake of foods rich in potassium. Schedule the dose to be taken in the evening. Monitor serum calcium and sodium levels daily. Take the radial pulse for 1 full minute before administering the drug.
Encourage intake of foods rich in potassium. 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 would encourage increased intake of foods high in potassium. The medication should be taken in the morning to decrease episodes of nocturia from diuresis.
The nurse is caring for a patient who needs medication to treat hypertension and to improve survival after experiencing a myocardial infarction. The nurse would anticipate that the patient will be prescribed which medication? Bosentan Eplerenone Treprostinil Sodium nitroprusside
Eplerenone is indicated to both treat hypertension and to improve survival after a myocardial infarction. Currently bosentan is specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe heart failure.
The health care provider prescribes a sodium nitroprusside intravenous infusion to manage a patient's blood pressure of 230/120 mm Hg. Which action(s) would the nurse implement before starting the infusion? Select all that apply. Evaluate the electrocardiogram. Perform a neurologic assessment. Assess oxygenation and ventilation. Obtain an intravenous infusion pump. Draw baseline serum electrolyte levels. Assess the patient for peripheral edema.
Evaluate the electrocardiogram. Perform a neurologic assessment. Assess oxygenation and ventilation. Obtain an intravenous infusion pump.
Which patient finding would warrant the nurse holding the prescribed amlodipine? Tachycardia Hypotension Angina pectoris Subarachnoid hemorrhage
Hypotension A patient who is scheduled to receive a calcium channel blocker should have blood pressure assessed before administration. Hypotension would be a contraindication to administering this medication.
A patient is taking an alpha1 blocker. Which assessment finding indicates a therapeutic effect to this medication therapy? Increased heart rate Increased urinary output Increased blood pressure Increased respiratory rate
Increased urinary output
A patient with coronary artery disease and diabetes mellitus has resistant hypertension despite therapy with benazepril. Which antihypertensive agent would the nurse avoid administering to this patient? Felodipine Propranolol Candesartan Hydrochlorothiazide
Propranolol A nonselective beta-adrenergic blocker such as propranolol can mask the clinical indicators of hypoglycemia by blocking the sympathetic stimulation caused by a low blood sugar level. Therefore propranolol is contraindicated for use in patients with diabetes mellitus. Felodipine, candesartan, and hydrochlorothiazide are not contraindicated in patients with diabetes.
A patient has developed toxicity while receiving lisinopril. Which action would the nurse expect to implement? Administer aspirin. Insert a Foley catheter. Send the patient for hemodialysis. Administer potassium chloride intravenously.
Send the patient for hemodialysis. In the case of toxicity and overdose, the patient will respond to dialysis, which can be used to eliminate the drug from the system. Aspirin, catheterization, and potassium chloride are neither helpful nor necessary.
The nurse is reviewing a medication history for a patient taking captopril. The nurse would contact the health care provider if the patient is also taking which medication? Aspirin Spironolactone Morphine sulfate Docusate sodium
Spironolactone Angiotensin converting enzyme (ACE) inhibitors, such as captopril, block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production.
The nurse is teaching the patient why hypertension must be treated. Which risk factors for hypertension would be included in the teaching plan? Select all that apply. Stroke Diabetes Emphysema Heart failure Cardiovascular disease
Stroke Heart failure Cardiovascular disease
A patient with hypertension is prescribed a diuretic as first-line drug therapy after lifestyle changes have been ineffective. Which type of diuretic would the nurse anticipate will be used? Loop Thiazide Osmotic Potassium-sparing diuretic
thiazide these diuretics such as hydrochlorothiazide are the most commonly used diuretics for the treatment of hypertension. Loop diuretics are used to treat heart failure and may be a third- or fourth-line medication to treat hypertension. Osmotic diuretics are not used to treat hypertension. Potassium-sparing diuretics are not first-line treatment of hypertension.
