Module 4 Pharm

A young female client of child-bearing age with hypertension is started on losartan. What information about family planning should the nurse include in the teaching plan?

"Losartan can cause birth defects in the developing fetus and should be stopped prior to becoming pregnant if possible."

sympathetic nervous system is also known as what?

"fight or flight"

beta blockers "last name"

"lol"

alpha blockers "last name"

"zosin" or "losin"

Epinephrine: Contraindications

-allergy to epinephrine, -narrow angle glaucoma (pupil dilation could cause blindness) -cardiac dysrhythmias.

Phentolamine is used for what?

-to treat extravasation of epinephrine The action of this alpha blocker (phentolamine) counteracts the effects of the epinephrine, which can prevent the needs for amputation.​

With each classification of antihypertensive medications, it is important to teach:

1. Do not stop abruptly or rebound hypertension can occur (betablocker can also have myocardial infarction); 2. Take blood pressure and pulse daily and record; 3. Rise slowly in stages to help prevent orthostatic hypotension.

Furosemide should be administered at a rate not to exceed

20 mg/minutes.

The normal range for potassium is

3.5-5.0 mEq/L.

_____of urine output in an adult client indicates renal impairment.

30 mL/hour

Orthostatic hypotension

A sudden drop in blood pressure upon standing

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine? a. In the morning b. At noon c. With supper d. At bedtime

A

A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? a. Never stop taking this medication abruptly. b. The medication will be stopped once symptoms subside. c. If adverse effects occur, stop taking the drug for 24 hours, and then resume. d. Be watchful for first-dose hypotension

A

A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect? a. Orthostatic hypotension b. Increased blood pressure c. Decreased urine flow d. Discolored urine

A

A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours

A

ACE inhibitors and ARBs both work to decrease blood pressure by which action? A. Prevent aldosterone secretion B. Increase the breakdown of bradykinin C. Enhance sodium and water resorption D. Prevent the formation of angiotensin II

A

Osmotic Diuretics indication for use

Acute kidney injury, reduces intracranial pressure, cerebral edema

During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to: a. notify his prescriber. b. reduce the dose of his beta blocker by half. c. continue the medication because this is an expected effect. d. skip the medication dose that day, and check his pulse again the next day

A

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? a. Intravenously, through a filter b. By rapid intravenous bolus c. By mouth in a single morning dose d. Through a gravity intravenous drip with standard tubing

A

The nurse is caring for a patient with a history of angina and hypertension who is diagnosed with moderate heart failure. The patient's current medication regimen includes digoxin, furosemide, and quinapril. What medication would the nurse anticipate the health care provider adding to the patient's medication regimen? A. Carvedilol B. Sotalol C. Esmolol D. Propranolol

A

The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure? a. Cardiac output and systemic vascular resistance b. Heart rate and peripheral resistance c. Blood volume and renal blood flow d. Myocardial contractility and arteriolar constriction

A

To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient? A. Furosemide B. Amiloride C. Triamterene D. Spironolactone

A

When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

A

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

A

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce which effect on the heart? A. Positive inotropic, positive chronotropic, and positive dromotropic effect B. Negative inotropic, positive chronotropic, and positive dromotropic effect C. Positive inotropic, negative chronotropic, and negative dromotropic effect D. Negative inotropic, negative chronotropic, and negative dromotropic effect

A

When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain

A

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? a. Digitalis b. Penicillin c. Potassium supplements d. Aspirin

A

Which laboratory test result is a common adverse effect of furosemide? A. Hypokalemia B. Hypernatremia C. Hyperchloremia D. Hypophosphatemia

A

Beta blockers: Adverse effects

Bradycardia, depression, constipation, fatigue, impotence, masking of hypoglycemia symptoms, orthostatic hypotension

A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? a. Diuretics b. Anticholinergics c. Penicillins d. Oral hypoglycemics e. Alcohol f. Anticoagulants

A, B, D, E

When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.) a. "You need to have your blood pressure checked once a week and keep track of the readings." b. "If you notice that the symptoms have gone away, you should be able to stop taking the drug." c. "An exercise program may be helpful in treating hypertension, but let's check with your doctor first." d. "If you experience severe side effects, stop the medicine and let us know at your next office visit." e. "Most over-the-counter decongestants are compatible with antihypertensive drugs." f. "Please continue taking the medication, even if you are feeling better."

A, C, F

Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply.) A. Dizziness B. Headache C. Hyperkalemia D. Mental confusion E. Muscle weakness

A,B,C

Beta blockers are used to treat which conditions? (Select all that apply.) A. Hypertension B. Angina pectoris C. Raynaud's disease D. Cardiac dysrhythmias E. COPD

A,B,D

A patient prescribed spironolactone asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply.) A. Apples B. Bananas C. Pineapple D. Lean meat E. Winter squash

A,C,D

Increasing potassium rich foods is contraindicated in what class of drugs?

ACE's and ARBs and would not be appropriate teaching for any antihypertensive medication.

Avoiding salt-substitutes is class specific to what drug classes?

ACEI and ARB's.

Which antihypertensive is better for patients with Diabetes?

ACEI-protect kidneys

Match the electrolyte imbalance that is associated with each medication. spironolactone

Hyperkalemia

Vasodilators indication for use

Hypertension

Alpha blocker: Indications

Hypertension, benign prostatic hyperplasia

Alpha blockers: Indications

Hypertension, benign prostatic hyperplasia

Alpha blockers: Interactions

Additive effects are known with beta-blockers and erectile dysfunction drugs (think Viagra-generic is sildenafil).​ Antagonistic effects occur with epinephrine, which means the alpha-blocker is not as effective.

Carbonic Anhydrase Inhibitors (CAI) Examples

Acetazolamide​

Beta blockers are not indicated for monotherapy for what type of client?

African Americans, used in combination with a diuretic.

Epinephrine: Indications

Allergic reactions, anaphylaxis asthma, bronchospasm, severe hypotension, and cardiac arrest​

Match the following medications with their classification. Doxazosin

Alpha 1 blocker

Match the following medications with their classification. Clonidine

Alpha 2 receptor agonist

Glomerular Filtration Rate

An estimate of the volume of blood that passes through the glomeruli of the kidney per minutes

positive dromotropic effect

An increase in the conduction of cardiac electrical impulses through the atrioventricular node, which results in the transfer of nerve action potentials from the atria to the ventricles. This ultimately leads to a systolic heartbeat (ventricular contractions).

Beta Blockers: Inications:

Angina, myocardial infarction, cardiac dysrhythmias, hypertension, heart failure​

CCB indications for use

Angina, hypertension, Supraventricular tachycardia (SVT), migraine headaches, atrial fibrillation/flutt

Match the following medications with their classification. Enalapril

Angiotensin Converting Enzyme Inhibitor (ACE)

Match the following medications with their classification. Olmesartan

Angiotensin II receptor blocker (ARB)

For a patient prescribed hydrochlorothiazide, the nurse should closely monitor which laboratory test value? A. Sodium B. Glucose C. Calcium D. Chloride

B

A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

B

A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug? a. Levothyroxine (Synthroid) for hypothyroidism b. Sildenafil (Viagra), an erectile dysfunction medication c. Omeprazole (Prilosec), a proton pump inhibitor d. Low-dose aspirin for stroke prevention

B

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Vasodilators

B

A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient? a. Atenolol (Tenormin) b. Carvedilol (Coreg) c. Acebutolol (Sectral) d. Esmolol (Brevibloc)

B

A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers

B

A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output

B

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety

B

Before administering eplerenone to a patient, what is the priority nursing action? A. Auscultate heart sounds. B. Check serum electrolytes. C. Assess level of consciousness. D. Obtain serum thiocyanate level.

B

During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring? a. The patient is experiencing an allergic reaction. b. The patient may be developing heart failure. c. More time is needed for the patient to see a therapeutic response to the drug. d. The patient is experiencing expected adverse effects of the drug.

B

The health care provider has prescribed dopamine to treat the patient's hypovolemic shock secondary to severe blood loss. The nurse prepares what additional treatment to be completed with this medication administration? A. Temporary pacing B. Fluid replacement C. Induced hypothermia D. Beta-stimulating drugs

B

The nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans often respond better to which combination of medications? A. ACE inhibitors and diuretics B. Diuretics and calcium channel blockers C. Diuretics and beta blockers D. ACE inhibitors and beta blockers

B

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory

B

The nurse is providing education to a patient prescribed spironolactone and furosemide. What information does the nurse explain to the patient regarding both medications together? A. Using two drugs increases blood osmolality and the glomerular filtration rate. B. This combination promotes diuresis but decreases the risk of low levels of potassium. C. The lowest dose of two different types of diuretics is more effective than a large dose of one type. D. This combination maintains water balance to protect against dehydration and electrolyte imbalance.

B

The nurse knows which drug is an example of a cardioselective beta blocker? A.Sotalol B.Atenolol C.Propranolol D.Labetalol

B

The nurse would question a prescription for a calcium channel blocker in a patient with which condition? A. Dysrhythmia B. Hypotension C. Angina pectoris D. Increased intracranial pressure

B

When assessing a patient taking triamterene, the nurse would monitor for which possible adverse effect? A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypernatremia

B

When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect? a. Metabolic alkalosis b. Elevated blood glucose c. Hyperkalemia d. Mental alertness

B

When preparing to administer intravenous furosemide to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate? A. 2 mg/min B. 4 mg/min C. 6 mg/min D. 8 mg/min

B

When teaching a patient about beta blockers such as atenolol and metoprolol, it is important for the nurse to instruct the patient about which drug information? A.Alcohol intake is encouraged for its vasodilating effects. B. Abrupt medication withdrawal may lead to a rebound hypertension C. Hot baths and showers will help increase the therapeutic effects of this drug. D. These medications may be taken with antacids to minimize gastrointestinal distress.

B

When teaching a patient about a new prescription for carvedilol the nurse explains that this medication reduces blood pressure by which action? (Select all that apply.) A. Relaxes muscle tone B. Decreases heart rate C. Peripheral vasodilation D. Increases urine output E. Promotes excretion of sodium

B,C

How would we evaluate if the beta blocker is working?

BP is lower If given for arithma or tachycardia heart rate is more regular

How will we evaluate if an ACEI is working?

Blood pressure lowers

What are the side effects of beta blockers?

Bradycardia impotance masking of hypoglycemia symptoms depression constipation fatigue orthostatic hypotension

Beta blockers: Contraindictations

Bradycardia, heart block, uncompensated heart failure, and severe pulmonary disease. The textbook lists pregnancy as a contraindication for beta-blockers, but according to the American College of Cardiology (ACC), beta-blockers are the first-line treatment of hypertension in pregnant women. The risk is for decreased intrauterine fetal growth, so the fetus should be monitored for growth during the pregnancy.

A patient asks the nurse about using potassium supplements while taking spironolactone. What is the nurse's best response? A. "I will call your health care provider and discuss your concern." B. "I would recommend that you take two multivitamins every day." C. "This diuretic is potassium sparing, so there is no need for extra potassium." D. "You will need to take potassium supplements for the medication to be effective.

C

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Potassium-sparing diuretics

C

Nonselective beta blockers may be used to treat hypertension and what other condition? A.Heart failure B.Heart block C.Supraventricular dysrhythmias D.COPD

C

The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia

C

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

C

The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics

C

The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates

C

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta1 adrenergic c. Beta2 adrenergic d. Alpha1 adrenergic

C

The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these? a. Fluids need to be restricted while on this medication. b. Take the medication with breakfast to promote the maximum effects of the drug. c. Get up slowly from a sitting or lying position. d. Blood pressure must be monitored because the medication may cause hypertension.

C

To evaluate the therapeutic effects of mannitol, the nurse should monitor the patient for which clinical finding? A.Increase in urine osmolality B. Decrease in serum osmolality C. Decrease in intracranial pressure D. Increase in cerebral blood volume

C

To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic? A. Furosemide B. Acetazolamide C. Spironolactone D. Hydrochlorothiazide

C

What is the classification of carvedilol? A. Beta blocker B. Alpha2 blocker C. Dual-action alpha1 and beta receptor blocker D. ACE inhibitor

C

What is the priority nursing diagnosis for a patient prescribed metoprolol? A. Risk for injury related to possible adverse effects of the adrenergic blockers B. Acute confusion related to adverse central nervous system effects of the drug C. Risk for decreased cardiac tissue perfusion related to effects of medication D. Deficient knowledge related to lack of information about the therapeutic regimen

C

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status? a. Blood pressure and pulse b. Serum potassium and sodium levels c. Intake, output, and daily weight d. Measurements of abdominal girth and calf circumference

C

When administering nitroprusside by continuous intravenous infusion, the nurse monitors for which symptom of drug toxicity? A. Fever B. Wheezing C. Hypotension D. Hyperglycemia

C

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? a. They work by inhibiting aldosterone. b. They are very potent, having a diuretic effect that lasts at least 6 hours. c. They have a rapid onset of action and cause rapid diuresis. d. They are not effective when the creatinine clearance decreases below 25 mL/min.

C

Which statement does the nurse include when completing discharge education for a patient prescribed metoprolol? A. "If you become dizzy, do not take your medication for 2 days and then restart on the third day." B. "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." C. "If you take your pulse and it is less than 60 beats/min, hold your medicine and call your health care provider for instructions." D. "Increase your intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."

C

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? a. He should take the diuretic with his evening meal. b. He should skip the diuretic dose if he plans to leave the house. c. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. d. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

D

patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse's immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better.

C

Acetazolamide is used to treat which conditions? (Select all that apply.) A. Dry eye syndrome B. Cardiac dysrhythmias C. High-altitude sickness D. Open-angle glaucoma E. Edema associated with heart failure

C,D,E

Match the following medications with their classification. Diltiazem

CCB

Match the following medications with their classification. Verapamil

CCB

Match the following medications with their classification. Amlodipine

Calcium Channel Blocker

Avoiding grapefruit juice is class specific to what drug?

Calcium channel blockers CCB

Match the following medications with their classification. Metoprolol

Cardio-selective beta-blocker

Which beta blocker has a mild effect on beta 2 blockers?

Carvedilol-safe for asthma and copd patients

What would be some assessments as a nurse prior to administering ACEI?

Check VS BP-HOLD if less than 100 K level Kidney function/creatine level urine out put history of renal disease

How do I know it is safe to administer the beta blocker?

Check patients VS HOLD: BP is less than 100 HR is less than 60 *check apical pulse for 1 min.

What assessments should we do before administrating epinephrine?

Check vitial signs -BP and HR

A client with hypertension and benign prostatic hyperplasia is prescribed tamsulosin. What data demonstrates the medication has achieved the therapeutic response

Client is able to fully empty bladder

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? a. "It takes time for a therapeutic response to develop." b. "She is too young for this particular medication; it will be changed." c. "She needs to take up to two puffs every 4 hours to ensure adequate blood levels." d. "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

D

A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an "embarrassing problem." What problem did the patient most likely experience with this medication that caused him to stop taking it? a. Urge incontinence b. Dizziness when standing up c. Excessive flatus d. Impotence

D

A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. "I don't have high blood pressure—why did my doctor give me this medicine?" Which explanation by the nurse is correct? a. "This medication will prevent blood clots that may lead to another heart attack." b. "Beta blockers will improve blood flow to the kidneys." c. "This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack." d. "Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack."

D

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with which of the following drug classes? A. Beta blockers B. Alpha1 blockers C. Direct renin inhibitors D. Monoamine oxidase inhibitors (MAOIs)

D

A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions? a. "Weigh yourself daily, and report any weight loss to your prescriber." b. "Increase your potassium intake by eating more bananas and apricots." c. "The impaired taste associated with this medication usually goes away in 2 to 3 weeks." d. "Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy."

D

A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct? a. "It's important to try to stay on your prescribed medication. Try to take it with sips of water." b. "Stop taking the diuretic for a few days, and then restart it when you feel better." c. "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician." d. "Please come into the clinic for an evaluation to make sure there are no complications."

D

A patient who is prescribed tamsulosin does not have a history of hypertension. The nurse knows this medication is also used for what condition? A. Migraine headache B. Pulmonary emboli C. Subarachnoid hemorrhage D. Benign prostatic hyperplasia (BPH)

D

A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response? a. "This therapy will take about 3 months." b. "This therapy will take about a year." c. "This therapy will go on until your symptoms disappear." d. "Therapy for high blood pressure is usually lifelong."

D

A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic? a. Captopril rarely causes first-dose hypotensive effects. b. Captopril has little effect on electrolyte levels. c. Captopril is a prodrug and is metabolized by the liver before becoming active. d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active

D

A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet)

D

An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension

D

During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse? a. "We need to monitor for drug toxicity." b. "We must watch for increased intraocular pressure." c. "The provider is assessing for visual changes that may occur with drug therapy." d. "The provider is making sure the treatment is effective over the long term."

D

During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication? A. Verapamil B. Nadolol C. Dobutamine D. Phentolamine

D

During discharge teaching, which statement by the nurse would be most appropriate for a patient prescribed a transdermal clonidine? A. "Occasional drooling is a common adverse effect of this medication." B. "Prolonged sitting or standing does not cause hypotension symptoms." C. "Your blood pressure should be checked by your health care provider two to three times a week." D. "The patch should be applied to a nonhairy site, and you should not suddenly stop using this drug."

D

During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation? a. It neutralizes the extravasated dobutamine immediately. b. It causes arterial vasoconstriction and reduced pain and swelling at the site. c. It increases peripheral vascular resistance and reduces arterial pressure at the site. d. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.

D

Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect? A. Urinary retention B. Bronchial constriction C. Decreased intestinal motility D. Increased heart rate and contractility

D

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? a. "Take this medication in the evening." b. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates." c. "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." d. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

D

The nurse assesses the patient's IV site, and it has infiltrated during the infusion of dopamine. The nurse will prepare which medication to treat this infiltration? A.Naloxone B. Lidocaine C. Nitroprusside D. Phentolamine

D

The nurse is assessing the patient's knowledge regarding drug therapy prescribed for the treatment of hypertension. Which statement by the patient indicates the need for further teaching by the nurse? A. "I will wear a medical alert bracelet." B. "I will move slowly from a sitting to standing position." C. "Blood pressure drugs can cause changes in sexual functioning." D. "When my blood pressure is over 140/90, I will take my medication."

D

The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

D

The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication? a. Angina b. Hypertension c. Glaucoma d. Asthma

D

The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? A. Fatigue B. Hypokalemia C. Orthostatic hypotension D. Dry, nonproductive cough

D

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? a. Hydrochlorothiazide (HydroDIURIL) b. Furosemide (Lasix) c. Acetazolamide (Diamox) d. Spironolactone (Aldactone)

D

The nurse would question the use of mannitol for which patient condition? A. Increased intraocular pressure B. Oliguria from acute renal failure C. Cerebral edema from head trauma D. Anuria related to end-stage kidney disease

D

To prevent cerebral artery spasms after a subarachnoid hemorrhage, the nurse anticipates administering which calcium channel blocker? A. Verapamil B. Diltiazem C. Amlodipine D. Nimodipine

D

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs? A. Diaphoresis B. Constipation C. Blurred vision D. Muscle weakness

D

Which is the pharmacological action of propranolol? A. Beta1-adrenergic antagonist B. Beta2-adrenergic antagonist C. Selective alpha-adrenergic antagonist D. Nonselective beta-adrenergic antagonist

D

Which medication would the nurse question if prescribed together with ACE inhibitors? A. Furosemide B. Morphine C. Docusate sodium D. Potassium chloride

D

Why does the health care provider prescribe furosemide 40 mg twice a day by mouth for a patient with a history of renal insufficiency? A. Furosemide is effective in treating patients with hypoaldosteronism. B. Furosemide helps the kidney with reabsorption of sodium and water. C. Furosemide has an antagonist effect to prevent respiratory alkalosis. D. Furosemide is effective in treating patients with impaired kidney function.

D

The nurse understands beta blockers produce which cardiovascular effects? A. Positive inotropic, positive chronotropic, and positive dromotropic B. Negative inotropic, positive chronotropic, and positive dromotropic C. Positive inotropic, negative chronotropic, and negative dromotropic D. Negative inotropic, negative chronotropic, and negative dromotropic

D causing a decrease in heart rate (negative chronotropic), conductivity (negative dromotropic), and contractility (negative inotropic).

When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) a. Dyspnea b. Constipation c. Tinnitus d. Muscle weakness e. Anorexia f. Lethargy

D, E, F

When using Epinephrine, the most concerning toxicity is CNS (seizures), what drug do we use if this occurs?

Diazepam

Match the following medications with their classification. Hydralazine

Direct acting vasodilator

Loop Diuretics indication for use

Edema associated with heart failure, renal disease, or hepatic disease; hypertension

Epinephrine: Toxicity and Overdose

Epinephrine is short-acting and most often, if overdose occurs, stopping the epinephrine will cause the toxic symptoms to dissipate. The most concerning toxicity is CNS (seizures) or cardiovascular (hypertension, Dysrhythmias). If seizures occur, this can be managed with diazepam. If hypertension occurs, esmolol can be used for rapid lowering of blood pressure. -Supporting the respiratory and cardiac systems is important in the management of epinephrine overdose.​

ACEI: Indications

Excellent antihypertensive drug, adjunctive drug for heart failure, nephroprotection for diabetic patients​

ARBs indications for use

Excellent antihypertensive, adjunctive drug for heart failure

Match the electrolyte imbalance that is associated with each medication. acetazolamide

Hypokalemia

Match the electrolyte imbalance that is associated with each medication. furosemide

Hypokalemia

Match the electrolyte imbalance that is associated with each medication. hydrochlorothiazide

Hypokalemia

What are the adverse effects associated with amlodipine?

Hypotension Ankle edema Bradycardia Reflex tachycardia Flushing

Ascites

Intraperitoneal accumulation of fluid containing large amounts of protein and electrolytes

If the epinephrine infiltrates, it can cause necrosis and gangrene to the tissues effected How can we prevent this?

If Phentolamine Mesylate is injected into the area of extravasation within 12 hours of infiltration, the tissue necrosis and sloughing can be prevented

What do we do if we have to give IV potassium?

slow, diluted, on a pump need cardiac monitoring device

When we are talking about blocking beta 1 what happens to the heart rate? selctive beta blockers

slows down-use for asthma and COPD

Which alpha blocker is used in BPH benign prostatic hyperplasia?

tamsulosin

Positive chronotropic effect

Increase in heart rate

Positive dromotropic effect

Increase in the conduction of cardiac electrical impulses

Positive inotropic effect

Increase in the force of the contraction of the heart muscle

Adrenergic blocking drugs effects:

Eye: pupil constriction (miosis) Lungs: bronchoconstriction Heart: Decreased heart rate Blood Vessels: Vasodilation, decreased blood pressure GU: relaxation of the bladder and prostate occurs with alpha 1 blockers

Adrenergic stimulating drug effects:

Eye: pupil dilation (Mydriasis) Lungs: bronchodilation Heart: increased heart rate Blood vessels: vasoconstriction GI: decrease GI motility Bladder: relaxes, urinary retention

What can happen If a patient gets a gastric ulcer?

GI bleeding- signs: pain extended abdomen bloody stools dark tary stools coffee ground emesis

What do we need to worry about with oral potassium supplements?

GI ulcers take it with food do not suck on pill-will cause mouth uclers sit up straight-will cause reflex if not

CAI indication for use

Glaucoma, edema, high-altitude sickness​

The nurse is about to administer a prescribed dose of metoprolol to a client with a cardiac dysrhythmia. What assessment data would be of most concern to the nurse?

Heart rate at 50 beats per minutes.

Vasodilators Examples:

Hydralazine, diazoxide, minoxidi

Match the electrolyte imbalance that is associated with each medication. Lisinopril

Hyperkalemia

Match the electrolyte imbalance that is associated with each medication. Triamterene

Hyperkalemia

Match the electrolyte imbalance that is associated with each medication. losartan

Hyperkalemia

What would we assess prior to administering furosemide?

K level-HOLD is k is low (3.5-5) muscles strength-sign of low k Check blood pressure

Match the following medications with their classification. Furosemide

Loop Diuretic

What is the risk with vasodilators?

MI-myocardial infraction monitor history of MI or if they have cardiac disease

Match the following medications with their classification. Propranolol

Non-selective beta-blocker

What is the difference between cardio-selective vs non-cardio-selective beta blockers?

Non-selective slow heart rate, but causes bronchoconstriction (not ok w/ asthma or COPD) Cardio-selective slow heart rate, have little risk of causing bronchoconstriction

Match the following medications with their classification. Mannitol

Osmotic diuretic

What are the contraindications for ACEI? (think PARK)

P-pregancy A-angioedema/allergy R-renal failure K-potassium levels can rise: hyperkalemia

Contraindications with ARB?

PARK -avoid foods high in k and salt subs

A client received epinephrine for an anaphylactic reaction in the emergency department 6 hours ago. Since that time, the client has been unable to void. What assessment should the nurse perform to determine the cause of urinary issue?

Palpate the area above the symphyses pubis bone

Match the following medications with their classification. Spironolactone

Potassium-sparing diuretic

What system does epinephrine stimulate?

SNS

Beta blockers: Toxicity and Overdose

Signs of overdose are severe bradycardia, hypotension and, potentially, heart block. The treatment is to withhold a dose or several doses of the prescribed beta-blocker, which may be all that is needed in some cases. If the overdose is more severe and the patient is symptomatic (pale, diaphoretic, light headed) the healthcare provider may prescribe atropine to help increase the heart rate. Atropine is the mainstay of treatment for symptomatic bradycardia. Glucagon has also been shown to be an effective antidote for beta-blocker overdose, however, insulin must be administered with glucagon to counteract the rise in blood sugar that occurs.​

How does Clonidine work?

Stimulate the alpha 2 receptors, which blocks sympathetic outflow, which reduces blood pressure

Alpha blockers: Toxicity and Management of Overdose

Support the blood pressure through IV fluid administration, administration of vasopressors (dopamine, norepinephrine)​

Cardiac output

The amount of blood ejected from the left ventricle

Extravasation

The leaking of fluid from a blood vessel into the surrounding tissues

The nurse administered epinephrine to a client with a severe case of angioedema related to administration of ACE inhibitors. What adverse effects should the nurse monitor for in this client? SELECT ALL THAT APPLY

Urinary retention Impaired renal tissue perfusion Palpitations Tremors Agitation

How can you tell the difference between urinary retention and decrease renal tissue perfusion?

You can palpate the bladder, above the symphysis pubis, and if you feel a hard, firm bladder, it means the problem is urinary retention. You can also a do a bladder scan and if there is urine in the bladder, it is urinary retention. If the bladder is empty, it could be decreased renal tissue perfusion. So look at output as one indicator of renal tissue perfusion. You can also look at lab work, look at the creatinine level. If it is rising, this is also an indicator of decreased renal tissue perfusion

What information should the nurse include when providing education to a patient newly prescribed furosemide?

a loop diuretic, that is potassium wasting. The patient should increase potassium intake, weight daily and record weight, and rise slowly in stages to prevent orthostatic hypotension.

What would be a contradiction with adrenergic stimulating drugs?

a rapid heart rate or dysrhythmia glaucoma

Tamsulosin does what?

alpha-1 blocker that is used to relax the prostate and neck of the bladder to help client's with BPH empty their bladder. It helps decrease frequency, urgency, and nocturia. It can cause orthostatic hypotension as an adverse effect.

Which is one of the most common CCB, and used for hypertension?

amlodipine

CCB Examples:

amlodipine, diltiazem, verapamil

For what conditions are beta blockers used?

angina MI cardiac dysrhythmias HYPERtension HF

Beta blockers: Indications

angina, myocardial infarction, cardiac dysrhythmias, hypertension and heart failure. Beta blockers are not indicated for monotherapy of hypertension in African American clients; it will be used in combination with a diuretic. Not effective when given alone

what is the mainstay treatment for symptomatic bradycardia?

atropine

What can non-selective beta blockers be used for? blocks beta 1 and beta 2

beta 1-slows HR beta 2-bronchoconstrction

Cardioselective beta blockers do what?

block only beta 1, meaning they slow the heart and have very little risk of causing bronchoconstriction

If we are giving mannitol IV, what do we need to do?

must be warmed if it is crystalized -send back to pharmacy to get warmed -administered with filter IV tubing

What is epinephrine used for?

cardiac arrest, allergic reactions

What patient teaching would you want to do with an ACEI?

careful in potassium contain foods-including salt sub. urine changes report thick tongue or lips-signs how to take BP

Nonselective Beta-Blockers (blocks beta 1 and beta 2​):

carvedilol, labetalol, propranolol​

Why do we not like to use CAI anymore?

causes metabolic issues

If we give epinephrine for an allergic reaction, how are we going to know that it worked?

no wheezing -no symptoms of an allergic reaction

When on beta blockers what mental health concern is important to remember?

depression

If administering Clonidine as a patch what would we need to do?

don't use heat-increase absorption change after 7 days wear gloves *patch rules if they stop medication abruptly- rebound hypertension

What do we teach patients who are on spironolactone?

don't use salt subs don't eat foods high in k weight BP

Which alpha blocker is used for hypertension?

doxazosin

Alpha blocker: Examples

doxazosin, prazosin, terazosin, tamsulosin

Common adverse effect with CCB because they cause strong vasodilation

edema, nasal congestion, hypotension

When using Epinephrine, the most concerning toxicity is CNS or cardiovascular (hypertension, dysrhythmias), if this occurs what drug do we use?

esmolol can be used for rapid lowering of blood pressure

If we are administering epinephrine IV for cardiac arrest, what is it important to remember to do?

follow with enough saline so that all of the epinephrine gets out of the tubing an into the blood stream -flush with 20ml of saline

Loop Diuretics Examples:

furosemide , torsemide, bumetanide :ide"

What is important patient teaching for Alpha blockers?

given at bedtime to limit orthostatic hypotension

Is there a food interaction that we need to worry about with the CCB?

grapefruit juice-inhibits CYP450 causes severe hypotension

What electrolyte is wasted by loop diuretics?

hates all of them-concern about potassium being wasted

How will you evaluate Tamsulosin is effective for BPH?

have improved urinations empty bladder more fully less frequency-less urgency start and stop stream of urine

Beta 1 is primarily found where?

heart

What does mannitol do?

helps decrease intercranial pressure used to treat acute kidney injury

Thiazides and Thiazide-Like Diuretics Example:

hydrochlorothiazide

When assessing K level with Potassium sparing drugs, like spironolactone, what are we looking for?

hyperkalemia

What is hydrochlorothiazide commonly used for besides edema

hypertension

doxazosin, prazosin, terazosin- what makes them special?

hypertension is the indication because they cause both arterial and venous dilation

Why do we use Alpha blockers?

hypertension, BPH cause vasodilation

Adverse effect of Losartan/ "ARBS"

hypotension hyperkalemia renal impairment fatigue dizziness

Calcium channel blockers cause what adverse effect?

hypotension, peripheral edema, tachycardia (reflex), bradycardia, constipation, and flushing.

For men its important to inform them that beta blockers cause what?

impotence

When do we want to administer all the diuretics' if a patient is taking them everyday?

in the morning-want them to get rid of fluid during the day not all night long

positive chronotropic effect

increase in heart rate

The most common administered diuretics

loop: furosemide-very strong

ARB's Examples:

losartan, valsartan, candesartan, olmesartan

Beta 2 is found where?

lungs

Prior to administering a beta blocker what assessments would you want to do as a nurse?

lungs sounds/ respiratory rate (important for nonselective beta blockers that effect airway) History of Asthma/COPD HR-HOLD if less 60 BP-HOLD if less than 100 diabetes

Can you think of a disease process you would want to use an adrenergic stimulating drug to treat?

lungs- since bronchodilation occurs with these drugs it would be useful with Asthma, and COPD blood pressure-this would help low blood pressure because it causes vasoconstriction

Beta-Blocker: Cardioselectivity (Blocks beta 1 selectively):

metoprolol, atenolol​

Furosemide is normally prescribed to take when during the day?

morning to help decrease nocturia.

If a patient has diabetes does that mean we cannot give them a beta blocker?

no-we know that they are at greater risk for masking their hypoglycemic symptoms need to check their blood sugar more carefully if on a beta blocker

How can we administer Clonidine?

orally, or applied as a transdermal patch which is left on for 7 days. -do not stop abruptly will cause rebound hypertension

Who would benefit from a cardio-selective beta blocker?

people with asthma or COPD because it is less likely to cause broncoconstriction

Most of the time when a patient is on a loop diuretic, what else do they need to be on?

potassium supplment

What foods would you teach the patient to eat to avoid hypokalemia?

potatoes bananas green veggies

What is treatment for a severe beta blocker overdose, where the patient is symptomatic- pale, diaphoric, light headed?

prescribe atropine to increase heart rate -glucagon can be an effective treatment, insulin must be administered with it

What would we teach the patient who is going home on beta blockers?

rise in stages how to check their BP and when to take it (before taking medication in the morning) don't stop taking abruptly-rebound hypertension

Signs of overdose with Beta blockers?

sever bradycardia HYPOtension heart block

If patient is diabetic and on a beta blocker what should be closely monitored?

signs of hypoglycemia as beta blockers mask tachycardia

Nonselective beta blockers do what?

slow the heart rate but can cause bronchoconstriction, especially in patients who have asthma or COPD

Some beta blockers are nonselective, what does this mean?

they block both Beta 1 and Beta 2

Tamsulosin is used for what?

to treat benign prostatic hyperplasia (BPH) because it causes relaxation of the smooth muscle in the bladder neck and the prostatic portion of the urethra. This allows the patient to more completely empty their bladder

What is the treatment for overdose of Beta Blockers?

treatment is to withhold a dose or several doses of beta blocker

Which CCB are mostly used on the heart?

verapamil, diltiazem

What would we teach the patient if they are on a loop diuretic?

weight daily- report 5lbs in 2 days increase k intake

Vasodilators, what do we need to know?

work directly on the blood vessels cause BP to drop

ACEI Examples:

​captopril, enalapril, lisinopril

Alpha blockers: Contraindications

•Allergy, hypotension​ •Use caution in hepatic and renal disease patients

Epinephrine: Interactions

•Beta blockers antagonize epinephrine effects​ •MAOI's can cause hypertensive crisis​ •Lab: increases blood sugar

Beta blockers: Interactions

•Decreased absorption​ Antacids​ •Additive effect​ digoxin, diuretics, neuromuscular blocking drugs, other cardiac drugs​ •Antagonistic effects Anticholinergic drugs

Alpha blockers: Adverse effects

•First dose phenomenon-severe and sudden drop in blood pressure.​ Orthostatic hypotension, dizziness, headache, constipation, edema, nasal congestion

Thiazides and Thiazide-Like Diuretics indication of uses

•Hypertension, edema

Potassium-Sparing Diuretics indication for use

•Hypertension, heart failure (it blocks cardiac remodeling), edema associated with liver disorders, portal vein hypertension

Beta Blocker: Examples

•Nonselective Beta-Blockers (blocks beta 1 and beta 2​ •carvedilol, labetalol, propranolol​ •Cardioselective Beta-Blockers (blocks beta 1 selectively​ •metoprolol, atenolol​

Epinephrine: Mechanism of action

•Stimulates Alpha1, which increases BP​ •Stimulates Beta1, which increases HR​ •Stimulates Beta2, which promotes bronchodilation​

Epinephrine: Adverse effects

•Tremors, agitation, insomnia, decreased renal tissue perfusion, urinary retention, palpitations, tachycardia, hypertension, ventricular fibrillation​ •Intravenous infiltration causes necrosis and tissue sloughing

Osmotic Diuretics Example:

•mannitol ​

Potassium-Sparing Diuretics Examples

•spironolactone, triamterene, amiloride​