Chapter 60, Chapter 51: Drugs for Heart Failure, Chapter 50: Drugs for Hypertension, Chapter 49 Vasodilators, Chapter 48 Calcium Channel Blockers, Chapter 47 Drugs acting on the RAAS, Chapter 44 Diuretics

An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response?

""Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes."

A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient's medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse's response?

"ACE inhibitors can prevent or reverse pathologic changes in the heart's structure."

A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?

"I should take this medication 1 hour before sitting down to a meal."

A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?

"I should take this medication on a full stomach."

A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?

"When my symptoms subside, I may discontinue the medications."

A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule?

6 or 7 times a day

Which patients may receive hydralazine to treat hypertension? (Select all that apply.)

A 1-month-old infant A 5-year-old child An older adult

A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:

A V blockade.

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development?

Aldosterone antagonist

Which are therapeutic uses of verapamil? (Select all that apply.)

Angina of effort Cardiac dysrhythmias Essential hypertension

An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct?

Below 8.0

The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism?

Blocking aldosterone receptors

A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer?

Blood glucose level of 60 mg/dL

A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?

Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.)

Diabetes insipidus Hepatic failure Postmenopausal osteoporosis

A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her?

Discuss using methyldopa instead while she is pregnant.

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

Drink extra fluids and avoid driving when drowsy.

An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family?

End-of-life care

A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats/min and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient?

Evaluating ankle edema

The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include?

Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis

A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do?

Explain that this drug binds with receptors for steroid hormones, causing this effect.

A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats/min, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?

Give the dose of digoxin and notify the provider of the potassium level.

What is the most reliable measure for assessing diabetes control over the preceding 3-month period?

Glycosylated hemoglobin level

A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

Hold the dose and notify the provider.

The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?

Hydralazine (Apresoline)

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

Hydrochlorothiazide and nadolol

A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication?

Hyperkalemia

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?

Improved exercise tolerance

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?

Increased tissue perfusion

A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?

Instruct the patient not to get up without assistance.

A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason?

It does not correct the underlying pathology of heart failure.

A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?

It may be uncomfortable enough that the drug will need to be discontinued.

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?

Lispro [Humalog]

A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for 1 injection. What should the nurse tell the patient?

This is an acceptable practice.

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.)

Ways to reduce hyperglycemic episodes, Smoking cessation, Emphasis on the importance of taking antihypertensive drugs consistently

A patient has had blood pressures of 150/95 and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect this patient's provider to order:

a thiazide diuretic.

A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:

adding a calcium channel blocker to this patient's drug regimen.

A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats/min and a blood pressure of 110/72 mm Hg. The nurse will request an order to:

administer a beta blocker.

A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:

hyperkalemia.

A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats/min, and the blood pressure is 130/88 mm Hg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:

is experiencing worsening of the disease.

A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child's parents, the nurse will expect to:

perform a detailed health history on the child.

A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to:

prevent reflex tachycardia.

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent:

rebound hypertension.

A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to:

reduce intracranial pressure.

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:

serum electrolyte levels.

A patient has three separate blood pressure (BP) readings of 120/100, 138/92, and 126/96 mm Hg. Which category describes this patient's BP?

Hypertension

A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:

ACE inhibitors and beta blockers.

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?

"I need to stop taking potassium supplements."

A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse's teaching about this drug?

"I will also take a beta blocker medication with this drug to prevent rapid heart rate."

A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?

"I will monitor the heart rate frequently to assess for reflex tachycardia."

A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed?

"I will need to take a beta blocker to prevent reflex tachycardia."

A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching?

"I will need to take potassium supplements when adding this drug."

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

"Beta blockers block the actions of angiotensin II."

A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug's side effects. Which statement by the patient indicates understanding of the teaching?

"I may become constipated, so I should increase fluids and fiber."

A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse?

"I may continue to have a glass of wine with dinner."

A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?

"Reflex tachycardia can negate the desired effects of vasodilators."

A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching?

"Taking this medication helps reduce my risk of stroke and heart attack."

A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching?

"Two or more drugs will lower blood pressure more quickly."

A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?

"When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."

A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included?

"You should use a carbohydrate counting approach to maintain glycemic control."

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

ACE inhibitors

A nurse is reviewing a patient's medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?

Captopril [Capoten] and spironolactone [Aldactone]

A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?

Check the patient for other symptoms of digitalis toxicity.

The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?

Decrease in cardiac work

An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern?

Elevated creatinine clearance

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.)

Flatulence, Diarrhea

A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?

Furosemide [Lasix]

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/min, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication?

Furosemide [Lasix]

Which statement is correct about the contrast between acarbose and miglitol?

Miglitol has not been associated with hepatic dysfunction.

A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?

Move slowly from sitting to standing when taking this drug.

A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats/min. What will the nurse do?

Notify the provider and ask about adding a beta-blocker medication.

A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?

Notify the provider and discuss ordering a beta blocker for this patient.

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug?

Once daily at bedtime

Which statement is accurate about the long-term complications of diabetes?

Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats/min, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?

Potassium level of 3.2 mEq/L

Which medications are most likely to cause postural hypotension? (Select all that apply.)

Prazosin [Minipress] Captopril [Capoten] Losartan [Cozaar]

A nurse checks a patient's vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?

Recheck the patient's blood pressure in the other arm.

A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient's chart before administering the medication will be most concerned about which other disease process?

Renal artery stenosis

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate?

Request an order for furosemide [Lasix].

A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom?

Ringing in the ears

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?

Sodium nitroprusside [Nitropress] IV

A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?

Sodium restriction

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?

Spironolactone [Aldactone]

A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient?

Spironolactone [Aldactone]

The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?

The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned?

The beta blocker can mask the symptoms of hypoglycemia.

A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

The patient should stop taking the medication and contact her provider immediately.

A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats/min and a blood pressure of 90/50 mm Hg. The nurse will anticipate:

administering intravenous norepinephrine (NE) and atropine and glucagon.

A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will:

assess the heart rate (HR) and give the dose if the HR is greater than 60 beats/min.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to:

avoid potassium supplements.

A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:

caution the patient not to get up abruptly.

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats/min. The nurse will observe this patient closely for:

decreased urine output.

A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request:

discontinuing the quinidine.

A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:

the DASH diet, sodium restriction, and exercise.