PrepU Ch. 26: Drug Therapy for Hypertension for Pharmocology
12. A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.) Damage to the gall bladder Damage to the heart Damage to the kidneys Damage to the pancreas Damage to the eyes
Damage to the heart Damage to the kidneys Damage to the eyes A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.
15. The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition? Asthma Glaucoma Diabetes mellitus Unstable angina pectoris
Diabetes mellitus ACE inhibitors are considered first-line antihypertensive agents for clients with diabetes mellitus because they reduce proteinuria and slow the progression of renal impairment.
6. A 71-year-old male client is being treated for hypertension. Which measurement is a partial indication of effective treatment and management? Systolic blood pressure above 140 mm Hg Diastolic blood pressure below 100 mm Hg Systolic blood pressure below 160 mm Hg Diastolic blood pressure below 90 mm Hg
Diastolic blood pressure below 90 mm Hg Successful treatment involves reducing blood pressure below hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
2. What drug is a safe and effective calcium channel blocker only if the nurse administers it as a sustained-release or extended-release preparation to treat hypertension? Atenolol Diltiazem Aliskiren Metoprolol
Diltiazem The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine, felodipine, isradipine, and nicardipine. Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem, nifedipine, nisoldipine, and verapamil. Aliskiren is a renin inhibitor. Atenolol and metoprolol are beta-blockers, not calcium channel blockers.
14. A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do? Decrease the dosage of the drug Maintain the current dosage of the drug Increase the dosage of the drug Discontinue the drug
Discontinue the drug The FDA has issued a black box warning for ACE inhibitors and ARBs during pregnancy because their use can cause injury and even death to a developing fetus.
20. A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact? For three weeks For two weeks For one week For four weeks
For one week The nurse should ensure that the transdermal patch is intact for a period of one week. A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.
9. 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. Monitor the client's level of consciousness. Assess the level of head pain. Administer antiemetic medication.
Implement interventions to lower blood pressure. Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. While appropriate, none of the other options have priority over decreasing the blood pressure.
14. What is the nurse's priority assessment question before giving a female client her prescription for an angiotensin II-receptor blocker (ARB)? "Do you eat something when you take your medications?" "When was your last menstrual period (LMP)?" "How much physical exercise do you get?" "Have you always weighed 130 pounds as an adult?"
"When was your last menstrual period (LMP)?" It would be important to know when the client's LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. The other questions are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive.
16. 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? "We always treat high blood pressure with medicine to prevent further damage to your body." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." "Maybe you do not need medication with your history." "The effects of high blood pressure are different for different people."
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." Hypertension causes damage to blood vessels within the body that may lead to cardiovascular and kidney damage. Hypertension may be treated with or without medications. It is not within the scope of the nurse to decide whether or not the client needs medications, but to provide the education regarding the disease process and medications.
10. 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? 150/100 mm Hg 140/90 mm Hg 130/80 mm Hg 100/70 mm Hg
130/80 mm Hg The blood pressure goal for a client with diabetes or kidney disease is 130/80 mm Hg. Values of 140/90 mm Hg and 150/100 mm Hg indicate the blood pressure is not under good control. Blood pressure of 100/70 mm Hg can increase the risk or orthostatic hypotension.
12. A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A vasopressor Another ARB An ACE inhibitor A diuretic
A diuretic When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. The addition of an ACE inhibitor, a vasopressor or another ARB is not appropriate.
TEST 1 1. 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? Until blood pressure is 120/80 mmHg Lifelong 5 years One year
Lifelong Once primary hypertension develops, management of the disorder becomes a lifetime task. Diet and exercise with weight loss can help to lower blood pressure; however, there are many factors even genetics that contribute to hypertension.
11. 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? Select all that apply. Atenolol Losartan Olmesartan Quinapril Ramipril
Losartan Olmesartan Angiotensin II receptor antagonists (ARBs), such as losartan and olmesartan, lower blood pressure by blocking the binding of angiotensin II at receptor sites in vascular smooth muscle and adrenal glands. Ramipril and quinapril are ACEIs, and atenolol is a beta blocker.
9. A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). What should the nurse explain is the hormone produced by the adrenal cortex? Renin Angiotensin Enalapril Aldosterone
Aldosterone The nurse should explain that aldosterone is the hormone produced by the adrenal cortex. Renin and angiotensin are hormones produced in the kidneys, and not by the adrenal cortex. Enalapril is not a hormone; it is an ACEI antihypertensive drug.
6. A client is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n): Beta adrenergic blocker Alpha-1 blocker Alpha-2 agonist Alpha- and beta-blocker
Alpha- and beta-blocker Carvedilol is an alpha- and beta-blocker.
5. A client has come to the clinic for the past 7 months with elevated blood pressure. The client has now been prescribed three different antihypertensives as well as a diuretic. The nurse knows that what other factors may be contributing to the client's consistent hypertension? (Select all that apply.) Nasal decongestant Meditation Herbal supplement Walking program OTC appetite suppressant
Nasal decongestant Herbal supplement OTC appetite suppressant Other factors that may contribute to hypertension include the use of nasal decongestants, herbal supplements, and OTC appetite suppressants. Meditation and a walking program may help to decrease or control hypertension.
13. The nurse is providing drug teaching for a client who is prescribed captopril. What drug-specific adverse effect will the nurse include in the drug teaching? Hepatic dysfunction Hypersensitivity reaction Persistent cough Sedation
Persistent cough Captopril is generally well tolerated but may cause an unrelenting cough, possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited. This can lead clients to discontinue the drug. Sedation, hypersensitivity reaction, and hepatic dysfunction are not among the known adverse effects.
2. The nurse is leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following is appropriate for managing hypertension in children? Select all that apply. Taking a daily multivitamin Promoting exercise Reducing dietary sodium Preventing obesity
Promoting exercise Preventing obesity Reducing dietary sodium Most principles for managing hypertension in adults also apply in children. Prevention of obesity, avoiding excessive sodium intake, and exercise are important nonpharmacologic measures. Multivitamin intake does not have a direct impact on hypertension management.
12. A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? By blocking the angiotensin II receptors By preventing renin secretion By preventing the conversion of angiotensin I By blocking the aldosterone receptors
By blocking the angiotensin II receptors Losartan brings about an antihypertensive effect by blocking the angiotensin II receptors. Losartan is an angiotensin II receptor antagonist. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors.
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6. The clinic nurse assesses a client taking benazepril to control hypertension. What change in the client's health status may require a change in drug therapy? The client is diagnosed with depression and begins taking a selective serotonin reuptake inhibitor (SSRI). The client's creatinine clearance is steadily declining. The client is treated for hepatitis A. The client is diagnosed with gastroesophageal reflux disease.
The client's creatinine clearance is steadily declining. Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function. Mental illness, hepatic disease, or GERD are not contraindications with this drug.
19. Which risk factors increase a client's risk for the development of hypertension? Select all that apply: advancing age Caucasian race cigarette smoking chronic alcohol consumption family history
advancing age family history cigarette smoking chronic alcohol consumption Advancing age, family history, smoking, and chronic alcohol consumption increase a client's risk of developing hypertension. Being Caucasian does not increase a client's risk of developing hypertension, however Black clients are at an increased risk.
15. A client has been newly diagnosed with primary hypertension. Which medication classification represented in the client's current medication regime should the nurse question when considering the treatment for this new diagnosis? angiotensin II receptor blockers ACE inhibitors direct vasoconstrictors antiadrenergics
direct vasoconstrictors Drugs used in the management of primary hypertension belong to several different groups, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and antiadrenergics. They decrease blood pressure by decreasing cardiac output or peripheral vascular resistance.
8. When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? myocardial hypertrophy increased venous tone arterial lumen dilation hepatic damage
myocardial hypertrophy Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
7. The goal of therapy for a client taking antihypertensive medication is to maintain: homeostasis. a fluid volume balance. compliance. the blood pressure within normal limits.
the blood pressure within normal limits. Helping the client to maintain the blood pressure within normal limits is the goal when drug therapy is instituted.
5.A 37-year-old client presents with a blood pressure of 128/78 mm Hg. What lifestyle change should the nurse suggest related to this assessment finding? "Be aware of your salt intake and limit hidden salt." "Get 7 to 8 hours of sleep each night." "Explore the possible use of a calcium channel blocker with your health care provider." "Try to increase your intake of potassium-rich foods."
"Be aware of your salt intake and limit hidden salt." This client may reduce the likelihood of developing hypertension with a reduction in salt intake. There is no need for this client to be placed on a calcium channel blocker or to increase potassium intake. Adequate sleep is important, but this is not directly related to blood pressure control.
4. A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response? "Increases client's perception of pain and decreases the heart rate." "Blocks conversion of angiotensin I to angiotensin II." "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." "Decreases the cardiac output by diuresis of sodium and water."
"It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." Amlodipine inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation. This leads to lowered blood pressure. Diuretics decrease the cardiac output by diuresis of sodium and water. This medication does not increase pain or affect the heart rate. ACE inhibitors block the conversion of angiotensin I to angiotensin II.
13. A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make? "There is an error on the prescription." "People of Asian descent excrete the drugs more rapidly, so the doses prescribed are smaller." "People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller." "I will contact the provider immediately."
"People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller." In general, people of Asian descent with hypertension require much smaller doses of beta-blockers, because they metabolize and excrete the drugs slowly.
10. 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?" "Have you always weighed 150 pounds?" "Do you eat something when you take your medications?" "How much physical exercise do you get?"
"When was your last menstrual period?" It would be important to know when the patient's LMP occurred and that the client is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the client who is beginning angiotensin II receptor blocker therapy.
18. The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "Maybe you do not need medication with your history." "We always treat high blood pressure with medicine to prevent further damage to your body." "The effects of high blood pressure are different for different people." "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." Hypertension causes damage to blood vessels within the body that may lead to cardiovascular and kidney damage. Hypertension may be treated with or without medications. It is not within the scope of the nurse to decide whether or not the client needs medications, but to provide the education regarding the disease process and medications.
1. Which client is most likely to be diagnosed with secondary hypertension? A client who is being treated for pheochromocytoma A client whose body mass index is 31 (obese) A client whose most recent blood pressure readings were 143/92, 147/94 and 144/94 mm Hg A client with type 1 diabetes who has developed nephropathy
A client who is being treated for pheochromocytoma The majority of clients with hypertension have the primary (essential) form, in which there is no obvious cause. A client with a pheochromocytoma would have secondary hypertension, because the cause is identifiable. Obesity and diabetes are associated with hypertension but are not the direct causes of it. A client with blood pressures of 143/92, 147/94, and 144/94 mm Hg would be likely diagnosed with hypertension, but not likely the secondary type.
4. A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information? Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced. ACE inhibitors are contraindicated during pregnancy because they are teratogenic. ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy. ACE inhibitor therapy can continue during pregnancy.
ACE inhibitors are contraindicated during pregnancy because they are teratogenic. It is important to instruct women of childbearing age to take measures to prevent pregnancy while taking captopril or other ACE inhibitors because the drugs are teratogenic. This therapy must be discontinued if pregnancy occurs.
20. A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). What should the nurse explain is the hormone produced by the adrenal cortex? Enalapril Aldosterone Angiotensin Renin
Aldosterone The nurse should explain that aldosterone is the hormone produced by the adrenal cortex. Renin and angiotensin are hormones produced in the kidneys, and not by the adrenal cortex. Enalapril is not a hormone; it is an ACEI antihypertensive drug.
16. 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? Calcium channel blockers Angiotensin II receptor blockers Selective aldosterone blockers Antihyperlipidemic drugs
Angiotensin II receptor blockers Losartan is an angiotensin II receptor blocker (ARB) and is recommended for clients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease. Antihyperlipidemic drugs help to reduce cholesterol. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls, these are recommended with caution in pregnant women. Selective aldosterone blockers do not show reduction of end-stage renal disease but are effective in treating severe CHF.
18. Mr. Zee is being discharged home after treatment for a myocardial infarction. During the hospital stay he was also diagnosed with uncomplicated diabetes mellitus type 2 and hypertension. The health care provider has prescribed several new drugs, one of which is captopril. What instruction is important to include in the teaching plan regarding captopril administration? Discontinue drug if persistent dry cough occurs. Avoid potassium supplements. Implement a low-carbohydrate diet as part of your weight loss program. Avoid dairy products.
Avoid potassium supplements. The nurse needs to explain to the client that the drug may produce a persistent dry cough, but that it is not serious. Poor oral intake and decreased sodium intake may predispose the client to the adverse effects of captopril. If the client normally uses a salt substitute containing potassium or potassium supplements, these substances may need to be discontinued to avoid possible hyperkalemia. Also, the nurse needs to advise the client to explore lifestyle changes intended to decrease blood pressure, such as weight loss, smoking cessation, increased exercise, and limited salt intake. The client need not avoid dairy products because these have no implications on the therapy.
11. A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? A temporary increase in renal function A sustained decrease in renal function Baseline renal function A sustained increase in renal dysfunction
Baseline renal function Antihypertensive drugs are frequently required by patients with renal impairment ranging from mild insufficiency to end-stage failure. It would be necessary to assess baseline renal function in these patients prior to beginning antihypertensive therapy.
11. A 48-year-old client who experienced an MI 10 years ago is now reporting frequent episodes of angina. The physical assessment identifies the client as being tachycardic. What is the first drug of choice for the treatment of this client? Beta-blockers Angiotensin II receptor blockers Alpha-blockers Calcium channel blockers
Beta-blockers Beta adrenergic blockers are the drugs of first choice for clients younger than 50 years of age with high-renin hypertension, tachycardia, angina pectoris, myocardial infarction, or left ventricular hypertrophy.
14. 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 blocking aldosterone from binding to mineralocorticoid receptors By blocking the movement of calcium ions into arterial smooth muscles By directly relaxing vascular smooth muscle By inhibiting the transformation of angiotensin I to angiotensin II
By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.
17. 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 directly relaxing vascular smooth muscle By blocking aldosterone from binding to mineralocorticoid receptors By blocking the movement of calcium ions into arterial smooth muscles By inhibiting the transformation of angiotensin I to angiotensin II
By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.
17. A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Constipation Photosensitivity GI irritation Cough
Cough Fosinopril is associated with an unrelenting cough that can lead clients to discontinue the drug. Constipation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. GI irritation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. Photosensitivity is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug.
6. Key behavioral determinants of blood pressure are related to what factor? Minimal body mass Dietary consumption of sugars and fat Comorbidities Dietary consumption of calories and salt
Dietary consumption of calories and salt Key behavioral determinants of blood pressure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.
20. A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent: Excessive hypotension Cardiac arrhythmias Renal failure ACE inhibitor toxicity
Excessive hypotension Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
3. 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? Baked fish, broccoli, and oranges Salad with a grilled chicken; unsweetened tea Ham sandwich with mustard, carrots and cheesy dip Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea
Ham sandwich with mustard, carrots and cheesy dip Dietitians usually recommend the Dietary Approaches to Stop Hypertension (DASH) diet. Studies indicate that blood pressure can be reduced by eating a diet low in saturated fat, total fat, and cholesterol and rich in fruits, vegetables, and low-fat dairy foods. The DASH diet includes whole grains, poultry, fish, and nuts and has reduced amounts of fats, red meats, sweets, and sugared beverages.
17. 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? Hypokalemia Hypercalcemia Hyperkalemia Hypocalcemia
Hyperkalemia When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.
5. 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 When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.
13. The emergency department nurse is asked to prepare a nitroprusside infusion for a client being brought to the hospital in an ambulance. What is this client's most likely diagnosis? Myocardial infarction accompanied by hypertension Hemorrhagic stroke Hypertensive crisis Hypertension associated with diabetic ketoacidosis
Hypertensive crisis Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence or absence of a comorbidity such as stroke, diabetic ketoacidosis, or MI does not increase the likelihood of use.
10. The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? It binds selectively to the mineralocorticoid receptors. It inhibits the movement of calcium ions across cell membranes. It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.
It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. Nitroprusside, which is used in hypertensive crisis, directly relaxes vascular smooth muscle, allowing the dilation of peripheral arteries and veins. Angiotensin II receptor blockers block the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. Selective aldosterone blockers bind selectively to the mineralocorticoid receptors, thereby blocking aldosterone from binding to these receptors, while calcium channel blockers inhibit the movement of calcium ions across cell membranes.
7. A client has been diagnosed with primary hypertension. Which medications are used to treat primary hypertension? Select all that apply. Loop diuretics Angiotensin receptor blockers (ARBs) Thiazide diuretics Angiotensin converting enzyme inhibitors Beta adrenergic antagonists
Thiazide diuretics Angiotensin converting enzyme inhibitors Angiotensin receptor blockers (ARBs) Current guidelines support a thiazide diuretic being used as first-line therapy, either alone or with an ACE inhibitor, ARB, or calcium channel blocker (CCB). Loop diuretics and beta adrenergic antagonists are not considered first-line therapies and can be added later.
19. The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse's best response? Increased risk for hepatic damage Arterial lumen dilation Myocardium hypertrophy Decreased risk of thrombosis
Myocardium hypertrophy Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
16. A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Force of myocardial contraction Peripheral vascular resistance Renal function Pulse pressure
Peripheral vascular resistance Arterial blood pressure reflects the force exerted on arterial walls by blood flow. It does not reflect pulse pressure, renal function, or force of myocardial contraction.
20. A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Smoking cessation Focus on finding a different job Decreased alcohol consumption Regular aerobic exercise Diet with more fruits and vegetables
Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation Lifestyle management of a client diagnosed with primary hypertension should focus on aerobic exercise, improved diet, weight loss, decreased alcohol consumption, and decreased cigarette smoking. Client education should focus on stress management techniques, and finding a different job is not appropriate at this time.
15. During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment? Hypertensive emergency Secondary hypertension Essential hypertension Rebound hypertension
Secondary hypertension Secondary hypertension results as a consequence of renal impairment. In secondary hypertension there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension it is called essential hypertension. Rebound hypertension occurs when a patient abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state that has to be lowered immediately.
4. A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? Take the medication at bedtime. Increase fluid intake for 48 hours before taking the first dose. Take the medication with a high-fat meal. Start with a low dose and increase gradually over 2 to 3 weeks.
Take the medication at bedtime. To prevent the first-dose phenomenon, first doses and first increased doses are taken at bedtime. Increased fluid and fats will not address this risk, and the medication is not typically increased gradually over several weeks.
18. 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 Diltiazem Verapamil Nicardipine
Valsartan Valsartan is an angiotensin II receptor blocker
7. 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: the first dose of the medication should be taken at breakfast. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. he should use a salt substitute containing potassium to avoid hypokalemia. a persistent, dry cough may occur; however, it is not serious.
a persistent, dry cough may occur; however, it is not serious. The nurse will advise the client that the captopril may produce a persistent, dry cough that is not serious. Clients may want to discontinue therapy because of the cough, but the nurse should encourage the client to continue therapy and help the client minimize the cough. However, if the cough becomes intolerable, the client should contact the prescriber. The client should be instructed to take the first dose at bedtime to minimize the possibilities of injury from first-dose hypotension. The client should be advised to notify the prescriber promptly if sore throat; fever; swollen hands or feet; irregular heartbeat; chest pain; swollen face, eyes, lips and tongue; difficulty breathing; or hoarseness occur. These effects could indicate angiedema, which can be life threatening. If the client normally uses a salt substitute containing potassium or a potassium supplement, these substances may need to be discontinued to avoid possible hyperkalemia. Hypokalemia is not a concern.
2. The nurse has completed medication teaching for a client who has been prescribed aliskiren. What meal choice made by the client best demonstrates an understanding of dietary concerns related to the drug? grilled cheese sandwich, french fries, and a fruit salad baked white fish, rice, and a green salad 2 egg omelet, hash brown potatoes, toast pork chop, quinoa, and spinach salad
baked white fish, rice, and a green salad The client should be instructed to avoid taking aliskiren, a direct renin inhibitor, with a high-fat meal because this significantly decreases the amount of available drug. White fish, rice, and a green salad are all low fat foods. Eggs, cheese, french fries, and pork chops are high in fat and would affect absorption of the medication.
12. How does captopril contribute to a reduction of a client's blood pressure? blocking the conversion of angiotensin I to angiotensin II dilating peripheral arteries and relaxing vascular smooth muscle increasing rebel excretion of sodium and water blocking the blood pressure-raising effects of angiotensin II
blocking the conversion of angiotensin I to angiotensin II ACE inhibitors such as captopril block the enzyme that normally converts angiotensin I to the potent vasoconstrictor angiotensin II. Calcium channel blockers dilate peripheral arteries and relax vascular smooth muscle. Angiotensin II receptor blockers mitigate the hypertensive effects of angiotensin II and diuretics increase water excretion.
1. A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client's most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? low sodium levels low hemoglobin levels elevated potassium levels elevated neutrophil levels
elevated potassium levels ACE inhibitors like ramipril carry a risk of hyperkalemia, and an elevated potassium level may warrant withholding the drug. Elevated neutrophils or low sodium and hemoglobin levels would not likely prompt this action.
8. 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: depression. falls. xerostomia (dry mouth). constipation.
falls Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression.
17. Losartan focuses on what aspect of the cardiac process to address the pathophysiology of heart failure? increasing stroke volume increasing heart rate reducing preload lowering blood pressure
lowering blood pressure Losartan potassium selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal glands. This, in turn, blocks the vasoconstrictive effect of the renin-angiotensin system and the release of aldosterone, leading to a decrease in the client's blood pressure. Losartan is not focused on reducing preload or increasing either stroke volume or heart rate.
10. 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 respiratory rate. question the client about her dietary intake. monitor the client's blood pressure. weigh the client.
monitor the client's blood pressure. Monitoring of blood pressure would be the priority assessment in the care of this client. Questioning the client about her dietary intake and weighing her would be appropriate, but secondary in importance. It is unnecessary to monitor the client's respiratory rate.
