ch 26 prepU
The nurse would encourage clients with prehypertension to follow what type of diet?
DASH diet
Key behavioral determinants of blood pressure are related to what factor?
Dietary consumption of calories and salt
What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?
Diltiazem, The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine , and nicardipine . Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem, and verapamil
The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia?
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.
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 patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact?
For one week, A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.
You are caring for a 53-year-old client being treated for hypertension. The nurse is teaching the client about nonpharmacologic methods of managing hypertension. While discussing dietary management, which might be an example of an appropriate meal?
Grilled chicken, green salad, and iced tea
A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension?
Stage 2, A client is diagnosed with stage 2 hypertension when their systolic blood pressure is greater than or equal to 160 mm Hg or their diastolic blood pressure is greater than or equal to 100 mm Hg. Stage I hypertension is defined as a systolic pressure between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg. Prehypertension is defined as a systolic pressure between 120 and 130 mm Hg or a diastolic pressure between 80 and 89 mm Hg. Normotension is defined as a systolic pressure of less than or equal to 120 mm Hg or a diastolic pressure of less than or equal to 80 mm Hg.
The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?
Hyperkalemia. When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk.
The classification of blood pressures published in 2003 offers new "stages" of blood pressures, ranging from normal to stage 2 hypertension. The client, an 80-year-old retired teacher, consistently has blood pressure readings of 146/86 mm Hg. In the 2003 guidelines, what would the client's blood pressure be designated?
Isolated systolic hypertension A systolic pressure of 140 or above, with a diastolic pressure below 90, is called isolated systolic hypertension and is more common in the elderly.
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."
The health care provider prescribes captopril (Capoten) for a client, and the nurse provides the client with the appropriate client education. What statement by the client tells the nurse that teaching has been effective?
"I will make sure that I rise slowly from a supine position."
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."
A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make?
"People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller."
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?
130/80 mm Hg. The blood pressure goal for a client with diabetes or kidney disease is 130/80 mm Hg.
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. 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 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
After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply?
Myocardium hypertrophy
Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age?
Nick, age 35, who is suffering from hepatic impairment. Clients who have impaired liver function have increased bioavailability of losartan because metabolism is impaired. They should be given a lower starting dose of the drug and be monitored for therapeutic and adverse effects.
A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure?
Peripheral vascular resistance
A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?
Potassium. Aliskiren is associated with hyperkalemia. Therefore, the nurse would need to closely monitor potassium levels.
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. Prehypertension is defined as a systolic pressure between 120 and 130 mm Hg or a diastolic pressure between 80 and 89 mm Hg. Stage 1 hypertension is defined as a systolic pressure between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg. Stage 2 hypertension is defined as a systolic pressure of greater than or equal to 160 mm Hg or a diastolic pressure greater than or equal to 100 mm Hg. Normotension is defined as a systolic pressure of less than or equal to 120 mm Hg or a diastolic pressure of less than or equal to 80 mm Hg.
You are leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following methods is appropriate for managing hypertension in children?
Prevention of obesity, avoiding excessive sodium intake, and exercise are important nonpharmacologic measures.
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 patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued?
Rebound 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?
Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation
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 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.The nurse will advise the client that the captopril may produce a persistent, dry cough that is not serious. Clients may want to discontinue therapy because of the cough, but the nurse should encourage the client to continue therapy and help the client minimize the cough. However, if the cough becomes intolerable, the client should contact the prescriber. The client should be instructed to take the first dose at bedtime to minimize the possibilities of injury from first-dose hypotension. The client should be advised to notify the prescriber promptly if sore throat; fever; swollen hands or feet; irregular heartbeat; chest pain; swollen face, eyes, lips and tongue; difficulty breathing; or hoarseness occur. These effects could indicate angioedema, which can be life threatening.
How does captopril contribute to a reduction of a client's blood pressure?
blocking the conversion of angiotensin I to angiotensin II
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. ACE inhibitors like ramipril carry a risk of hyperkalemia, and an elevated potassium level may warrant withholding the drug.
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. Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults.
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
A clinic nurse is assessing a new client prior to the client seeing the health care provider. The client has a history of hypertension and takes benazepril (Lotensin) to control the disease process. A priority nursing assessment in this client would be to assess the client for a history of:
renal disease. Benazepril is an ACE inhibitor and these drugs are contraindicated in the presence of impaired renal function.
