PrepU Questions to Prepare for Pharm Exam 2 -- Blood Pressure
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? An ACE inhibitor Another ARB A vasopressor 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.
A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of: Chest pain Increased hair growth Pupil constriction Absent reflexes
Absent reflexes Manifestations of cyanide toxicity include absent reflexes, dilated pupils, dyspnea, headache, vomiting, dizziness, ataxia, loss of consciousness, imperceptible pulse, pink color, distant heart sounds, and shallow breathing. Hair growth is an adverse effect of minoxidil. Chest pain is an adverse effect associated with vasodilator therapy related to changes in blood pressure.
A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor? Captopril Aliskiren Candesartan Mecamylamine
Aliskiren Aliskiren is a renin inhibitor. Mecamylamine is a ganglionic blocker. Candesartan is an angiotensin II receptor blocker; captopril is an ACE inhibitor.
Which client with recent diagnosis of hypertension is most likely to benefit from a combination of medications for initial treatment? An adult, African American client A young adult client with poor adherence to treatment A client is pre-operative A client who is trying to combine weight loss with blood pressure control
An adult, African American client For African-American patients, initial drug therapy guidelines include a combination of thiazide diuretics with an ACE inhibitor, ARB or CCB. None of the other listed clients has specific indications for this treatment approach.
A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions? Tachycardia Tachypnea Bradypnea Bradycardia
Bradycardia Explanation: When combined with ranitidine, calcium channel blockers can have an enhanced effect. Calcium channel blockers relax blood vessels, increase the supply of oxygen to the heart, and reduce the workflow, which may cause the heart to slow. Neither tachycardia, tachypnea, nor bradypnea are related to combining ranitidine with calcium channel blockers.
After teaching a group of nursing students on the mechanism of action of angiotensin-converting enzyme inhibitor (ACEI) drugs, the instructor determines the session is successful after the students correctly choose which action as the result of aldosterone? Inhibits renin secretion Causes sodium and water retention Promotes angiotensin I conversion Causes excess potassium retention
Causes sodium and water retention Aldosterone causes retention of sodium and water. This in turn causes a rise in blood pressure. ACEIs act by inhibiting the conversion of angiotensin I to angiotensin II. Aldosterone does not inhibit the release of renin and is not involved in the retention of potassium. Angiotensin-converting enzymes, and not aldosterone, are involved in the conversion of angiotensin I to angiotensin II.
An African American client has been diagnosed with hypertension and will begin treatment with a calcium channel blocker. What antihypertensive agent is the most likely addition to the drug regimen? Diuretic Beta-adrenergic blocker Vasodilator Digitalis
Diuretic Recommendations for treatment of hypertension in individuals of African American descent, including those with diabetes, includes initial therapy with a CCB and/or thiazide-type diuretic.
Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites? Guanabenz Nadolol Labetalol Prazosin
Prazosin Prazosin is an alpha-1 blocker that is used to treat hypertension. Labetalol and guanabenz are alpha- and beta-blockers used to treat hypertension. Nadolol is a beta-blocker used to treat hypertension.
Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites? Prazosin Nadolol Labetalol Guanabenz
Prazosin Prazosin is an alpha-1 blocker that is used to treat hypertension. Labetalol and guanabenz are alpha- and beta-blockers used to treat hypertension. Nadolol is a beta-blocker used to treat hypertension.
A client is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n): Beta adrenergic blocker Alpha- and beta-blocker Alpha-1 blocker Alpha-2 agonist
alpha- and beta-blocker Carvedilol is an alpha- and beta-blocker.
A male client who has been receiving verapamil for several months comes to the clinic reporting significant dizziness, light-headedness, and fatigue. He also reports frequent episodes of nausea and swelling of his ankles. Drug toxicity is suspected. Which question would be critical to ask the client? "Are you taking any over-the-counter pain relievers like ibuprofen?" "Have you been drinking any grapefruit juice lately?" "When did you take the last dose of the drug?" "Are your spli
"Have you been drinking any grapefruit juice lately?" Explanation: Verapamil, like other calcium channel blockers, interacts with grapefruit juice, increasing the concentration of calcium channel blockers and leading to toxicity. Calcium channel blockers do not interact with ibuprofen. Splitting or crushing the pills could lead to a release of the drug all at once, but this is more common when the drug is first taken. Asking about the time the client last took the drug might be important, but it would not address the problem associated with the significant adverse effects.
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." "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." "Blocks conversion of angiotensin I to angiotensin II." "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." Explanation: 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.
A nurse is caring for a client who has been prescribed captopril. Which instruction is important to include when teaching the client about the medication? "The dosage will need to be evaluated each week." "Take this medication on an empty stomach." "This medication will decrease your heart rate." "You can take this medication at different times each day."
"Take this medication on an empty stomach." Oral captopril should be taken on an empty stomach because food decreases drug absorption. Captopril is an angiotensin converting enzyme inhibitor (ACE-inhibitor) and will decrease the blood pressure by decreasing the conversion of angiotensin I to angiotensin II in the kidneys. It does not affect the heart rate. Blood pressure medications should be taken at the same time each day to avoid rebound hypertension. Captopril and blood pressure will be evaluated monthly to make sure a decrease in blood pressure is occurring.
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." "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." "We always treat high blood pressur
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." Explanation: 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
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? 100/70 mm Hg 130/80 mm Hg 140/90 mm Hg 150/100 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.
The nurse is teaching a client with hypertension about the prescribed transdermal clonidine. The nurse determines the session is successful when the client correctly articulates which instruction(s)? Select all that apply. A new patch is applied daily. If the patch loosens, a new patch should be applied. The use of the adhesive overlay is not necessary. A different body area should be selected for each application. The patch should be applied to a hairless area.
A different body area should be selected for each application. The patch should be applied to a hairless area. The patch is applied to a hairless area of intact skin on the upper arm or torso; the patch is kept in place for 7 days. The adhesive overlay is applied directly over the system to ensure the patch remains in place for the required time. A different body area is selected for each application. If the patch loosens before 7 days, the edges can be reinforced with nonallergenic tape. The date the patch was placed and the date the patch is to be removed can be written on the surface of the patch with a fiber-tipped pen.
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? ACE inhibitor therapy can continue during pregnancy. 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 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.
A nursing student is preparing a presentation discussing hypertension. Which factor(s) should the student explain can increase the risk of someone developing hypertension? Select all that apply. Family history Chronic alcohol consumption Caucasian race Advancing age Cigarette smoking
Advancing age Family history Cigarette smoking Chronic alcohol consumption Explanation: Risk factors for hypertension include advancing age (women older than 55 years and men older than 45 years), family history, cigarette smoking, obesity, excessive dietary intake of salt and too little intake of potassium, lack of physical activity, and chronic alcohol consumption. Black Americans have higher rates than Asian, Caucasian, or Hispanic individuals.
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? Angiotensin Enalapril Renin 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.
Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause? Azilsartan Aliskiren Valsartan Olmesartan
Aliskiren Aliskiren is a direct renin inhibitor and may cause hyperkalemia. The other medications are angiotensin II receptor antagonists and do not cause an increase in serum potassium levels.
Which nursing interventions should a nurse specifically perform for a client prescribed losartan? Select all that apply. Assess laboratory values. Keep the head of bed elevated. Review allergy history. Review family history for seizures. Discuss lifestyle changes. Obtain blood pressure.
Assess laboratory values. Obtain blood pressure. Review allergy history. Discuss lifestyle changes. To assess for the therapeutic and adverse effects, the nurse should monitor the client's blood pressure. In addition, the nurse should review the laboratory values, including kidney and liver function tests, and serum electrolyte levels, especially potassium. The nurse should also address lifestyle modifications such as weight loss, smoking cessation and restricted salt intake. Keeping the client's head elevated is not necessary with losartan. Reviewing the family history for seizures is not warranted as the medication is used to decrease blood pressure.
Which nursing interventions should a nurse specifically perform for a client prescribed losartan? Select all that apply. Review family history for seizures. Discuss lifestyle changes. Assess laboratory values. Obtain blood pressure. Review allergy history. Keep the head of bed elevated.
Assess laboratory values. Obtain blood pressure. Review allergy history. Discuss lifestyle changes. To assess for the therapeutic and adverse effects, the nurse should monitor the client's blood pressure. In addition, the nurse should review the laboratory values, including kidney and liver function tests, and serum electrolyte levels, especially potassium. The nurse should also address lifestyle modifications such as weight loss, smoking cessation and restricted salt intake. Keeping the client's head elevated is not necessary with losartan. Reviewing the family history for seizures is not warranted as the medication is used to decrease blood pressure.
An African American client is being treated for a new diagnosis of hypertension. What antihypertensive agent would the nurse expect to be prescribed? Calcium channel blocker Beta-adrenergic blocker ACE inhibitor Angiotensin II receptor blocker
Calcium channel blocker In client of African descent, thiazide diuretics and calcium channel blockers are effective and recommended as initial drug therapy. ACE inhibitors, some ARBs (e.g., losartan and telmisartan), and beta-adrenergic blockers are less effective as monotherapy in African Americans.
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? Disproportionate rise in diastolic blood pressure Changes in temperature or color of skin Increased urinary output Vomiting and nausea
Changes in temperature or color of skin While it is important to monitor a client for a change in urinary output or a disproportionate rise in diastolic blood pressure, clients with a history of occlusive vascular disease must be monitored closely for changes in temperature or color of skin or extremities. If such changes occur, the nurse must consult with the provider to determine whether the benefits of dopamine outweigh the risk for possible necrosis. Vomiting and nausea are common adverse effects of the drug.
The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Clonidine Amlodipine Candesartan Enalapril
Clonidine Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route.
A client is admitted to the emergency department with a severe headache, nausea, shortness of breath, and blood pressure of 200/120 mm Hg. Which response should the nurse prioritize? Take a blood pressure every 30 minutes. Measure the pulse rate every hour. Alternate the arms for assessing the blood pressure and pulse. Continuously monitor the client's status.
Continuously monitor the client's status. When the client has a severe hypertensive emergency (such as an extremely elevated blood pressure), does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The alarm should be set to alert the medical staff if the blood pressure continues to rise. The client is at risk of developing serious complications such as a stroke, kidney failure, or retinopathy if the blood pressure is not lowered quickly.
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 heart Damage to the pancreas Damage to the gall bladder Damage to the kidneys Damage to the eyes
Damage to the heart Damage to the kidneys Damage to the eyes Explanation: A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.
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: Increased cardiac output Decreased venous return Decreased heart rate Increased stroke volume
Decreased venous return Explanation: Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. The heart rate increases in an attempt to meet the demands of the body
A client with which diagnosis should be prescribed captopril as the first-line treatment for hypertension? Glaucoma Diabetes mellitus Angina pectoris Asthma
Diabetes mellitus Captopril is the first-line agent for treating hypertension in diabetic clients, particularly those with type 1 diabetes. Captopril can be used for hypertension in clients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus.
The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia? Labetalol Clonidine Enalapril Diltiazem
Diltiazem Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol's adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine's adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness.
After teaching a group of students about nitroprusside and cyanide toxicity, the instructor determines that the teaching was successful when the students identify what as an assessment finding? (Select all that apply.) Dyspnea Bounding pulse Dilated pupils Hyperactive reflexes Distant heart sounds Shallow breathing
Dyspnea Dilated pupils Distant heart sounds Shallow breathing Explanation: 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.
Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Increased intracranial pressure Stevens-Johnson syndrome Exacerbation of chronic cardiovascular conditions Cerebral ischemia
Exacerbation of chronic cardiovascular conditions Explanation: Clinicians use adrenergic agents to treat asthma, hypotension, shock, cardiac arrest, and anaphylaxis in older adults. These drugs stimulate the heart to increase rate and force of contraction and blood pressure. Because older adults often have chronic cardiovascular conditions (e.g., angina, arrhythmias, heart failure, coronary artery disease, hypertension, peripheral vascular disease) that are aggravated by adrenergic drugs, careful monitoring by the nurse is required. The actions of norepinephrine do not pose an increased risk for any of the other mentioned conditions.
A male client's friend tells him to stop taking his metoprolol because he read that it causes cancer. The nurse encourages the client to consult his prescriber because abrupt withdrawal from the drug may cause what effect? Bradycardia Atrial arrhythmias Postural hypotension and falls Exacerbation of his angina
Exacerbation of his angina The FDA has issued a black box warning for clients with CAD who are withdrawing from oral forms of atenolol, metoprolol, nadolol, propranolol, and timolol; abrupt withdrawal has resulted in exacerbation of angina, increased incidence of ventricular arrhythmias, and the occurrence of MIs.
A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent: Cardiac arrhythmias ACE inhibitor toxicity Renal failure Excessive hypotension
Excessive hypotension Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent: Cardiac arrhythmias Renal failure Excessive hypotension ACE inhibitor toxicity
Excessive hypotension Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action? Checking the client's blood glucose levels before each meal and at bedtime Frequent assessment of the client's car
Frequent assessment of the client's cardiac status Explanation: Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina. As a result, there is a need for astute cardiac assessment. The use of hydralazine does not directly necessitate close monitoring of electrolytes or blood sugars, even though these are prudent assessment measures. There is a risk of dizziness and possibly falls with the use of any antihypertensive, but it is unnecessary to supervise all of the client's ADLs.
The nurse is providing education regarding lifestyle changes to a client diagnosed with hypertension. When providing dietary instruction on a low-sodium diet, which dietary choice would the nurse identify as most appropriate? Grilled hamburger, French fries, and a cola drink Ham sandwich, potato chips, and cookie Grilled chicken, green salad, and apple Hot dog, baked beans, and coleslaw
Grilled chicken, green salad, and apple Therapeutic regimes include sodium restriction. The grilled chicken, green salad, and apple represent low-sodium dietary choices. Hot dog, baked beans, and coleslaw are high in sodium. Grilled hamburger, French fries, and cola are high in sodium. Ham sandwich, potato chips, and cookie are high in sodium.
A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question? "He's in shock because his heart can't pump effectively. This drug will help by increasing his heart rate significantly." "He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pum
He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." Explanation: Cardiogenic shock is caused by the myocardium's inability to contract efficiently and maintain an adequate cardiac output. Dobutamine is prescribed for treatment because it acts mainly on beta1 receptors in the heart to increase the force of myocardial contraction. It is less vasoactive than some other drugs and it causes a minimal increase in heart rate.
A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe? Digoxin Hydrochlorothiazide Hydralazine hydrochloride Atorvastatin calcium
Hydrochlorothiazide If losartan alone does not control blood pressure, a low dose of diuretic may be added. Hydrochlorothiazide is a diuretic agent. Atorvastatin calcium is not a diuretic agent but rather a statin medication. Hydralazine is not a diuretic agent but rather a vasodilator. Digoxin is not a diuretic agent but rather a digitalis glycoside.
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? Spironolactone Amiloride Triamterene Hydrochlorothiazide
Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body. Subsequently, the client is at risk for hypokalemia. Amiloride, spironolactone, and triamterene are potassium-sparing diuretics. The client using these diuretics would need to be monitored for hyperkalemia because potassium is not lost along with sodium.
The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching? Hypernatremia Hyperkalemia Hypokalemia Hypermagnesemia
Hyperkalemia By blocking production of angiotensin II, the ACE inhibitors decrease aldosterone production (thus reducing retention of sodium and water and increasing the retention of potassium). Hyperkalemia may develop in clients who have diabetes mellitus or renal impairment.
Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases risk of stroke. Hypertension increases risk of liver disease Hypertension increases the workload of the heart. Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of colorectal carcinoma.
Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart. Plaque, stroke, and increased workload are consequences of hypertension. Increased risk of kidney disease, heart failure, and blindness are also consequences of hypertension.
The nurse is administering a beta blocker to a client with hypertension. Which would the nurse expect this drug to do? Select all that apply. Increase renal blood flow Decrease heart rate Decrease cardiac muscle contraction Increase renin release Block vasodilation
Increase renal blood flow Decrease heart rate Decrease cardiac muscle contraction Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause the heart to beat more slowly and with less force, which lowers blood pressure. Beta blockers also help widen veins and arteries to improve blood flow. 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 client is receiving lisinopril for the treatment of hypertension. The client began taking ibuprofen over the counter for arthritis pain. Which adverse effect is likely to occur with this combination of medications? Decreased heart rate Increased cough Increased blood pressure Increased heart rate Decreased blood pressure
Increased blood pressure Explanation: The administration of NSAIDs, like ibuprofen, to a client receiving an ACEI, like lisinopril, can result in decreased hypotensive effects of ACEIs, resulting in increased blood pressure. Lisinopril does not affect heart rate. A cough can develop with the use of lisinopril but does not have anything to do with the concomitant use with Motrin.
A client is receiving IV norepinephrine for treatment of shock. What is the goal of administration? Increased cardiac contractibility Increased cardiac output Increased heart rate Increased blood pressure
Increased blood pressure Norepinephrine is a pharmaceutical preparation of the naturally occurring catecholamine norepinephrine. It has predominant alpha-receptor agonist effects and results in potent peripheral arterial vasoconstriction. As a result, it increases blood pressure more than it increases heart rate, force of contraction, or cardiac output.
A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe? Increased heart rate Orthostatic hypotension Decreased cardiac output Decreased heart rate
Increased heart rate Administration of isoproterenol increases heart rate and cardiac output. Although peripheral vascular resistance is always decreased, blood pressure may be increased or decreased.
A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe? Orthostatic hypotension Increased heart rate Decreased heart rate Decreased cardiac output
Increased heart rate Administration of isoproterenol increases heart rate and cardiac output. Although peripheral vascular resistance is always decreased, blood pressure may be increased or decreased.
A patient with hypertension has a fungal infection and has been prescribed fluconazole for the fungal infection and losartan for hypertension. Which risk is associated with such concomitant drug usage? Increased risk of hypersensitivity reaction Increased risk of adverse effects of losartan Increased risk of hypoglycemia Decreased hypotensive effect of losartan
Increased risk of adverse effects of losartan Increased risk of adverse effects of losartan is associated with the concomitant use of fluconazole and losartan. Decreased hypotensive effect of losartan is seen with use of indomethacin and does not occur with the concomitant use of these drugs. Increased risk of hypoglycemia and increased risk of hypersensitivity do not occur with the concomitant use of these drugs
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 directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single sub
It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. Explanation: 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.
A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Lisinopril Verapamil Furosemide Diltiazem
Lisinopril Explanation: Angiotensin-converting enzyme inhibitors (ACEIs) act primarily for suppress the renin-angiotensin-aldosterone system, and lisinopril is an ACEI. Verapamil and diltiazem are calcium channel blockers and furosemide is a diuretic.
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. Losartan Olmesartan Quinapril Ramipril Atenolol
Losartan Olmesartan Explanation: 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.
The rescue squad brought a 48-year-old client 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. The client is disoriented and vomits. What is the nurse's primary goal in this hypertensive emergency? Lower blood pressure as quickly as possible Assess for a cause of hypertension before proceeding Lower blood pressure gradually Obtain complete medical history
Lower blood pressure as quickly as possible Explanation: Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. The cause can be explored after the crisis has been resolved. A medical history, if necessary, can also be postponed.
Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect? Angela, who is in her first trimester of pregnancy Mark, who is suffering from impaired renal function Hilda, who is showing symptoms of chronic cough Karl, who is showing symptoms of angioedema confined to the face and lip
Mark, who is suffering from impaired renal function Because the patient suffers from impaired renal function, the nurse must closely monitor Mark for neutropenia, the most common side effect in such patients. Also at risk are patients with heart failure and collagen vascular diseases. Neutropenia generally resolves quickly after captopril is discontinued. Captopril should be administered cautiously to patients who are showing symptoms of chronic cough or angiedema. If the patient becomes pregnant while taking captopril, therapy should be discontinued as soon as possible. However, such patients do not face as much of a risk of neutropenia as patients with impaired renal function.
Why do clients with impaired renal function require cautious use of epinephrine? Epinephrine can cause lysis of Bowman's capsules, further reducing renal function. Epinephrine is fully resorbed in the proximate tubules and can accumulate to toxic levels. Epinephrine increases the pH of urine and constitutes a risk for urosepsis. Metabolites may accumulate and increase the risk of adverse effects.
Metabolites may accumulate and increase the risk of adverse effects. The renal system eliminates many adrenergic drugs and their metabolites. In the presence of renal disease, these compounds may accumulate and cause increased adverse effects. None of the other options accurately describe the need for caution when administering epinephrine to a client diagnosed with renal impairment.
Why do clients with impaired renal function require cautious use of epinephrine? Epinephrine increases the pH of urine and constitutes a risk for urosepsis. Epinephrine can cause lysis of Bowman's capsules, further reducing renal function. Metabolites may accumulate and increase the risk of adverse effects. Epinephrine is fully resorbed in the proximate tubules and can accumulate to toxic levels.
Metabolites may accumulate and increase the risk of adverse effects. The renal system eliminates many adrenergic drugs and their metabolites. In the presence of renal disease, these compounds may accumulate and cause increased adverse effects. None of the other options accurately describe the need for caution when administering epinephrine to a client diagnosed with renal impairment.
A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate? Dopamine Midodrine Clonidine Methyldopa
Midodrine Explanation: Midodrine is an alpha-specific adrenergic agent that is used to treat orthostatic hypotension. Dopamine is a sympathomimetic agent that is used to treat shock. Methyldopa and clonidine are alpha-2 blockers used to treat hypertension.
A patient is receiving a vasodilator that is available only in oral form. Which agent would the nurse most likely identify as being used? Hydralazine Nitroprusside Minoxidil Diazoxide
Minoxidil Minoxidil is administered only orally. Diazoxide is administered IV. Nitroprusside is administered IV. Hydralazine is administered orally, intramuscularly, or intravenously.
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? Reporting adverse effects of treatment Documenting the administration of medications Monitoring for complications and side effects of treatment Safely administering prescribed fluids
Monitoring for complications and side effects of treatment Explanation: General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. The other options are correct but not more important functions of nursing care than monitoring for complications and side effects of treatment.
Hubert, who is on hydralazine therapy, exhibits the symptoms of fever and arthralgia. Which action would help determine if a serious adverse effect has occurred? Monitoring the decrease in the plasma renin level Monitoring the CBCs and the antinuclear antibody titer Monitoring the drug serum levels Monitoring the elevations in blood pressure
Monitoring the CBCs and the antinuclear antibody titer It is important for the nurse to monitor the CBCs and the antinuclear antibody titer for indications of hydralazine-induced lupus. This monitoring is more important than monitoring for hypotension, drug serum levels, or plasma renin levels, especially if arthralgia, fever, splenomegaly, continued malaise, or other unexplained symptoms develop. SLE develops more frequently in females, whites, and patients who have been on this drug for 6 months or longer.
The nurse recognizes that which medication may be used to treat a hypertensive crisis? Nitroprusside Hydralazine Amlodipine Minoxidil
Nitroprusside Explanation: Nitroprusside is administered during a hypertensive crisis intravenously. Hydralazine and minoxidil are used for severe hypertension, and amlodipine is also administered for hypertension.
The nurse is preparing to administer nadolol. Which assessment(s) should the nurse investigate before administering the medication? Select all that apply. Pulse rate on both arms Blood pressure on one arm Blood pressure on both arms Blood pressure in the sitting position Pulse rate on one arm
Pulse rate on both arms Pulse rate on one arm Blood pressure in the sitting position Blood pressure on both arms Explanation: Preadministration assessment for any antihypertensives should include blood pressure and pulse rate on both arms, not just one, with the client in lying, sitting, and standing positions.
The nurse is reviewing lab results where the client has elevated BUN and creatinine levels. The nurse would question the administration of which antihypertensive? Nifedipine Diltiazem Amlodipine Quinapril
Quinapril Quinapril is an ACE inhibitor and is contraindicated in clients with renal failure. Nifedipine, diltiazem, and amlodipine are calcium channel blockers and are not contraindicated in renal failure
The nursing instructor is teaching a group of students about the various medications used to treat hypertension. After the session, the instructor determines the session is successful when the students correctly connect which action(s) with calcium channel blockers? Select all that apply. Increased oxygen supply to the heart Increased workload on the kidneys Reduced workload on the heart Decreased blood pressure Relaxation of blood vessels
Relaxation of blood vessels Increased oxygen supply to the heart Reduced workload on the heart Decreased blood pressure The use of calcium channel blockers results in relaxation of blood vessels, increased oxygen supply to the heart, reduced workload on the heart, and decreased blood pressure. The overall goal of treating hypertension is to help decrease the workload on the heart and kidneys. One of the dangers of a hypertensive crisis is kidney damage due to the increased workload.
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 magnesium levels Serum calcium levels Blood glucose levels Serum potassium levels
Serum potassium levels Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy.
A client, aged 60 years, is receiving nitroprusside for hypertensive emergency. The nurse would be alert for the development of which reaction? Blindness Rebound hypertension Stroke Significant hypotension
Significant hypotension Explanation: An older adult client is at risk for significant hypotension when receiving nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Rebound hypertension can occur when an individual suddenly stops taking an antihypertensive medication. This puts extreme stress on target organs such as the heart, kidney, and eyes, which could result in a stroke or blindness in the client if not treated quickly.
An elderly client with hypertension is prescribed labetalol. Which instruction(s) should the nurse prioritize giving the client? Select all that apply. Sit on the bed for 1 or 2 minutes when rising from a lying position. Take the antihypertensive less frequently if hypotension occurs. Rise quickly from a chair when moving to a standing position. Increase salt intake to counteract the hypotension. Have someone assist the client if dizziness or weakness occurs.
Sit on the bed for 1 or 2 minutes when rising from a lying position. Have someone assist the client if dizziness or weakness occurs. Explanation: Some antihypertensive medications can cause orthostatic hypotension which can lead to increased risk of falls. The nurse explains that when rising from a lying position, the client should sit on the edge of the bed for 1-2 minutes; the client should rise slowly from a chair and then stand for 1 to 2 minutes; and when symptoms of orthostatic hypotension occur, someone assisting the client in getting out of bed or a chair can decrease the risk of falls due to orthostatic hypotension. The client should not decrease or change the dose without consulting with the health care provider first, as this may cause rebound hypertension. Increased sodium intake will not counteract hypotension but could increase the blood pressure leading to more adverse reactions.
A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse? Ask the prescriber to reduce the dose Obtain an order for naloxone Slow the rate of the infusion Give the nitroprusside at the ordered rate
Slow the rate of the infusion Explanation: Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.
When describing the action of calcium channel blockers, which would be an expected effect? Arterial contraction Increased venous return Slowed impulse formation Increased contractility
Slowed impulse formation Calcium channel blockers slow cardiac impulse formation in the conductive tissues, depress myocardial contractility, and relax and dilate arteries, leading to a fall in blood pressure and a decrease in venous return.
On several occasions, the nurse checks a client's blood pressure. The readings are 130/79 mm Hg, 136/78 mm Hg, and 128/88 mm Hg. What term would the nurse use to document the client's blood pressure? Normal Elevated Stage 2 hypertension Stage 1 hypertension
Stage 1 hypertension This client is exhibiting stage 1 hypertension, which is defined as a systolic pressure of 130-139 mm Hg or a diastolic pressure of 80-89 mm Hg. Stage 2 hypertension is defined as a systolic pressure of at least 140 mm Hg or a diastolic pressure of at least 90 mm Hg. Elevated blood pressure is a systolic pressure of 120-129 mm Hg and a diastolic pressure less than 80 mm Hg. Normal blood pressure is systolic pressure below 120 mm Hg and diastolic pressure below 80 mm Hg.
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 treated for hepatitis A. The client's creatinine clearance is steadily declining. The client is diagnosed with gastroesophageal reflux disease. The client takes a selective serotonin reuptake inhibitor (SSRI) for depression.
The client's creatinine clearance is steadily declining. Explanation: 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.
Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure? Thiazide diuretics Potassium-sparing diuretics Loop diuretics Osmotic diuretics
Thiazide diuretics ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. ACE inhibitors are not routinely combined with loop or osmotic diuretics. Potassium-sparing diuretics may be used in combination, but less commonly.
A client has been diagnosed with primary hypertension. Which medication(s) are used to treat primary hypertension? Select all that apply. Beta adrenergic antagonists Angiotensin converting enzyme inhibitors Loop diuretics Angiotensin receptor blockers (ARBs) Thiazide diuretics
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.
The nurse is preparing to administer norepinephrine IV to a client. What intervention can the nurse take to minimize the risk for extravasation? In older adults, administer medication into a large vein in a lower extremity. Warm the medication before administration. Administer phentolamine just prior to the induction of the medication. Use a central line to administer the medication.
Use a central line to administer the medication. The Federal Drug Administration (FDA) has issued a black box warning regarding the potential risk of tissue damage with extravasation of norepinephrine. The drug should be infused into a large vein or central line if possible. The use of leg veins should be avoided in older adults and in those with occlusive disorders. If extravasation occurs, diluted phentolamine should be injected into the area with a small-gauge hypodermic needle as soon as possible to prevent sloughing and necrosis of the tissue. Warming the medication would not affect the risk for extravasation.
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? Nicardipine Diltiazem Valsartan Verapamil
Valsartan Explanation: Valsartan is an angiotensin II receptor blocker.
Nonpharmacologic management should be tried alone or with drug therapy. What methods of nonpharmacologic management are used in the treatment of hypertension? (Select all that apply.) Diet including no concentrated sweets Limited alcohol intake Weight reduction Hot tub soaks Moderate sodium restriction
Weight reduction Limited alcohol intake Moderate sodium restriction Nonpharmacologic management of hypertension should be tried alone or with drug therapy. For example, weight reduction, limited alcohol intake, moderate sodium restriction, and smoking cessation may be the initial treatment of choice if the client is hypertensive and overweight. The hot water in a hot tub may actually increase blood pressure.
The nurse is caring for a 39-year-old client of African descent who is 25 lb (11.36 kg) overweight and who has received a new diagnosis of hypertension. What initial drug therapy should the nurse anticipate? angiotensin-converting enzyme (ACE) inhibitor calcium channel blocker beta-blocker diuretic
diuretic Clients of African descent are at highest risk for developing hypertension, with men being more likely than women to develop the disease. Clients of African descent have documented differences in response to antihypertensive therapy. They are most responsive to single-drug therapy and diuretics. The first -line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. Clients of African descent are less responsive to ACE inhibitors and beta-blockers.
