HTN meds
The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? "I can take this medication in the morning to reduce nighttime urination." "I will rise slowly when changing from a sitting to a standing position." "My heart rate may slow down with this drug. I will call if my pulse is below 60." "I need to increase my intake of fluids and foods that are high in fiber."
"I will rise slowly when changing from a sitting to a standing position."
An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."
"Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect."
The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? Observe for respiratory depression. Monitor the electrocardiogram for tachycardia. Initiate oxygen therapy via nasal cannula at 2 L/min. Adjust the intravenous infusion rate to the blood pressure response.
Adjust the intravenous infusion rate to the blood pressure response.
Clonidine
Alpha2 Agonist
Hydralazine drug interactions
Antihypertensive medications Give with BB to protect againt reflex tachycardia
Clonidine drug interactions
BB Dig MAO-I
Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? Diuretic and beta blocker Beta blocker and ACE inhibitor ACE inhibitor and calcium channel blocker Diuretic and calcium channel blocker
Beta blocker and ACE inhibitor
Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? Peripheral pulses Homans' sign Blood pressure Capillary refill
Blood pressure
Beta blockers drug interactions
CCB Insulin
Clonidine AE
CNS: drowsiness, dizziness, nightmares, anxiety, depression GI: Dry mouth (xerostomia) and constipation CV: bradycardia, decreased CO, rebound hypertension with abrupt withdrawal GU: impotence Caution with older adults: orthostatic hypotension and CNS adverse effects
Why shouldnt pt's abruptly stop taking clonidine?
Can cause rebound hypertension
Beta blockers action
Decrease heart rate, decreased ventricular contractility & cardiac workload Reduced conduction through AV node
Clonidine Contraindications
Diabetes Category C SA node dysfunction Recent MI Coronary insufficiency
Which medication is first line for HTN?
Diltiazem
The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? Hydrochlorothiazide [HCTZ] Enalapril [Vasotec] Propranolol [Inderal] Methyldopa [Aldomet]
Enalapril [Vasotec]
Hydralazine uses
Essential hypertension Hypertensive crisis Heart failure
Sodium Nitroprusside AE
Excessive hypotension Cyanide poisoning & thiocyanate toxicity (rare) Consistent monitoring is required
Sodium Nitroprusside
Fastest-acting antihypertensive agent Causes venous and arteriolar dilation IV only, protect from light Immediate onset
Prazosin AE
First dose effect Reflex tachycardia Fluid retention
Beta blockers uses
HTN Angina, MI, heart failure, dysrhythmias, etc.
Prazosin uses
HTN Tx of alpha-1 agonist (Epi) BPH
Clonidine uses
HTN- not first line
Selective dilation of arterioles
Hydralazine
Sodium Nitroprusside uses
Hypertensive emergencies
Beta blockers AE
Hypotension Bradycardia HF Bronchoconstriction Hypoglycemia Rebound cardiac excitation Insomnia, depression
Hydralazine AE
Hypotension Dizziness Reflex tachycardia Fluid retention Systemic lupus erythematosus-like syndrome (painful joints, fever, nephritis) HA, weakness, and fatigue
The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? Furosemide will help reduce reflex tachycardia. Many vasodilators cause retention of sodium and water. Thiocyanate may accumulate in patients receiving nitroprusside. Vasodilators can cause serious orthostatic hypotension.
Many vasodilators cause retention of sodium and water.
The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? Methyldopa [Aldomet] Propranolol [Inderal] Captopril [Capoten] Valsartan [Diovan]
Methyldopa [Aldomet]
Beta blockers nursing implications
Monitor HR, BP, and respirations Hold drug if BP < 90 Systolic and HR < 60 Avoid abrupt discontinuation Causes rebound cardiac excitation
Selective dilation of veins
Nitroglycerin
The nurse reviews the medication treatment regimen for a patient with chronic hypertension. To promote optimal medication adherence, which frequency of drug dosing should the nurse advocate for this patient? Once a day Three times a day Four times a day Every 8 hours
Once a day
Dilate arterioles and veins
Prazosin
Clonidine action
Selective activation of alpha2 receptors in the CNS Reduce the firing of sympathetic neurons in blood vessels and the heart Effects similar to those of the direct-acting adrenergic receptor blockers Lead to vasodilation
Prazosin action
Selective blockade of alpha 1 receptors arterial & venous vasodilation Relaxes smooth muscles in bladder, increased urine flow and decreased residual urine
Hydralazine action
Selective dilation of the arterioles Relaxation of vascular smooth muscle of the arterioles, decreased peripheral resistance, decreased arterial blood pressure Decreased blood pressure, stimulation of the baroreceptor reflex, increased heart rate and myocardial contraction Decreased BP stimulates the RAA system which causes a release of aldosterone
Which laboratory result may be a consequence of therapy with a thiazide diuretic? Serum glucose level of 58 mg/dL Serum potassium level of 5.3 mEq/L Serum sodium level of 135 mEq/L Serum uric acid level of 10.4 mg/dL
Serum uric acid level of 10.4 mg/dL
The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this mediacation? Heart failure Myocardial infarction Angina pectoris Severe hypertension
Severe hypertension
A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? Minoxidil [Loniten] Hydralazine [Apresoline] Sodium nitroprusside [Nipride] Hydralazine and isosorbide dinitrate [BiDil]
Sodium nitroprusside [Nipride]
A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? Furosemide [Lasix] Sodium nitroprusside [Nitropress] Metoprolol [Lopressor] Diltiazem [Cardizem]
Sodium nitroprusside [Nitropress]
The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessement data indicate the patient may be experiencing thiocyanate toxicity? Sudden confusion Difficulty breathing Erythematous rash Gastrointestinal bleeding
Sudden confusion
The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? To reduce the risk of headache To improve hypotensive effects To prevent heart failure To protect against reflex tachycardia
To protect against reflex tachycardia
Clonidine transdermal administration
Transdermal applied every 7 days Applied to hairless upper arm or torso Keep in a place that is easy to find
First dose effect nursing considerations
Warn patients about first dose effect Take first dose at bedtime to eliminate risk of first dose effect Avoid driving or other hazardous activities for first 12-24 hours Rise slowly from lying to sitting and let legs dangle from bed before standing to reduce hypotension Sit or lie down if dizziness, lightheadedness occur