Antihypertensive Study Module

Thrombolytic therapy was administered to a client following an acute inferior myocardial infarction. The nurse giving discharge instructions to the client evaluates a need for further teaching when the client makes which statement?

" I will apply pressure for 10 minutes for minor bleeding"

A hospitalized client with angina continues to have chest pain after the initial administration of a sublingual nitroglycerin tablet. The nurse would take which action?

Give another nitro in 5 min

Mr. Carey's echocardiogram shows LVH. What does this mean?

He is at great risk for sudden cardiac death

Mr. Schwin calls to say that his propranolol XL got wet. He wants to know if he can skip his next two doses and start taking the medication again when he gets home. What should you reply?

Refill the prescription immediately

The nurse prepares to administer digoxin to a 3-year-old with a diagnosis of heart failure and notes that the apical heart rate is 120 beats per minute. Which nursing action is appropriate?

administer the digoxin

The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril orally daily. The nurse evaluates the need for further teaching when the client makes which statement?

"I can skip a dose once a week"

Warfarin sodium has been prescribed for a client, and the nurse teaches the client and family about the medication. Which statement by the client indicates a need for further teaching?

"I will not take any over-the-counter medications except aspirin"

The nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium. Which statement made by the client reflects the need for further teaching?

"I will take enteric-coated aspirin for my headaches because it is coated"

ARB

-sartan

A client is taking ticlopidine hydrochloride. The nurse tells the client to avoid which substance while taking this medication?

Acetylsalicylic acid

Glaucoma

topical formulations reduce intraocular pressure

Carvedilol

-Beta 2 agonist -Produces vasodilation even with long-term use -Promotes bronchodilation

Selective B-Blocker and Carvedilol

-Decreases angiotensin II-mediated vasoconstriction -Decreases heart rate, contractility -Decreases aldosterone-mediated volume expansion

Selective B-blocker

-Peripheral vascular resistance may increase with long-term use -Can cause bronchoconstriction -Lose selectivity with high doses

Concerns with thiazide diuretics

-The more sodium consumed, the more potassium is lost in urine -Hypokalemia can cause insulin resistance -NSAIDs counteract efficacy -These drugs compete for renal elimination with uric acid, which can cause gout.

A client receiving total parenteral nutrition (TPN) has a history of heart failure. The primary health care provider has prescribed furosemide 40 mg orally daily to prevent fluid overload. The nurse is giving instructions about taking furosemide in relation to the client's health plan. Which statement by the client indicates a need for further teaching?

" I need to eat foods more in potassium"

The client has been prescribed nifedipine. The nurse is instructing the client about nifedipine. Which client statement indicates a need for further teaching?

"If I see empty tab shells in my stool, I need to report it to my doctor"

Concerns with potassium-sparing diurectis

-These drugs can cause gynecomastia in men -Patients must avoid salt substitutes -These drugs can cause hyperkalemia -These drugs can increase the growth of facial hair in women

Dihydropyridine calcium channel blocker

-dipine

Beta blocker

-lol

Nondihydropyridine CCBs

-not for heart failure or AV block -decreased heart rate -decreased cardiac contractility

ACE inhibitor

-pril

Dihydropyridine CCBs

-vasodilation of coronary arteries -vasodilation of arterioles in periphery

Diuretic

-zide

Later, Mr. Schwin is resting with a normal BP and heart rate and no signs of bronchoconstriction. The hospitalist reports that his heart rate is 55 bpm and asks what heart rate range is acceptable. After checking his record, how would you respond.

He had bradycardia while taking another beta blocker and was switched to propranolol. His typical resting heart is 50-60

The next day, Mrs. Schwin, a nurse, calls. Mr. Schwin is in the ED experiencing anaphylaxis after stepping on a nest of yellow jackets. the EMT-P gave him epinephrine, but he is suffering extreme bronchoconstriction. What explanation would you give?

His propranolol XL prevented the epinephrine from reaching his lung

After taking lisinopril for 2 months, Mrs. Melon complains that "food doesn't taste the same anymore." Which response explains why?

Loss of the sense of taste is a possible side effect of your ACE inhibitor. A zinc supplement may help

Nifedipine has been prescribed for a client with Raynaud's disease, and the nurse reinforces medication instructions with the client about the medication. Which statement by the client indicates a need for further teaching?

Nausea and drowsiness are expected, and if they occur, I don't really need to worry about it"

Warfarin sodium is prescribed for a client. The nurse expects that the primary health care provider will prescribe which laboratory tests to monitor for a therapeutic effect of the medication? Select all that apply.

PT, PTT, INR

Enoxaparin sodium is prescribed for the client following hip replacement surgery. The nurse prepares to have which available in the event that an overdose of the medication occurs?

Protamine sulfate

A physician tells the nurse that a potassium-retaining diuretic is being prescribed for the client with heart failure. The nurse reviews the health care physician's prescriptions expecting that which medication will be prescribed?

Spironolactone

The nurse is reinforcing instructions to a client with essential hypertension about medication therapy with irbesartan. Which client statement would indicate a need for further teaching?

The medication reduces my need for exercise

The nurse is caring for a client with chronic heart failure who is taking digoxin 0.125 mg daily. Before administering the medication, the nurse reviews the serum digoxin level that was drawn earlier in the day. The result is 1 ng/mL. Which action would the nurse take based on this laboratory result?

administer the dose of medication as scheduled

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium. The nurse is told that the client's prothrombin time is 18 seconds with a control of 11 seconds. Which action would the nurse plan?

administer the next dose of warfarin sodium

A client recently began medication therapy with propranolol. The nurse would be most concerned after noting the presence of which effect in this client?

audible expiratory wheezes

A potassium-retaining diuretic is prescribed for a client with heart failure. Which foods would the nurse instruct the client to avoid?

bananas

Performance anxiety

beta blockers dampen the fight-or-flight response of shaking limbs, tachycardia, and perspiration

A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is most important for the nurse to check before administering a second dose of the medication?

blood pressure

The nurse is caring for a client who is receiving hydralazine. The nurse evaluates the effectiveness of the medication by monitoring which client parameters?

blood pressure

The nurse is assisting in monitoring a client who received hydralazine hydrochloride to treat autonomic dysreflexia. Which finding accurately indicates that the medication is effective?

blood pressure declines

The nurse is assisting in preparing a diet plan for a client who is taking the anticoagulant, warfarin. The nurse instructs the client to limit which food from the diet?

broccoli

Agents that do not increase BP

calcium carbonate antacids, magnesium supplements, low-dose aspirin

Atenolol hydrochloride is prescribed for a hospitalized client. The nurse would perform which as a priority action before administering the medication?

check the client's BP

A client with heart failure who is taking furosemide and digoxin calls the nurse and complains of anorexia and nausea. The nurse would take which action?

check the result of the potassium level drawn 3 hours ago

A client is being treated with atenolol for hypertension. The client tells the nurse, "I am very tired and weak since I began taking the medication." Based on the client's statement, the nurse determines that the client is experiencing which problem?

common side effect

The nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride is prescribed for the child. The nurse determines that this medication has been prescribed to achieve which result?

control hypertension

A client arrives at the health care clinic for follow-up care and evaluation of the effectiveness of prazosin. Which finding indicates a therapeutic effect related to the use of this medication?

decrease in blood pressure

A client has taken his first dose of lisinopril about 2 hours ago and begins to develop fullness in his face and hoarseness. Which action would the nurse take first?

determine the client's ability to breathe effectively

ARBs are more likely than ACE inhibitors to produce hyperkalemia

false

Hypertension is usually a result of some other problem, such as sleep apnea or age-related renal disease.

false

People with "white coat hypertension" have normal BP outside the provider's office.

false

Spironolactone is contraindicated if an ARB is being used to treat hypertension

false

Beta Blockers other use

glaucoma

The nurse notes that a client is being treated with nesiritide. The nurse would expect this client to be experiencing which disorder?

heart failure

Hydralazine/isosorbide dinitrate other use

heart failure in african american patients

The nurse is preparing to administer digoxin, 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?

heart rate

Alpha 2 Agonist other use

heroin withdrawal

The nurse is planning to administer hydrochlorothiazide to a client. Which are concerns related to the administration of this medication?

hypokalemia, hyperglycemia, sulfa allergy

The nurse is caring for a client who has been prescribed furosemide and is monitoring for adverse effects associated with this medication. Which would the nurse recognize as potential adverse effects? Select all that apply.

increased urinary frequency, hypokalemia

Agents that can increase BP

licorice, alcohol, ibuprofen

Migraine headache

lipid-soluble beta blockers cross the blood-brain barrier and produce vasodilation

The nurse has a prescription to give a client a scheduled dose of digoxin. Before administering the medication, the nurse routinely screens for which signs/symptoms that could indicate early signs of digoxin toxicity?

loss of appetite, nausea, vomiting

A client with diabetes mellitus who has been controlled with daily insulin has been placed on atenolol for the control of angina pectoris. Because of the effects of atenolol, the nurse determines that which is the most reliable indicator of hypoglycemia?

low blood glucose level

MI

low-dose beta blockers reduce the risk of second MI

A client is being discharged with a prescription for propranolol. When reinforcing instructions to the client about the medication, the nurse would include which information?

medication should be withheld if the pulse rate drops below 60 bpm

The nurse is assisting in preparing a plan of care for a client who will be receiving a calcium antagonist to prevent preterm delivery. Which action does the nurse include in the plan of care for the client to detect a side effect of the medication?

monitor for increases in maternal and fetal heart rates

A client is diagnosed with an acute myocardial infarction and is receiving tissue plasminogen activator, alteplase. Which action is a priority nursing intervention?

monitor for signs of bleeding

A client is being treated for acute heart failure with intravenously administered bumetanide. The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats per minute; and respirations, 24 breaths per minute. After the initial dose, which is the priority assessment?

monitoring blood pressure

ACE inhibitors and ARBs other use

nephropathy in diabetes

Mr. Carey's ABI is 0.81. This means that he has:

reduced blood flow in the periphery and an increased risk of death from cancer

Angina pectoris

reduced cardiac output in turn reduces cardiac oxygen demand

The nurse reinforces dietary instructions to a client who will be taking warfarin sodium. The nurse tells the client to avoid which food item?

spinanch

A client who takes a diuretic every evening expresses frustration with the medication and wants to stop therapy. When the nurse explores the reasoning, the client says, "It keeps me up all night. I feel as though I should bring my pillow into the bathroom!" Which action can the nurse suggest to assist the client in successfully adapting to this therapy?

switching to a morning administration of the medication

Isosorbide mononitrate is prescribed for a client with angina pectoris. The client tells the nurse that the medication is causing a chronic headache. Which action would the nurse suggest to the client?

take the medication with food

A client with angina pectoris who was given a first dose of newly prescribed nitroglycerin sublingual tablets complains of slight dizziness and headache. The nurse takes which action first?

takes the clients blood pressure

The nurse is monitoring a client who is taking propranolol. Which data collection finding would indicate a potential serious complication associated with propranolol?

the development of audible expiratory wheezes

Hyperthyroidism

the risks of atrial fibrillation and arterial clot formation are reduced

The nurse is reviewing the primary health care provider's (PHCP) prescriptions for a client scheduled for a cardiac catheterization and notes that the PHCP has prescribed tirofiban. The nurse understands that this medication has been prescribed for which purpose?

to inhibit thrombus formation

A 55-year-old patient has a 90% chance of having hypertension before the end of his or her life.

true

A patient's feet should be on the floor when BP is measured

true

Individuals whose BP does not drop during sleep have an increased risk of cardiovascular events such as stroke or heart attack

true

One reason for switching patients from an ACE inhibitor to an ARB is to relieve chronic cough

true

The risk of angioedema is about 90% less in patients taking ARBs than in those taking ACE inhibitors

true

CCBs other use

variant angina

A client is receiving digoxin daily. The nurse suspects digoxin toxicity after noting which signs and symptoms? Select all that apply.

visual disturbances, nausea and vomiting, serum digoxin level of 2.3 ng/mL

A client with angina pectoris has just been started on medication therapy with nitroglycerin. In planning care for this client, the nurse would place priority on measuring which data?

vital signs

The nurse notes that a client in a long-term care facility is receiving a daily dose of furosemide. The nurse writes in the care plan to monitor which parameter on a daily basis?

weight

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as characteristic of which description?

within the therapeutic range