Pharm 2. Chapter 43 Drugs Affecting Blood Pressure

Which of the following questions would be most important for a nurse to ask a female patient who is starting on an angiotensin II receptor blocker for hypertension?

"When was your last menstrual period?"

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."

Most clients with Stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially? (Choose one)

2

A patient with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the physician concludes that losartan alone is not adequately controlling the hypertension. What would the physician likely add to the regimen to improve control?

A diuretic

A nurse is educating a group of nursing students on the mechanism of actions of angiotensin converting enzyme inhibitors (ACEI). Which of the following should the nurse explain as the hormone produced by the adrenal cortex?

Aldosterone

Mr. Emmeott is seen by the physician for follow-up for diabetic nephropathy. The physician 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?

Angiotensin II receptor blockers

The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock?

Bradycardia

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which of the following modes of action helps losartan to bring about its antihypertensive effect?

By blocking the angiotensin II receptors

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient's nurse should recognize that the therapeutic effect of this drug is achieved in what way?

By inhibiting the transformation of angiotensin I to angiotensin II

An African American patient is being treated for stage 2 hypertension. What antihypertensive agent is the drug of choice for this patient?

Calcium channel blocker

A patient is receiving fosinopril. Which adverse effect would the nurse caution the patient about to help to promote compliance?

Cough

Your 71-year-old male patient has recently been diagnosed with hypertension. Which of the following measurements is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

Key behavioral determinants of blood pressure are related to what factor?

Dietary consumption of calories and salt

A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent which of the following?

Excessive hypotension

A patient is receiving verapamil. Which of the following would be important for the nurse to stress that the patient avoid?

Grapefruit juice

The nurse is educating a client with hypertension about dietary changes that help to decrease blood pressure. Which of the following menu selections indicates the need for further client education?

Ham sandwich with mustard, carrots and cheesy dip

A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?

Hydrochlorothiazide

You are caring for a patient at risk of shock. What physiologic response would you know to look for while assessing for shock?

Hypoperfusion of tissues

When preparing a plan of care for a client in hypovolemic shock, which of the following partial nursing diagnoses might be relevant to the patient's condition?

Ineffective Tissue Perfusion

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?

Left ventricle

Once a client develops primary hypertension, therapy should last for how long? (Choose one)

Lifelong

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify which of the following as an example of an angiotensin II receptor blocker?

Losartan

Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect?

Mark, who is suffering from impaired renal function

A patient has recently been diagnosed with hypertension. Which of the following outcomes is most important in this patient?

Multiple diastolic blood pressure readings <90 mm Hg

After receiving the results of his echocardiogram, your patient has many questions regarding results and their impact on his lifestyle. He is a 57-year-old Hispanic man with a 10-year history of hypertension. Disturbed by all the dietary changes proposed by the cardiologist, he questions what effect hypertension has on his heart. What is your reply?

Myocardium hypertrophy

A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme inhibitor (ACE inhibitor)?

Persistent cough

A nurse checks a client's blood pressure and finds it to be 130/82. This client should be classified as having which stage of hypertension?

Prehypertension

The client has elevated BUN and creatinine levels. The nurse would question the administration of which of the following antihypertensives?

Quinapril

A provider chooses to treat an African American client suffering from hypertension with a beta blocker and diuretic instead of an ACE inhibitor. The nurse knows that the provider did this for what reason?

Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors.

A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?

Restore and maintain adequate tissue perfusion.

A patient is experiencing orthostatic hypotension that is due to his antihypertensive therapy. Which nursing diagnosis would be most appropriate?

Risk for injury

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 of the following is the most likely consequence of renal impairment?

Secondary hypertension

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension? (Choose one)

Stage 2

The client has a blood pressure of 165/100 mmHg. The nurse knows that this client would be in classified as which stage of hypertension?

Stage 2

A patient has had multiple blood pressure readings that indicate he is hypertensive. How is hypertension defined?

Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg

A patient who is malnourished and has hypertension is being treated with losartan (Cozaar). How should the dose of the medication be adjusted in this patient?

The dose should be lower than normal.

A 26-year-old white male patient has been prescribed captopril for hypertension. A nurse has been assigned to the patient to provide education regarding the use of this drug. The nurse will advise the patient that

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

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for

falls.

Primary hypertension comprises 90% to 95% of hypertensive cases. It is hypertension for which no cause can be found. Which drug groups are used in the management of primary hypertension? Select all that apply.

• ACE inhibitors • Antiadrenergics • Angiotensin II receptor blockers

When describing the adverse effects associated with ACE inhibitors, which of the following would the nurse include? Select all that apply.

• Constipation • Proteinuria • Photosensitivity • Cough

The nurse is administering a beta blocker to a patient with hypertension. Which of the following would the nurse expect this drug to do? Select all that apply.

• Increase renal blood flow • Decrease heart rate • Decrease cardiac muscle contraction

A client with newly diagnosed hypertension should be counseled to do which of the following? Select all that apply:

• Lose weight • Stop smoking • Reduce stress

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)

• Monitoring for drug effects • Promoting compliance with the prescribed pharmacologic modifications • Promoting compliance with the prescribed lifestyle modifications