Ch 43 questions

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? -Systolic blood pressure above 140 mm Hg -Diastolic blood pressure below 100 mm Hg -Diastolic blood pressure below 90 mm Hg -Systolic blood pressure below 160 mm Hg

Diastolic blood pressure below 90 mm Hg

A patient is admitted to the unit with problems controlling their serum glucose levels. The patient has hypertension as a co-morbidity, and the physician has ordered hydralazine for this patient. The nurse caring for this patient knows that hydralazine is a(n): -indirect vasodilator. -indirect vasoconstrictor. -direct vasodilator. -direct vasoconstrictor.

Direct vasodilator

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 -Increase the dosage of the drug -Decrease the dosage of the drug -Maintain the current dosage of the drug

Discontinue the drug The FDA has issued a black box warning for ACE inhibitors and ARBs during pregnancy, because their use can cause injury and even death to a developing fetus.

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? -Inform the client that the drug should be immediately discontinued. -Inform the client that this is an adverse effect of the medication that may lead to pneumonitis. -Explain why it will be necessary to obtain a sputum sample. -Explain that drugs like ramipril often cause a cough.

Explain that drugs like ramipril often cause a cough ACE inhibitors like ramipril may precipitate a cough and may necessitate discontinuation of the drug. This is not, however, an emergency or an indication of lung infection or lung inflammation.

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? -Close monitoring of the client's electrolyte levels -Supervision of the client when performing activities of daily living -Frequent assessment of the client's cardiac status -Checking the client's blood glucose levels before each meal and at bedtime

Frequent assessment of the client's cardiac status Hydralazine is associated with an increase in cardiac output that can precipitate palpitations, tachycardia, and angina.

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? -Assess the level of head pain. -Administer antiemetic medication. -Monitor the client's level of consciousness. -Implement interventions to lower blood pressure.

Implement interventions to lower blood pressure.

When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition? -Ineffective Tissue Perfusion -Activity Intolerance -Social Isolation -Excess Fluid Volume

Ineffective Tissue Perfusion ITP: decrease in oxygen, resulting in failure to nourish tissues at capillary level

A 37-year-old client presents with a blood pressure of 118/86 mm Hg. What advice should the nurse provide to this client? -"Ensure 7 to 8 hours of sleep each night." -"Be aware of your salt intake and limit hidden salt." -"Try to increase your intake of potassium-rich foods." -"Explore the possible use of a calcium channel blocker with your care provider."

"Be aware of your salt intake and limit hidden salt." This client is prehypertensive and may possibly reduce the likelihood of developing hypertension with a reduction in salt intake.

Pressure within the vascular system is determined by which? (Select all that apply) a. peripheral resistance b. stroke volumes c. sodium load d. heart rate e. total intravascular volume f. rate of erythropoietin release

A, B, D, E

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? -Moexipril -Losartan -Minoxidil -Amlodipine

Losartan Moexipril- ACE Minoxidil- vasodilator Amlodipine- calcium channel blocker

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? -increased -lowered -prescribed according to normal dosages -discontinued

Lowered

Hypertension is associated with a. loss of vision b. strokes c. atherosclerosis d. all of the above

All of the above

The stepped-care approach to the treatment of hypertension includes a. lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake b. use of a diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes c. a combination of antihypertensive drug classes to achieve desired control d. all of the above

All of the above

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? -Antihyperlipidemic drugs -Calcium channel blockers -Selective aldosterone blockers -Angiotensin II receptor blockers

Angiotensin II receptor blockers

A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely? -Potassium -Sodium -Magnesium -Chloride

Potassium Aliskiren is associated with hyperkalemia. Therefore, the nurse would need to closely monitor potassium levels. Diuretics can lead to hyponatremia, hypomagnesemia, and hypokalemia.

A patient who is hypertensive becomes pregnant. Which is the safest medication for the patient? a. Angiotensin II receptor blocker b. ACE inhibitor c. beta-blocker d. calcium-channel blocker

Beta-blocker

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 directly relaxing vascular smooth muscle -By blocking aldosterone from binding to mineralocorticoid receptors -By blocking the movement of calcium ions into arterial smooth muscles -By inhibiting the transformation of angiotensin I to angiotensin II

By inhibiting the transformation of angiotensin I to angiotensin II

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? -Essential hypertension -Secondary hypertension -Rebound hypertension -Hypertensive emergency

Secondary Hypertension

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 -Changes in heparin dose -Changes in walking pattern -Changes in respiratory rate

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? -Vomiting and nausea -Increased urinary output -Changes in temperature or color of skin -Disproportionate rise in diastolic blood pressure

Changes in temperature or color of skin 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.

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? -Increase infusion and re-assess SBP in 2 minutes. -Stop the infusion and administer diluted phentolamine. -Assess urine output, and report to prescriber if less than 30 mL/h. -Establish a new IV site with at least 20-gauge needle.

Stop the infusion and administer diluted phentolamine. Extravasation (infiltration of IV fluids outside of the vein) of the norepinephrine IV site has occurred as noted by redness and edema. The nurse's first action is to stop the infusion and immediately administer diluted phentolamine, the antidote to minimize sloughing and necrosis of the tissue. The nurse can then establish a new patent IV site and titrate the drug to keep SBP greater than 90 mm Hg. After increasing the drip, the nurse would assess the SBP again. The nurse can assess urine output and report if it is less than 30 mL/h.

Droxipoda, an antihypotensive drug, should be used a. only with patients who are confined to the bed b. in the treatment of acute shock c. in patients with known pheochromocytoma d. to treat orthostatic hypotension in patients whose lives are impaired by the disorder

To treat orthostatic hypotension in patients whose lives are impaired by the disorder

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: -the first dose of the medication should be taken at breakfast. -if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. -a persistent, dry cough may occur; however, it is not serious. -he should use a salt substitute containing potassium to avoid hypokalemia.

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

The RAAS is associated with which? (Select all that apply) a. intense vasoconstriction and BP elevation b. blood flow through the kidneys c. production of surfactant in the lungs d. release of aldosterone from the adrenal cortex e. retention of sodium and water in the kidneys f. liver production of fibrinogen

a, b, d, e

A client taking an ACE inhibitor is scheduled for surgery. Because this medication may be dangerous in the setting of general anesthesia, the nurse should a. stop the drug without discussing with providers b. alert the provider caring for the patient, and mark the clients chart prominently c. cancel the surgery and consult with the prescriber d. monitor fluid levels and make sure the fluids are restricted before surgery

alert the provider caring for the patient, and mark the clients chart prominently

Essential hypertension is the most commonly diagnose form of high BP. Essential hypertension is a. caused by a tumor in the adrenal gland b. associated with no known cause c. related to renal disease d. caused by liver dysfunction

associated with no known cause

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? -Cough -Constipation -GI irritation -Photosensitivity

cough

Baroreceptors are the most important factor in controlling fast changes in BP. Baroreceptors a. are evenly distributed throughout the body to maintain pressure in the system b. sense pressure and immediately send that information to the medulla in the brain c. are directly connected to the SNS d. are as sensitive to oxygen levels as to pressure changes

sense pressure and immediately send that information to the medulla in the brain

ACE inhibitors work on the renin-angiotensin system to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells of the lungs, which is usually the site of this conversion, the use of ACE inhibitors often results in a. spontaneous pneumothorax b. pneumonia c. unrelenting cough d. respiratory depression

unrelenting cough