Hypertension

Treatment recommendations for hypertension stage 1

- Complete heart disease stroke and risk assessment -Assess for modifiable and nonmodifiable risk factors -Educate lifestyle and diet changes -Medication may be started here -reassess in 3-6 months if no medication, and monthly with medication until controlled.

nonpharmalogical therapy for hypertension

- DASH diet +reduce sodium +increase potassium - Moderate alcohol consumption - Lose weight - stop smoking -Increase physical activity

Treatment recommendations for hypertension stage 2

-Assess for modifiable and nonmodifiable risk factors -Educate lifestyle and diet changes - May start one 2 different classes of BP medications -follow up monthly until controlled

Hydrochlorothiazide (HCTZ)

-Diuretic -Side Effects: Hypotension - Headache & dizziness +Assess BP before administering. Hold for SBP<100 or as per parameters and notify health care provider. Hypokalemia (teach pt to increase potassium in diet) + Monitor potassium levels, Hold for decreased potassium level and notify health care provider. Hypovolemia - Weigh patients daily Hyperglycemia (if patient is diabetic, educate pt to monitor BS more frequently) Elevated uric acid (gout)

Target organs most frequently effected by HTN

-Heart -Brain -Peripheral vasculature -Kidney -Eyes

Function of diagnostic and laboratory testing for hypertension

-Identify or rule out causes of secondary hypertension -Evaluate target organ disease -Determine overall cardiovascular risk -Establish baseline levels before therapy is initiated.

Nursing considerations when taking blood pressure

-Patient should be seated quietly for 5 minutes in a chair, with feet on the floor and arms supported at heart level. -Use auscultatory method with a properly calibrated instrument. -Use appropriately sized cuff to ensure accurate readings. -Obtain at least two measurements taken at different times/days to diagnose HTN.

Nursing interventions for hypertensive crisis

-Raise HOB -decreases blood flow back to heart -Monitor vitals frequently - look for trends and assess how each medication works -monitor for neurological symptoms - watching for signs of decreased blood flow to the brain and s/s of stroke

Goal with blood pressure regulation

-control blood pressure to avoid target organ damage

elevated blood pressure

120-129/<80

Hypertension Stage 1

130-139/80-89

Hypertension Stage 2

140 or higher/90 or higher

Normal lab range for potassium

3.5-5.0 mEq/L

The nurse determines that which blood pressure would meet the criteria for a diagnosis of stage 1 hypertension? (Select all that apply.) a. 134/84 mm Hg b. 138/88 mm Hg c. 144/92 mm Hg d. 156/96 mm Hg e. 182/100 mm Hg

A & B

The nurse would contact the physician if a client who has been prescribed hydrochlorothiazide has which condition? Select all that apply. a. Gout b. Systemic lupus erythematosus c. Osteoarthritis d. Otitis media e. Diabetes mellitus

A, B, E Rationale: Caution should be used with thiazide and thiazide-like diuretics if the client has the following conditions: systemic lupus erythematosus, diabetes mellitus, gout, liver disease, hyperparathyroidism, or bipolar disorder. Otitis media and osteoarthritis do not have any contraindications for use with this drug.

What instructions would the nurse include in the teaching plan for a client taking digoxin at home? Select all that apply. a. "Check your pulse every day before taking the medication." b. "Take the drug with some type of food to avoid an upset stomach." c. "Hold the medication and notify the doctor if your pulse is below 60 beats/min." d. "Call your doctor if you notice an irregular heart rhythm or you feel nauseated." e. "Weigh yourself each day at the same time and wearing the same type of clothing."

A,C,D,E Rationale:Daily weights help to evaluate the effectiveness of the drug and the control of heart failure. A pulse rate of less than 60 beats/min might suggest digoxin toxicity, so clients should be taught to check pulse before taking the medication. Irregular heart rhythm or nausea may indicate digoxin toxicity and should be reported to the provider. Drug absorption is delayed if the drug is taken with food, so this would not be good advice.

Which BP regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. release of norepinephrine b. secretion of prostaglandins c. stimulation of the sympathetic nervous system d. stimulation of the parasympathetic nervous system e. activation of the renin-angiotensin-aldosterone system

A,C,E

The nurse works in a clinic with a high percentage of African American clients. How do cultural considerations impact the nursing care provided to these clients? Select all that apply. a. African Americans are more responsive to single-drug therapy. b. First-line drug therapy for an African American should begin with a calcium channel blocker. c. Increased adverse effects are seen when African American clients take loop diuretics. d. African Americans are less responsive to angiotensin-converting enzyme inhibitors and beta-blockers. e. African Americans are more responsive to diuretics, calcium channel blockers, and alpha-blockers.

A,D,E Rationale: African Americans are most responsive to single-drug therapy (as opposed to combination drug regimens); more responsive to diuretics, calcium channel blockers, and alpha-adrenergic blockers; and less responsive to angiotensin-converting enzyme inhibitors and beta-blockers. Increased adverse effects (depression, fatigue, drowsiness) often occur when using thiazide, and thiazide-like diuretics, not loop diuretics. Because African Americans are more responsive to diuretics, the treatment approach should include the first-line use of a diuretic, not a calcium channel blocker, in combination with diet and other lifestyle changes.

A newly admitted client is in a hypertensive crisis, and the provider has prescribed enalaprilat. What is the nurse's best action? A. Establish intravenous access. B. Assess the client's blood pressure in lying, sitting, and standing positions. C. Question the provider about the use of this medication. D. Assess the client's swallowing ability and risk for aspiration

A. Establish intravenous access. Rationale: Enalaprilat would be administered IV for severe hypertension. Postural blood pressures would not be assessed during a hypertensive crisis. Swallowing assessment is unnecessary because of the IV route. There is no obvious reason for questioning the provider.

Valsartan (Diovan)

Angiotensin II Receptor Blocker Fewer side effects as compared to ACE inhibitors Side effects: -Angioedema -Hypotension +change positions slowly +Monitor BP -Dizziness Nursing assessment/considerations -Assess BP before administering. +Hold for SBP<100 or as per parameters and notify health care provider.

Angiotensin-converting enzyme (ACE) inhibitors

Block conversion of angiotensin I to angiotensin II which causes vasodilation, reduction of pathological changes in blood vessels and the heart, excretes sodium and water but retains potassium.

4 C's of Hypertension (Complications)

C- Coronary Artery Disease C- Coronary Rheumatic Fever C- Congestive Heart Failure C- Cardio Vascular Accident

Hypertension nursing interventions for Diuretics

DIURETIC • Daily Weight • Intake and Output (I & O) • Urine Output • Response of BP • Electrolytes • Take Pulses • Ischemic Episodes (TIA)

How does smoking and diabetes affect blood pressure?

It reduce endothelial function -> leads to increased risk of CVD

DASH (Dietary Approaches to Stop Hypertension)

Low-fat eating plan that is high in fruits, vegetables, and low-fat dairy foods; shown to reduce blood pressure.

Angiotensin II Receptor Blockers (ARBs)

Lower blood pressure by blocking the angiotensin II enzyme from causing vasoconstriction

What should a nurse also monitor with a patient presenting with hypertensive crisis?

Monitor for neurological symptoms -Stroke, decreased blood flow to the brain. -Are they confused, is this their baseline, speech clear, facial droop

A client is receiving a diuretic as part of his or her treatment plan for hypertension. The nurse would monitor the client for signs and symptoms of hyperkalemia if the client was receiving which agent? a. Hydrochlorothiazide b. Indapamide c. Spironolactone d. Chlorthalidone

Rationale: Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia. Hydrochlorothiazide, indapamide, and chlorthalidone are associated with causing hypokalemia.

Why is it important to monitor electrolytes for a patient receiving drug therapy for hypertension?

The medications can cause imbalance with potassium

hypertension is also known as

The silent killer because the signs and symptoms go unnoticed.

blood volume

The total amount of blood circulating within the body

What drug does the nurse administer to act as a renin inhibitor? a. Aliskiren b. Nifedipine c. Nitroprusside d. Hydralazine

a. Aliskiren Rationale: In late 2007, a new class of drugs for treating hypertension was introduced with the approval of aliskiren. Aliskiren directly inhibits renin, leading to decreased plasma renin activity and inhibiting the conversion of angiotensinogen to angiotensin I. This inhibition of the renin-angiotensin-aldosterone system leads to decreased blood pressure, decreased aldosterone release, and decreased sodium reabsorption. Nitroprusside and hydralazine are vasodilators. Nifedipine is a calcium channel blocker.

The nurse is administering a beta-blocker to a client with hypertension. What effects should the nurse anticipate will occur? Select all that apply. a. Decreased cardiac muscle contraction b. Decreased heart rate c. Increased renal blood flow d. Vasoconstriction e. Increased renin release

a. Decreased cardiac muscle contraction b. Decreased heart rate c. Increased renal blood flow Rationale: A beta-blocker blocks vasoconstriction, decreases heart rate, decreases cardiac muscle contraction, and increases blood flow to the kidneys, leading to a decrease in the release of renin.

A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment? a. Digoxin b. Human B-type natriuretic peptide c. Ivabradine d. ACE inhibitors

a. Digoxin Rationale: Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, ACE inhibitors, or ivabradine also may be used, but these drugs are not the most common ones used.

What would the nurse expect to assess in the client who has been given nitroprusside and who has developed cyanide toxicity? Select all that apply. a. Distant heart sounds b. Hyperactive reflexes c. Dilated pupils d. Dyspnea e. Shallow breathing

a. Distant heart sounds c. Dilated pupils d. Dyspnea e. Shallow breathing Rationale: Cyanide toxicity is manifested by dyspnea, headache, vomiting, dizziness, ataxia, loss of consciousness, imperceptible pulse, absent reflexes, dilated pupils, pink color, distant heart sounds, and shallow breathing.

A patient with newly discovered high BP has an average reading if 158-98 mmHg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient. a. Drug therapy will be needed because BP is still not at goal. b. BP monitoring should continue for 3 months to confirm a diagnosis of HTN. c. Lifestyle changes are less important since they were not effective, and drugs will be started. d. More changes in the patient's lifestyle are needed for a longer time before starting drug therapy.

a. Drug therapy will be needed because BP is still not at goal.

A client is receiving an ACE inhibitor. The nurse ensures that the client's hydration status is maintained to prevent what adverse effect? a. Excessive hypotension b. ACE inhibitor toxicity c. Renal failure d. Cardiac arrhythmias

a. Excessive hypotension Rationale: Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.

When analyzing the results of cardiac diagnostic testing, the nurse expects that the highest pressure will be found where? a. Left ventricle b. Left atrium c. Right ventricle d. Right atrium

a. Left ventricle

A hospital client with a history of hypertension has been administered a one-time dose of captopril because the client's blood pressure exceeds desired levels. After administering the medication, what is the nurse's best action? a. Reassess the client's blood pressure in 15 minutes. b. Monitor the client's oxygen saturation levels and respiratory rate for the next hour. c. Measure the client's blood pressure at 60, 90, and 120 minutes. d. Ensure that the client remains in bed with side rails raised.

a. Reassess the client's blood pressure in 15 minutes. Rationale: The onset of captopril is 15 minutes with a peak between 30 and 90 minutes. There may be a falls risk due to decreased blood pressure, but this would not normally require bed rest and side rails. There is no reason to believe the client's respiratory status is at risk. The nurse should not wait 1 hour before reassessing blood pressure.

Calcium Channel Blockers

agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation. used to prevent or treat angina pectoris, some arrhythmias, and hypertension

Lisinopril (Zestril, Prinivil)

antihypertensive, ACE inhibitor --(Does NOT effect HR) Side effects -First‑dose orthostatic hypotension -Hypotension +Change positions slowly +Monitor BP -Cough (dry, nonproductive cough) -Possible hyperkalemia - due to how it works with the kidneys -Angioedema: rare but potentially fatal +This includes swelling of lips mouth, tongue and can occlude airway Nursing assessment/considerations -Assess BP before administering. +Hold for SBP<100 or as per parameters and notify health care provider. -Monitor potassium -Monitor kidney function

A client is receiving acetazolamide in a sustained-release form. The nurse would anticipate the onset of diuresis in approximately which time frame? a. 3 hours b. 2 hours c. 4 hours d. 1 hour

b. 2 hours Rationale: Acetazolamide in sustained-release form has an onset of action of 2 hours.

The nurse is assessing a 56-year-old client. When teaching the client about the risks of hypertension, the nurse should identify the goal of keeping the client's blood pressure at what level? a. <130/<80 b. <140/<90 c. <150/<100 d. <120/<70

b. <140/<90 Rationale: Target blood pressure for clients under 60 is <140/<90 mm Hg.

A client in intensive care is beginning to show signs and symptoms of increased intracranial pressure. What action should the nurse perform in order to prepare for the administration of mannitol? a. Inspect the client's ventogluteal injection site. b. Ensure the client has reliable intravenous access. c. Assist the client up to the bathroom to void. d. Administer a potassium supplement as prescribed.

b. Ensure the client has reliable intravenous access. Rationale: Mannitol is only available for intravenous administration; intramuscular injection is not possible. Assisting a client to the bathroom who has increased intracranial pressure would be unsafe for the client and likely to exacerbate the condition. There is no need to administer a potassium supplement.

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is: a. A low-calcium diet b. Excess alcohol intake c. A family history of hypertension d. Consumption of a high-protein diet

b. Excess alcohol intake

The home health care nurse is visiting an elderly patient who is taking a prescribed calcium channel blocker. In conducting dietary teaching, the nurse instructs the client that what food is contraindicated to take with a calcium channel blocker? a. Oranges b. Grapefruit c. Bananas d. Grapes

b. Grapefruit

A client is receiving verapamil. What should the nurse instruct the client to avoid when teaching the client about this drug? a. Yogurt b. Grapefruit juice c. Apple juice d. Milk

b. Grapefruit juice Rationale: Verapamil, like other calcium channel blockers, interacts with grapefruit juice. This increases the concentration of calcium channel blockers and leads to toxicity, so grapefruit juice should be avoided.

A client with heart failure calls the clinic because of a concern about their pulse rate. The client is taking ivabradine and has a heart rate of 50 beats/min. What instruction should the nurse give the client? a. Hold the medication and present to the emergency department. b. Hold the medication and come in for assessment. c. Take the medication and monitor the heart rate closely throughout the day. d. Take the medication, because the lowered heart rate is a therapeutic effect

b. Hold the medication and come in for assessment. Rationale: A pulse rate below 60 beats/min would be an indication to withhold the medication and notify the provider. This would not necessitate emergency treatment unless there were other worrisome symptoms.

A nurse knows that thiazide diuretics can have various adverse effects. Which conditions are possible adverse effects of these drugs? Select all that apply. a. Hypocalcemia b. Hyperglycemia c. Hyperuricemia d. Hypokalemia e. Hypotension

b. Hyperglycemia c. Hyperuricemia d. Hypokalemia e. Hypotension Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia (increased uric acid levels), hypercalcemia, hypotension, and hyperglycemia (with long-term use).

The nurse is working in the emergency room and receives a client with a blood pressure of 240/138. The client is unconscious and will undergo testing for a stroke. What medication is likely to be ordered for this client? a. Diltiazem b. Nitroprusside c. Losartan d. Isradipine

b. Nitroprusside Rationale:The vasodilators act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in blood pressure. They do not block the reflex tachycardia that occurs when blood pressure drops. They are indicated for the treatment of severe hypertension that has not responded to other therapy and are most often used in emergency situations. Diltiazem, isradipine, and losartan can only be administered PO, which is contraindicated in an unconscious client and would not get the rapid response an IV drug will achieve

When describing the adverse effects associated with ACE inhibitors, what should the nurse include? Select all that apply. a. Leukocytosis b. Proteinuria c. Bradycardia d. Photosensitivity e. Constipation

b. Proteinuria d. Photosensitivity e. Constipation Rationale:Constipation is a possible adverse effect of ACE inhibitors. Proteinuria is a possible adverse effect of ACE inhibitors. Photosensitivity is a possible adverse effect of ACE inhibitors. Reflex tachycardia is a possible adverse effect of ACE inhibitors. Pancytopenia is a possible adverse effect of ACE inhibitors

A client is receiving candesartan. The nurse understands that this drug acts in which manner? a. Prevents angiotensin-converting enzyme from converting angiotensin I to angiotensin II b. Selectively binds with angiotensin II receptors in the vascular smooth muscle c. Inhibits the movement of calcium ions across the heart and arterial muscle cell membranes d. Increases the excretion of sodium and water from the kidney

b. Selectively binds with angiotensin II receptors in the vascular smooth muscle Rationale: Candesartan is an angiotensin II receptor blocker that binds with angiotensin II receptors in the vascular smooth muscle to prevent angiotensin II from binding to these sites. ACE inhibitors prevent ACE from converting angiotensin I to angiotensin II. Calcium channel blockers inhibit calcium ion movement across muscle cells of the heart and arterial muscle cells. Diuretics increase the excretion of sodium and water from the kidney

The nurse examines a clinic client who is taking a diuretic for hypertension and tells the nurse her family is planning a trip to Africa to go on safari. What is the nurse's priority teaching point to share with this client? a. Take an extra tablet during periods of strenuous exercise or activity to lower blood pressure. b. Take care to stay well hydrated in a hot climate to prevent hypotension. c. Do not take extra tablets with you on your trip because the heat will degrade them. d. Tell the provider who gives your travel immunizations that you are taking medications.

b. Take care to stay well hydrated in a hot climate to prevent hypotension. Rationale: Adults need to be reminded of safety precautions that may be needed in hot weather because fluid loss to perspiration will reduce circulating blood volume and can result in dangerous hypotension. This client should be taught the importance of drinking plenty of fluids to maintain hydration. Any client taking any medication should be taught to disclose all medications to each provider, so this is not direction specific to this drug. There is no need to take extra medication as the risk is hypotension. When traveling, it is always a good idea to take extra medication in case a pill is dropped or lost. Heat will not degrade the medication if adequate measures are taken to protect them (i.e., don't leave them out in the sun, keep in a closed container).

The nurse is caring for a 36-year-old woman diagnosed with pulmonary arterial hypertension who will begin taking ambrisentan. What is a priority teaching point related to this medication? a. This drug can be taken after the first trimester of pregnancy but is contraindicated during breast-feeding. b. This drug should not be taken when pregnant, so use of a barrier contraceptive is important. c. This drug should not be taken when pregnant, so a prescription for oral birth control is needed. d. The client will need to learn how to self-administer subcutaneous injections.

b. This drug should not be taken when pregnant, so use of a barrier contraceptive is important. Rationale: Ambrisentan is an oral drug given once daily. It is pregnancy category X and should not be used in pregnancy. Because ambrisentan interacts with oral contraceptives, the client should be taught to use barrier contraceptives instead.

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to promote compliance? a. Diarrhea b. Cough c. Blurred vision d. Nausea

b. cough Rationale:Fosinopril is associated with an unrelenting cough that can lead clients to discontinue the drug. Constipation, not diarrhea, is an adverse effect of ACE inhibitors. GI irritation is an adverse effect of ACE inhibitors, but fosinopril is one of the ACE inhibitors that are generally well tolerated. Photosensitivity, not blurred vision, is an adverse effect of ACE inhibitors.

An African American client with hypertension is receiving lisinopril. What is the nurse's priority assessment? a. Serum electrolyte levels b. Skin integrity c. Airway patency d. Nutritional status

c. Airway patency Rationale: Lisinopril is associated with airway obstruction, and it occurs more commonly in African Americans; airway patency is always the top priority. GI irritation and upset can occur, but this would not be the highest priority. Rash and photosensitivity can occur, but this would not be the highest priority. Pancytopenia is a problem that would require close monitoring; altered serum electrolyte levels are not associated with lisinopril use.

An adult client has concurrent diagnoses of hypertension and unstable angina. What medication would most benefit these two health problems? a. ACE inhibitor b. Alpha1-blocker c. Calcium channel blocker d. Vasodilator

c. Calcium channel blocker Rationale: Calcium channel blockers have the unique benefit of treating angina and hypertension. Other classes of antihypertensives do not have this indication.

A client is receiving carvedilol to treat hypertension. What should the nurse do when educating the client in order to enhance adherence? a. Book the client's follow-up appointment well in advance. b. Provide the client with a log book for tracking blood pressure results. c. Caution the client about the significant risk for adverse effects. d. Help the client identify resources for paying for this high-cost medication.

c. Caution the client about the significant risk for adverse effects. Rationale: Carvedilol is an alpha- and beta-blocker that can cause fatigue, loss of libido, inability to sleep, and GI and genitourinary disturbances, causing clients to be unwilling to continue taking these drugs. Anticipatory guidance may be helpful in this regard. This medication is not noted to be particularly expensive. Booking follow-up and providing a log book may be beneficial but will not necessarily increase compliance.

A client with a history of hypertension has been admitted for surgical repair of an inguinal hernia. When admitting the client, the nurse learns that the client takes ramipril 10 mg PO daily for hypertension. What is the nurse's best action? a. Withhold the client's next scheduled dose of the medication. b. Assess the client's blood pressure q15 minutes preoperatively. c. Ensure that the surgical team is aware of this. d. Arrange for the client's surgery to be postponed.

c. Ensure that the surgical team is aware of this. Rationale:The nurse should alert the surgeon and mark the client's chart prominently if the client is to undergo surgery to alert medical personnel that the blockage of compensatory angiotensin II could result in hypotension after surgery. The care team would subsequently make a decision about holding the medication or postponing surgery. Thorough assessment is necessary preoperatively, but it is not necessary to assess blood pressure every 15 minutes.

The nurse assesses a 5-year-old child with hypertension in the pediatric clinic. What is the first treatment to be prescribed for this child? a. Beta-blockers b. A mild diuretic c. Lifestyle changes d. Angiotensin-converting enzyme inhibitors

c. Lifestyle changes Rationale:Lifestyle changes should be instituted before drug therapy if at all possible. Weight loss and increased activity may bring an elevated blood pressure back to normal in many children. If drug therapy is used, a mild diuretic may be tried first, with monitoring of blood glucose and electrolyte levels on a regular basis. Beta-blockers have been used with success in some children; adverse effects may limit their usefulness in others. The safety and efficacy of the angiotensin-converting enzyme (ACE) inhibitors and the angiotensin receptor blockers (ARBs) have not been established in children.

A nurse is caring for a client whose blood pressure is 148/89 mm Hg. This will affect the client's cardiac oxygen consumption by: a. increasing heart rate. b. increasing preload. c. increasing afterload. d. inhibiting conduction.

c. increasing afterload. Rationale: Afterload is the resistance against which the heart has to beat. When pressure inside the arteries is elevated, afterload must increase to overcome the higher pressure to pump blood into the aorta. Heart rate, preload, and muscle stretch are unlikely to be increased initially, but long-term untreated hypertension will begin to affect other factors, increasing oxygen consumption.

Diltiazem (Cardizem)

calcium channel blocker Side Effects: -Hypotension -Orthostatic Hypotension -Peripheral Edema -Bradycardia -Cardiac Dysrhythmias Nursing Consideration: -Assess BP before administering. Hold for SBP<100 or as per parameters and notify health care provider. -Assess HR before administering. Hold for HR<60 or as per parameters and notify health care provider. -Monitor cardiac rhythm (if applicable) -Educate: Do not take with Grapefruit Juice/Grapefruit

Amlodipine (Norvasc)

calcium channel blocker Side Effects: -Hypotension -Orthostatic Hypotension -Peripheral Edema -Reflux Tachycardia Nursing Consideration: -Assess BP before administering. Hold for SBP<100 or as per parameters and notify health care provider. - Do not take with grapefruit/grapefruit juice

A client asks the nurse why a diuretic has been prescribed for the treatment of his high blood pressure. What is the nurse's best response? a. "Diuretics indirectly slow the heart, which then decreases blood pressure by increasing urination." b. "Diuretics remove urine from the circulatory system, cause a drop in blood pressure." c. "Diuretics relax the blood vessel wall, which then moves fluid and reduces blood pressure." d. "Diuretics decrease water and sodium in the blood vessels, reducing blood pressure."

d. "Diuretics decrease water and sodium in the blood vessels, reducing blood pressure." Rationale: Diuretics are used to decrease volume and sodium, which then decreases pressure in the system. Diuretics do not have an effect on the blood vessel wall; they decrease water and sodium in the blood vessel, which decreases pressure. Cardiotonics strengthen the heart muscle, which slows the rate, not diuretics. Diuretics cause the removal of fluid from circulation; however, urine is never in circulation because it is created by the kidneys.

A patient taking hydrochlorothiazide tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? a. "Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure. b. "Hydrochlorothiazide (HydroDIURIL) dilates your blood vessels so you urinate more and your blood pressure decreases." c. "Hydrochlorothiazide (HydroDIURIL) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases." d. "Hydrochlorothiazide (HydroDIURIL) works in your kidneys causing you to urinate more and that decreases your blood pressure."

d. "Hydrochlorothiazide (HydroDIURIL) works in your kidneys causing you to urinate more and that decreases your blood pressure."

A client has been diagnosed with hypertension and will begin taking valsartan. What safety education should the nurse provide? a. "You'll need to have blood drawn to ensure that the drug is at a safe level in 7 days." b. "Avoid foods that are high in potassium and avoid salt substitutes, which often have potassium in them." c. "You'll need to avoid drinking grapefruit juice while you're taking this medication." d. "Try to avoid standing up too quickly until you know how the drug affects you."

d. "Try to avoid standing up too quickly until you know how the drug affects you." Rationale:Valsartan, like most antihypertensives, can cause syncope and dizziness resulted from lower blood pressure. The client should be cautious when beginning the medication in order to avoid falls. Grapefruit juice and sources of potassium are not contraindicated. Follow-up blood work is not necessary.

A patient has a blood pressure reading of 126/84 mm/Hg. She asks the nurse if she has high blood pressure. What is the best response by the nurse? a. "You have prehypertension; unfortunately, this will progress to hypertension." b. "You have prehypertension, and must begin medication." c. "You have prehypertension, but it isn't really serious. d. "You have prehypertension; let's discuss your lifestyle."

d. "You have prehypertension; let's discuss your lifestyle."

The provider orders a phosphodiesterase inhibitor for the pediatric client. What is the nurse's priority action? a. Begin continuous monitoring of oxygen saturation. b. Move the child into a private room equipped with cardiac monitoring. c. Weigh the child to get the most current weight. d. Consult with the provider about the use of this drug with a child.

d. Consult with the provider about the use of this drug with a child. Rationale: The phosphodiesterase inhibitors are not recommended for use in children, so the nurse should call the provider to question use of this drug. Questioning the order is the priority action and precedes any other actions. Weighing the child would be a good plan if the drug could be administered. There is no indication of a need for cardiac monitoring or a private room. Oxygen saturation monitoring would depend on the client's condition related to altered oxygenation.

e nurse is caring for an African American client with heart failure. What drug, if administered, would the nurse expect to be more effective in this client than in those who are not African American? a. Milrinone b. Ivabradine c. Digoxin d. Isosorbide dinitrate and hydralazine (BiDil)

d. Isosorbide dinitrate and hydralazine (BiDil) Rationale:The drug, BiDil, is a fixed-combination drug containing isosorbide dinitrate and hydralazine. This combination of vasodilators was studied in 1999 in the Vasodilator-Heart Failure Study and was found to be only moderately effective in general but was very effective in the subset of African American clients. Further studies were done, and the African American Heart Failure Study (A-HeFT) found that this combination of drugs had a significant impact in decreasing deaths and hospitalizations related to HF in African American clients.

In teaching a patient with hypertension about controlling the illness, the nurse recognizes that: a. All patients with elevated BP need drug therapy b. Obese persons must achieve a normal weight to lower BP. c. It is not necessary to limit salt in the diet if the patient is taking a diuretic. d. Lifestyle modifications are needed for all persons with elevated BP.

d. Lifestyle modifications are needed for all persons with elevated BP.

A client is receiving a vasodilator that is only available in oral form. The nurse knows this is what drug? a. Hydralazine b. Nitroprusside c. Valsartan d. Minoxidil

d. Minoxidil Rationale: Minoxidil is only administered orally. Nitroprusside is administered IV. Hydralazine is administered orally, intramuscularly, or intravenously. Valsartan is an angiotensin II receptor blocker.

A patient's blood pressure has not responded to the prescribed drugs for hypertension. Which of the following should the nurse assess first? a. Potential for drug interactions b. Progressive target organ damage c. Possible use of recreational drugs d. Patient's adherence to drug therapy

d. Patient's adherence to drug therapy

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. What nursing diagnosis would be most appropriate? a. Ineffective airway clearance b. Fluid volume deficit c. Impaired peripheral tissue perfusion d. Risk for injury

d. Risk for injury Rationale: Risk for injury is appropriate because the changes in blood pressure with position changes increase the client's risk for falls. Ineffective airway clearance would be appropriate if the client has copious respiratory secretions or the unrelenting cough of ACE inhibitors. Impaired peripheral tissue perfusion would be appropriate if the client was experiencing changes in the color or circulation to his or her extremities. Fluid volume deficit would be appropriate if the client was dehydrated.

The nurse obtains the most accurate blood pressure measurement by doing what? a. Asking the client to hold the arm out straight at heart level b. Measuring blood pressure as soon as the client enters the exam room c. Having the client make a fist with the hand on the arm where BP will be measured d. Selecting the proper size cuff

d. Selecting the proper size cuff Rationale:Select a cuff that is the correct size for the client's arm (a cuff that is too small may give a high reading; a cuff that is too large may give a lower reading). Do not take the BP as soon as the client enters the room but take the time to try to put the client at ease. Ensure that the arm that will be used for the cuff is supported rather than having the client hold the arm out straight. Encourage the client to relax the muscles in the arm rather than making a fist to get a more accurate reading.

The nurse collects an admission history from a client who is taking digoxin but is admitted with exacerbated heart failure. What assessment finding might contribute to reduced digoxin effectiveness? a. Use of quinidine b. Frequently eating licorice c. Use of erythromycin for an infection d. Use of St. John's wort

d. Use of St. John's wort Rationale:St. John's wort and psyllium have been shown to decrease the effectiveness of digoxin; this combination should be avoided. Increased digoxin toxicity has been reported with ginseng, hawthorn, and licorice. Clients should be advised to avoid these combinations. There is a risk of increased therapeutic effects and toxic effects of digoxin if it is taken with verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine.

A priority consideration in the management of the older adult with hypertension is to: a. prevent primary hypertension from converting to secondary hypertension b. recognize that older adults are less likely to adhere to the drug therapy regimen than a younger adult. c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. use precise technique in assessing BP of the patient because of the possible presence of an auscultatory gap.

d. use precise technique in assessing BP of the patient because of the possible presence of an auscultatory gap.

primary hypertension

denotes high blood pressure from an unidentified cause; also called essential hypertension

secondary hypertension

high blood pressure caused by the effects of another disease

hypertensive crisis

higher than 180 and/or higher than 110

blood pressure (BP)

measurement of pressure exerted by blood against walls of blood vessel

Diuretics

medications that reduce fluid volume in the body by promoting diuresis.

Afterload

resistance to left ventricular ejection must overcome to circulate blood

Creatine Clearance Test

test done to measure the total amount of creatinine excreted in the urine by the kidneys

Preload

volume of blood in ventricles at end of diastole