Pharmacology Prep U CH. 43

A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy?

Serum potassium levels

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

Cough

When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to:

Decreased venous return

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

Key behavioral determinants of blood pressure are related to what factor?

Dietary consumption of calories and salt

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?

Discontinue the drug

A client develops a severe elevation in blood pressure. The physician orders an ACE inhibitor to be given intravenously. Which agent would be most likely?

Enalaprilat

A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow up the client's statement?

Explain that drugs like ramipril often cause a cough.

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

Grilled chicken, green salad, and apple

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education?

Ham sandwich with mustard, carrots and cheesy dip

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

Stage 2

The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client's SBP is 88 mm. Which action would the nurse implement first?

Stop the infusion and administer diluted phentolamine.

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?

Hydrochlorothiazide

The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock?

Hypoperfusion of tissues

A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed?

Hypotensive crisis

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?

Implement interventions to lower blood pressure.

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 directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

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

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

Which statement made by a client prescribed hydrochloride indicates effective teaching about beta-blocker therapy?

"I'll make sure not to stop taking my propranolol suddenly."

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?

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

A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?

2

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 diuretic

African Americans are more likely to have severe hypertension and to require multiple drugs, for what reasons? (Select all that apply.) A. Low circulating renin B. Increased salt sensitivity C. A higher incidence of obesity D. Increased level of anxiety

A. Low circulating renin B. Increased salt sensitivity C. A higher incidence of obesity

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.) A. Monitoring for drug effects B. Promoting compliance with the prescribed pharmacologic modifications C. Promoting compliance with the prescribed lifestyle modifications D. Providing financial assistance with daily expenses

A. Monitoring for drug effects B. Promoting compliance with the prescribed pharmacologic modifications C. Promoting compliance with the prescribed lifestyle modifications

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

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

The nurse has admitted a client with type 1 diabetes mellitus who has been prescribed captopril for treatment of hypertension. The nurse knows this medication is used in clients with diabetes for what reason?

It reduces proteinuria.

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?

Left ventricle

A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long?

Lifelong

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?

Losartan

The squad brought a 48-year-old man to the ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the client reports severe headache and drowsiness. He becomes disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency?

Lower blood pressure as quickly as possible

The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?

Monitoring for complications and side effects of treatment

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

Angiotensin II receptor blockers

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

Potassium

On several occasions, the nurse checks a client's blood pressure. The readings are 130/82 mm Hg, 136/84 mm Hg, and 128/88 mm Hg. The nurse would expect this client to be classified as having which stage of hypertension?

Prehypertension

Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) A. Hypertension increases risk of liver disease B. Hypertension increases risk of stroke. C. Hypertension increases risk of colorectal carcinoma. D. Hypertension increases the workload of the heart. E. Hypertension increases the buildup of atherosclerotic plaque.

B. Hypertension increases risk of stroke. D. Hypertension increases the workload of the heart E. Hypertension increases the buildup of atherosclerotic plaque.

Key behavioral determinants of blood pressure are related to what factor? A. Providing financial assistance with daily expenses B. Monitoring for drug effects C. Modification of drug dosage D. Promoting compliance with the prescribed pharmacologic modifications E. Promoting compliance with the prescribed lifestyle modifications

B. Monitoring for drug effects D. Promoting compliance with the prescribed pharmacologic modifications E. Promoting compliance with the prescribed lifestyle modifications

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

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?

By inhibiting the transformation of angiotensin I to angiotensin II

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

Risk for injury

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?

Secondary hypertension

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. A. Smoking cessation B. Focus on finding a different job C. Regular aerobic exercise D. Decreased alcohol consumption E. Diet with more fruits and vegetables

C. Regular aerobic exercise E. Diet with more fruits and vegetables D. Decreased alcohol consumption A. Smoking cessation

A client has been prescribed metoprolol. The nurse should caution the client against abrupt cessation of treatment to avoid which undesired result? Select all that apply. A. myocardial infarction B. ventricular hyperplasia C. angina D. a type IV hypersensitivity reaction

C. angina A. myocardial infarction

A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume?

Changes in heart contraction

Mr. Seeman, 65 years old, is admitted to the hospital for cardiogenic shock. He is placed on dopamine to improve his blood pressure. He also has a history of peripheral vascular disease, hyperlipidemia, and diabetes mellitus type 2. What adverse effect(s) would require health care provider notification?

Changes in temperature or color of skin

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:

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

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

blocking the conversion of angiotensin I to angiotensin II

Which antihypertensive medication can be administered by transdermal patch?

clonidine

A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. The nurse first reviews the client's most recent blood work and should consider withholding the dose because of what laboratory finding?

elevated potassium levels

An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect?

falls

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:

falls

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

hydrochlorothiazide

What electrolyte imbalance might a diabetic client be prone to develop when prescribed captopril?

hyperkalemia

A teenage client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?

instant bronchodilation

A malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client?

lowered

A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:

monitor the client's blood pressure.

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

myocardial hypertrophy

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

persistent cough

An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified?

prehypertension

A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition?

pulmonary edema