WEEK 9: Part 1 Drugs that Affect the Heart and Blood Vessels

C. a thiazide diuretic. This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective, but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy, but should also begin drug therapy because hypertension already exists.

1. A patient has had blood pressures of 150/95 mm Hg 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. a beta blocker. B. a loop diuretic and spironolactone. C. a thiazide diuretic. D. counseling on lifestyle changes.

C. LDL less than 100 mg/dL

A 45-year-old female smoker with a family history of coronary heart disease (CHD) has been prescribed a lipid-lowering medication. Which outcome would be most important for this patient? A. Cholesterol total less than 200 mg/dL B. HDL greater than 40 mg/dL C. LDL less than 100 mg/dL D. Triglycerides less than 150 mg/dL

A. perform a detailed health history on the child. Because the incidence of secondary hypertension is much higher in children than adults, it is important to obtain an accurate health history to help uncover primary causes. Once the type of hypertension is established, the teaching interventions may be useful. Hypertension must be treated, and it is incorrect to reassure parents that their child may just outgrow the condition.

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: A. perform a detailed health history on the child. B. provide teaching about antihypertensive medications. C. reassure the parents that their child may outgrow this condition. D. teach the parents about lifestyle changes and a special diet.

A. administer a beta blocker. This patient is showing signs of reflex tachycardia, so a beta blocker is indicated to slow the heart rate. Patients with heart failure who take hydralazine often require the addition of isosorbide dinitrate, which also dilates veins. There is no indication for reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium and water retention is present.

A female patient with essential hypertension is being treated with hydralazine (Apresoline) 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to: A. administer a beta blocker. B. administer a drug that dilates veins. C. reduce the dose of hydralazine. D. give the patient a diuretic.

A. Notify the provider and discuss ordering a beta blocker for this patient. Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI; beta blockers are indicated for patients with pre-existing heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition.

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? A. Notify the provider and discuss ordering a beta blocker for this patient. B. Notify the provider and suggest a thiazide diuretic as initial therapy. C. Order a diet low in sodium and high in potassium for this patient. D. Recheck the patient's blood pressure in 4 hours to verify the result.

C. Recheck the patient's blood pressure in the other arm. Diagnosis of hypertension should be based on several blood pressure readings, not just one. High readings should be confirmed in the contralateral arm. Low-sodium diets are indicated for patients with confirmed hypertension. An electrocardiogram and blood tests are indicated for patients with confirmed hypertension to rule out primary causes. Thiazide diuretics are first-line drugs for confirmed hypertension.

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? A. Instruct the patient to consume a low-sodium diet. B. Prepare the patient for an electrocardiogram and blood tests. C. Recheck the patient's blood pressure in the other arm. D. Request an order for a thiazide diuretic.

D. "When my symptoms subside, I may discontinue the medications." Patients should be taught that hypertension treatment is lifelong and that medications must be continued even when symptoms subside. Long-term problems may still occur without symptoms. Reporting drug side effects is necessary so that other drugs may be tried if needed.

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? A. "I may experience serious long-term problems even if I am not having symptoms." B. "I should report side effects to the provider since other drugs may be substituted." C. "I will need to take medications on a long-term basis." D. "When my symptoms subside, I may discontinue the medications."

C. Increased tissue perfusion Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload, which allows cardiac output and tissue perfusion to increase. A decrease in preload would be the result of dilation of capacitance vessels, or veins. Dilation of arterioles increases cardiac output. Ventricular contraction results when preload is increased.

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? A. Decreased cardiac preload B. Decreased cardiac output C. Increased tissue perfusion D. Increased ventricular contraction

B. Increased tissue perfusion Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload, which allows cardiac output and tissue perfusion to increase. A decrease in preload would be the result of dilation of capacitance vessels, or veins. Dilation of arterioles increases cardiac output. Ventricular contraction results when preload is increased

A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient? A. Increased ventricular contraction B. Increased tissue perfusion C. Decreased cardiac preload D. Decreased cardiac output

C. AV blockade. Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia

A nurse is caring for a patient who is receiving Calan for hypertension and Lanoxin for heart failure. The nurse will observe this patient for: A. gingival hyperplasia. B. migraine headaches. C. AV blockade. D. reflex tachycardia

A. AV blockade. Verapamil and digoxin both suppress impulse conduction through the AV node; when the two drugs are used concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rare cases with verapamil, but it is not an acute symptom. Verapamil can be used to prevent migraine, and its use for this purpose is under investigation. Verapamil and digoxin both suppress the heart rate. Nifedipine causes reflex tachycardia.

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. AV blockade. B. gingival hyperplasia. C. migraine headaches. D. reflex tachycardia

A. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." Hydralazine can cause severe reflex tachycardia; a beta blocker is usually given to counter this effect. Postural hypotension is minimal with hydralazine. Patients should be taught to report joint pain, which indicates an SLE syndrome and requires discontinuation of the drug. Minoxidil can cause excessive hair growth, not hydralazine

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? A. "I will also take a beta blocker medication with this drug to prevent rapid heart rate." B. "I may develop joint pain, but this side effect will decrease over time." C. "This drug may cause excessive hair growth on my face, arms, and back." D. "I will need to ask for assistance when getting up out of a chair."

D. "This drug will help lower my blood pressure and will benefit my kidneys." ACE inhibitors reduce blood pressure and help preserve renal function in people with diabetes. ACE inhibitors dilate both veins and arterioles. ACE inhibitors work on the renin-angiotensin-aldosterone system, not the nervous system. ACE inhibitors do not have effects on the bronchioles of the lungs.

A nurse is caring for a patient with hypertension and diabetes. The patient's prescriber recently ordered an angiotensin-converting enzyme (ACE) inhibitor. Which statement by the patient indicates understanding of the nurse's teaching about this drug? A. "ACE inhibitors only dilate veins, so I may have more edema in my ankles." B. "ACE inhibitors prevent the nervous system from causing increased blood pressure." C. "This drug can also cause shortness of breath because of bronchoconstriction." D. "This drug will help lower my blood pressure and will benefit my kidneys."

A. "Beta blockers block the actions of angiotensin II." Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin.

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? A. "Beta blockers block the actions of angiotensin II." B. "Beta blockers decrease heart rate and contractility." C. "Beta blockers decrease peripheral vascular resistance." D. "Beta blockers decrease the release of renin."

D. "You should continue your exercise program to increase your HDL serum levels." Regular exercise can reduce LDL cholesterol and elevate high-density lipoprotein (HDL) cholesterol, thereby reducing the risk of coronary heart disease (CHD). The patient should consider the cholesterol-lowering drug an adjunct to a proper diet and exercise. Drug therapy cannot replace other important interventions, such as diet and exercise. The patient should never be instructed to double the dose. Constipation is a side effect of most cholesterol-lowering agents. The patient should be encouraged to eat a high-fiber diet and increase fluids if not contraindicated.

A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education? A. "This medication will replace other interventions you have been trying." B. "It is important for you to double your dose if you miss one to maintain therapeutic blood levels." C. "Stop taking the medication if you experience constipation." D. "You should continue your exercise program to increase your HDL serum levels."

A. Evaluating ankle edema Fluid retention is a common and serious adverse effect of minoxidil, because it can lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and vomiting may occur with this drug but is not a serious side effect. Hypertrichosis occurs in about 80% of patients taking the drug, but its effects are cosmetic and not life threatening. It may be important to monitor the blood glucose level in some patients, because the drug can alter glucose tolerance, but this effect is not as serious as fluid retention.

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 per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient? A. Evaluating ankle edema B. Monitoring for nausea and vomiting C. Noting the presence of hypertrichosis D. Obtaining a blood glucose

A. Evaluating ankle edema Fluid retention is a common and serious adverse effect of minoxidil, because it can lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and vomiting may occur with this drug but is not a serious side effect. Hypertrichosis occurs in about 80% of patients taking the drug, but its effects are cosmetic and not life threatening. It may be important to monitor the blood glucose level in some patients, because the drug can alter glucose tolerance, but this effect is not as serious as fluid retention

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? A. Evaluating ankle edema B. Noting the presence of hypertrichosis C. Obtaining a blood glucose D. Monitoring for nausea and vomiting

C. "I will monitor the heart rate frequently to assess for reflex tachycardia." Reflex tachycardia is not an expected effect; the greater risk is cardiosuppression and bradycardia. Because beta blockers and verapamil have the same effects on the heart, there is a risk of excessive cardiosuppression. To minimize this risk, the two drugs should be given several hours apart. Hypotension may occur and should be treated with IV norepinephrine.

A nurse is preparing to assist a nursing student in administering 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? A. "I will check to see when the last dose of the beta blocker was given." B. "I will monitor vital signs closely to assess for hypotension." C. "I will monitor the heart rate frequently to assess for reflex tachycardia." D. "I will prepare to administer intravenous norepinephrine if necessary."

C. "I can take cholestyramine with my hydrochlorothiazide." Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine.

A nurse is providing discharge teaching instructions for a patient taking cholestyramine (Questran). Which statement made by the patient demonstrates a need for further teaching? A. "I will take warfarin (Coumadin) 1 hour before my medicine." B. "I will increase the fluids and fiber in my diet." C. "I can take cholestyramine with my hydrochlorothiazide." D. "I will take digoxin 4 hours after taking the cholestyramine."

D. "I cannot take digoxin while on this medication." Digoxin can be taken 1 hour before or 4 hours after taking a bile acid sequestrant. Colesevelam reduces the LDL cholesterol level, which is one of its therapeutic uses. Colesevelam augments statin therapy. Colesevelam does not significantly interact with or reduce the absorption of statins, digoxin, warfarin, or most other drugs.

A nurse is providing patient education about colesevelam (Welchol), a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching? A. "Colesevelam will reduce my levels of low-density lipoprotein." B. "Colesevelam will augment my statin drug therapy." C. "I will not have to worry about having as many drug interactions as I did when I took cholestyramine." D. "I cannot take digoxin while on this medication."

C. anticoagulant effects; increased Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may need to be reduced.

A nurse is reviewing a patient's medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____. A. level of gemfibrozil; increased B. level of gemfibrozil; reduced C. anticoagulant effects; increased D. anticoagulant effects; reduced

A. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia. Colesevelam can help control hyperglycemia in patients with diabetes; therefore, hypoglycemia is a possible risk. Hyperglycemia is not a risk for patients with diabetes who take colesevelam. Insulin and colesevelam do not interact; therefore, the insulin can be taken at the patient's preferred time or times. Either insulin or oral antidiabetic agents can be taken with colesevelam.

A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient? A. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia. B. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hyperglycemia. C. The patient needs to take the insulin at least 3 hours before the colesevelam. D. The patient needs to use an oral antidiabetic agent or agents, not insulin, with colesevelam.

B. "Reflex tachycardia can negate the desired effects of vasodilators." Reflex tachycardia, which is a compensatory mechanism in response to decreased blood pressure, can negate the desired effect of a vasodilator by eventually increasing blood pressure. Baroreceptors relay information to the vasomotor center of the medulla; the medulla sends impulses to the heart. Beta blockers are given to counter reflex tachycardia. Reflex tachycardia can be produced by dilation of both arterioles and veins.

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? A. "Baroreceptors in the aortic arch stimulate the heart to beat faster." B. "Reflex tachycardia can negate the desired effects of vasodilators." C. "Reflex tachycardia is more likely to occur when beta blockers are given." D. "Venous dilation must occur for reflex tachycardia to occur."

D. "Reflex tachycardia can negate the desired effects of vasodilators." Reflex tachycardia, which is a compensatory mechanism in response to decreased blood pressure, can negate the desired effect of a vasodilator by eventually increasing blood pressure. Baroreceptors relay information to the vasomotor center of the medulla; the medulla sends impulses to the heart. Beta blockers are given to counter reflex tachycardia. Reflex tachycardia can be produced by dilation of both arterioles and veins

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? A. "Venous dilation must occur for reflex tachycardia to occur." B. "Baroreceptors in the aortic arch stimulate the heart to beat faster." C. "Reflex tachycardia is more likely to occur when beta blockers are given." D. "Reflex tachycardia can negate the desired effects of vasodilators."

A. "I may become constipated, so I should increase fluids and fiber." Constipation is common with verapamil and can be minimized by increasing dietary fiber and fluids. Verapamil lowers the heart rate. Peripheral edema may occur secondary to vasodilation, and patients should notify their prescriber if this occurs, because the prescriber may use diuretics to treat the condition. Verapamil and digoxin have similar cardiac effects; also, verapamil may increase plasma levels of digoxin by as much as 60%, so digoxin doses may need to be reduced.

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? A. "I may become constipated, so I should increase fluids and fiber." B. "I may experience a rapid heart rate as a result of taking this drug." C. "I may have swelling of my hands and feet, but this will subside." D. "I may need to increase my digoxin dose while taking this drug."

C. rebound hypertension. Sodium nitroprusside acts rapidly and is given only intravenously. Rebound hypertension occurs immediately when the IV is stopped, so an oral antihypertensive should be given simultaneously. Cyanide poisoning can occur with sodium nitroprusside, but giving hydralazine does not counter this adverse effect. Hydralazine does not prevent fluid retention or reflex tachycardia.

A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside (Nitropress) and oral hydralazine (Apresoline). The nurse will explain that this is done to prevent: A. cyanide poisoning. B. fluid retention. C. rebound hypertension. D. reflex tachycardia.

D. "Two or more drugs will lower blood pressure more quickly." Multi-drug therapy does not lower blood pressure more quickly. Using more than one drug often means that doses can be decreased. Some agents can offset adverse effects of other agents. Treatment via different mechanisms increases the likelihood of success.

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? A. "Multi-drug therapy often means that drugs may be given in lower doses." B. "Some agents are used to offset adverse effects of other agents." C. "Treatment of hypertension via different mechanisms increases success." D. "Two or more drugs will lower blood pressure more quickly."

A. prevent reflex tachycardia. Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers can reduce the adverse cardiac effects of nifedipine

A patient begins taking Procardia, along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: A. prevent reflex tachycardia. B. minimize gingival hyperplasia. C. prevent constipation. D. reduce flushing

D. prevent reflex tachycardia. Beta blockers are combined with nifedipine to prevent reflex tachycardia. Beta blockers do not reduce flushing, minimize gingival hyperplasia, or prevent constipation. Beta blockers can reduce the adverse cardiac effects of nifedipine.

A patient begins taking nifedipine (Procardia), along with a beta blocker, to treat hypertension. The nurse understands that the beta blocker is used to: A. reduce flushing. B. minimize gingival hyperplasia. C. prevent constipation. D. prevent reflex tachycardia.

B. Do not crush or chew tablet.

A patient has been prescribed extended-release nifedipine. Teaching regarding administration should include which instruction? A. Administer 1 hour before or 2 hours after meals. B. Do not crush or chew tablet. C. Take with grapefruit juice to improve absorption. D. Take on an empty stomach.

C. "I will need to take potassium supplements when adding this drug." Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Patients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis.

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? A. "I should continue following the DASH diet when adding this drug." B. "I should not take an ACE inhibitor when adding this drug." C. "I will need to take potassium supplements when adding this drug." D. "I will not experience a significant increase in diuresis when adding this drug."

B. "You should come into the clinic for liver enzymes in 1 month." Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods.

A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate? A. "Statins reduce the risk of stroke." B. "You should come into the clinic for liver enzymes in 1 month." C. "Statins reduce the risk of coronary events in people with normal LDL levels." D. "You should maintain a healthy lifestyle and avoid high-fat foods."

C. a thiazide diuretic. This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists

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. a loop diuretic and spironolactone. B. counseling on lifestyle changes. C. a thiazide diuretic. D. a beta blocker.

A. Hypertension Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg. When systolic and diastolic BP fall into different categories, classification is based on the higher category. This patient has a hypertensive diastolic BP. Isolated systolic hypertension occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg. Because this patient has an elevated diastolic BP, it is not considered normal. Prehypertension occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg.

A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient's BP? A. Hypertension B. Isolated systolic hypertension C. Normal D. Prehypertension

D. Sodium nitroprusside (Nitropress) IV Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV. Minoxidil is effective, but its severe side effects make it a second-line drug.

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? A. Captopril PO B. Hydralazine (Apresoline) 25 mg PO C. Minoxidil 20 mg PO D. Sodium nitroprusside (Nitropress) IV

A. Nitropress IV Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be used but should be given IV. Minoxidil is effective, but its severe side effects make it a second-line drug. Also a big test taking clue in this question is that the question says SEVERE, Nitropress is the only answer with an IV medication, you would not treat a severe HTN crisis with a PO medication

A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication? A. Nitropress IV B. Apresoline 25 mg PO C. Minoxidil 20 mg PO D. Captopril PO

A. Facial flushing D. Gastric upset E. Itching Adverse effects of nicotinic acid include intense flushing of the face, neck, and ears; itching; and GI upset (nausea, vomiting, and diarrhea). Constipation and hypoglycemia are not adverse effects of niacin therapy.

A patient is being started on nicotinic acid (Niaspan) to reduce triglyceride levels. The nurse is providing patient education and should include which adverse effects? (Select all that apply.) A. Facial flushing B. Constipation C. Hypoglycemia D. Gastric upset E. Itching

D. Pulse 50 beats/min Blockade of cardiac calcium channels can cause bradycardia, AV block and HF

A patient is prescribed diltiazem. It would be a priority to withhold the drug and contact the prescriber if which assessment finding is present? A. BP 150/85 mm Hg B. Constipation C. Dizziness with position changes D. Pulse 50 beats/min

B. INR 3

A patient is prescribed gemfibrozil and warfarin. Which lab result suggests that the warfarin dose is therapeutic? A. International normalized ratio (INR) 1 B. INR 3 C. INR 6 D. INR 10

A. caution the patient not to get up without assistance. Postural hypotension occurs when moving from a supine or seated position to an upright position. It is caused by relaxation of smooth muscle in veins, which allows blood to pool in veins and decreases venous return of blood to the heart. Patients taking such drugs should ask for assistance when getting up to prevent falls. Prolonged use of vasodilators can lead to expansion of blood volume and fluid overload, so increasing fluid intake is not appropriate. Shortness of breath is a symptom associated with heart failure. Tachycardia can occur when the blood pressure drops as a result of the baroreceptor reflex.

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: A. caution the patient not to get up without assistance. B. encourage the patient to increase fluid intake. C. tell the patient to report shortness of breath. D. warn the patient about the possibility of bradycardia.

C. Drink extra fluids and avoid driving when drowsy. Clonidine can cause dry mouth and sedation; patients should be warned to drink extra fluids and avoid driving. Beta blockers do not reverse these drug side effects. Discontinuing clonidine abruptly can cause severe rebound hypertension. These are common side effects that do not abate over time.

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient? A. Beta blockers can reverse these side effects. B. Discontinue the medication immediately and notify the provider. C. Drink extra fluids and avoid driving when drowsy. D. Notify the provider if symptoms persist after several weeks.

C. myopathy. When gemfibrozil and a statin are taken concurrently, the risk of myopathy is increased more than with either agent alone. Migraines, hypothyroidism, and heart failure are not drug-to-drug interactions.

A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual's medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of: A. migraines. B. hypothyroidism. C. myopathy. D. heart failure.

D. Discuss using methyldopa instead while she is pregnant. Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.

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? A. Controlling her blood pressure will decrease her risk of preeclampsia. B. Ask the provider about changing to an ARB during pregnancy. C. Continue taking the ACE inhibitor during her pregnancy. D. Discuss using methyldopa instead while she is pregnant.

A. nausea and vomiting.

A patient taking both verapamil and digoxin is at greater risk for digoxin toxicity. The nurse should assess and monitor the patient for early symptoms of digoxin toxicity, which include A. nausea and vomiting. B. slurred speech. C. cough. D. photophobia.

D. The patient's creatinine kinase levels Creatinine kinase levels are the best laboratory indicator of myopathy and/or rhabdomyolysis, which may lead to renal failure. As can the statins, gemfibrozil and other fibrates can cause myopathy. Fibrates must be used with caution in patients taking statins. Concurrent use of gemfibrozil and rosuvastatin does not cause tendon tenderness or a lupuslike syndrome. Liver function levels should be determined at the start of statin therapy and every 6 months thereafter in patients who do not have liver disease.

A patient taking gemfibrozil (Lopid) and rosuvastatin (Crestor) concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor? A. For tendon tenderness B. For a lupuslike syndrome C. The patient's LFT results D. The patient's creatinine kinase levels

B. The patient's creatinine kinase levels Creatinine kinase levels are the best laboratory indicator of myopathy and/or rhabdomyolysis, which may lead to renal failure. As with the statins, gemfibrozil and other fibrates can cause myopathy. Fibrates must be used with caution in patients taking statins. Concurrent use of gemfibrozil and lovastatin does not cause tendon tenderness or a lupus-like syndrome. Liver function levels should be determined at the start of statin therapy and every 6 months thereafter in patients who do not have liver disease

A patient taking gemfibrozil and lovastatin concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor? A. For tendon tenderness B. The patient's creatinine kinase levels C. The patient's liver function test results D. For a lupus-like syndrome

B. the DASH diet, sodium restriction, and exercise. This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated.

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: A. ACE inhibitors and calcium channel blocker medications. B. the DASH diet, sodium restriction, and exercise. C. increased calcium and potassium supplements. D. thiazide diuretics and lifestyle changes.

C. "I will need to take a beta blocker to prevent reflex tachycardia." Amlodipine produces selective blockade of calcium channels in blood vessels with minimal effects on the heart. Reflex tachycardia is not common, so a beta blocker is not indicated to prevent this effect. Dizziness and facial flushing may occur. Peripheral edema may occur and should be reported to the provider. Amlodipine is given once daily.

A patient who has been taking verapamil (Calan) for hypertension complains of constipation. The patient will begin taking amlodipine (Norvasc) to prevent 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? A. "I can expect dizziness and facial flushing with nifedipine." B. "I should notify the provider if I have swelling of my hands and feet." C. "I will need to take a beta blocker to prevent reflex tachycardia." D. "I will need to take this drug once a day."

C. Sustained-release formulas of nifedipine cause a more gradual drop in BP.

A patient who has experienced palpitations (reflex tachycardia) while taking nifedipine 20 mg 3 times a day has had his prescription changed to nifedipine ER 60 mg once a day. The patient asks the nurse how taking the same medication once a day instead of 3 times a day will help prevent palpitations. What should the nurse's response include? A. Rapid-acting formulas of nifedipine are more potent than sustained-release formulas. B. Blood levels of rapid-acting formulas of nifedipine rise more rapidly than with sustained-release formulas. C. Sustained-release formulas of nifedipine cause a more gradual drop in BP. D. Sustained-release formulas of nifedipine suppress the automaticity of the heart like verapamil.

C. Kidneys Elevated CK level is an indication of muscle damage. Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage

A patient who is receiving lovastatin experiences chest pain. CK level is 580 units/mL (CK-MM 99%) and troponin T 0.02 g/mL. It is of greatest priority for the nurse to monitor the functioning of which organ? A. Brain B. Heart C. Kidneys D. Lungs

B. "A reduction usually is seen within 2 weeks." Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months too see a change. The blood level of LDL cholesterol is not reduced immediately upon starting the drug; a reduction is seen within 2 weeks. Blood cholesterol is affected, specifically LDL cholesterol, not triglycerides.

A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer? A. "At least 6 months is required to see a change." B. "A reduction usually is seen within 2 weeks." C. "Blood levels normalize immediately after the drug is started." D. "Cholesterol will not be affected, but triglycerides will fall within the first week."

B. "A reduction usually is seen within 2 weeks." Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months to see a change. The blood level of LDL cholesterol is not reduced immediately upon starting the drug; a reduction is seen within 2 weeks. Blood cholesterol is affected, specifically LDL cholesterol, not triglycerides

A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, "How long will it take until I see an effect on my LDL cholesterol?" The nurse gives which correct answer? A. "It will take 6 months to see a change." B. "A reduction usually is seen within 2 weeks." C. "Blood levels normalize immediately after the drug is started." D. "Cholesterol will not be affected, but triglycerides will fall within the first week."

A. administering intravenous norepinephrine (NE) and isoproterenol. Verapamil toxicity can cause bradycardia and hypotension. Isoproterenol should be given to treat bradycardia and NE for hypotension. DC cardioversion is indicated for ventricular tachydysrhythmias, which this patient does not have. Patients with hypotension should be placed in Trendelenburg's position. Beta blockers will only exacerbate these effects.

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 per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate: A. administering intravenous norepinephrine (NE) and isoproterenol. B. assisting with direct-current (DC) cardioversion. C. placing the patient in an upright position. D. preparing to administer a beta blocker.

D. Palpitations, disorientation, and respiratory depression This rate may precipitate a drop in BP; additionally, prolonged infusions or rapid infusions may increase risk for cyanide or thiocyanide poisoning which involve the central nervous system (CNS)

A patient who weighs 165 lb is receiving IV nitroprusside sodium 300 mcg/min. An important nursing assessment at this dose is for what? A. Adequate fluid intake and urinary output B. Anorexia, nausea, and vomiting C. Fever, flushing, and chills D. Palpitations, disorientation, and respiratory depression

A. "I will take Tylenol with my medication to reduce the inflammatory effects." Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. Tylenol will not reduce the flushing or inflammatory effects of the medication; further patient teaching is required. The flushing reaction diminishes in several weeks and can be attenuated by taking 325 mg of aspirin 30 minutes before each dose. Nicotinic acid is hepatotoxic; therefore, the patient should be taught to have the liver enzymes checked and to self-monitor for signs and symptoms. Nicotinic acid reduces low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels.

A patient with a history of angina and hypertension is being started on nicotinic acid (Niacin). The nurse is providing patient education. What statement made by the patient demonstrates a need for further teaching? A. "I will take Tylenol with my medication to reduce the inflammatory effects." B. "I will be cautious taking this medication, because I have mild liver damage." C. "I will take an aspirin 30 minutes before my niacin to reduce flushing." D. "This medication will lower my triglyceride levels."

A. adding a calcium channel blocker to this patient's drug regimen. In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient's blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated.

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: A. adding a calcium channel blocker to this patient's drug regimen. B. lowering doses of the antihypertensive medications. C. ordering a high potassium diet. D. adding spironolactone to the drug regimen.

A. ACE inhibitors ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient? A. ACE inhibitors B. Beta blockers C. Direct-acting vasodilators D. Thiazide diuretics

C. Move slowly from sitting to standing when taking this drug. The most disturbing side effect of alpha blockers is orthostatic hypotension. Patients taking these drugs should be cautioned to stand up slowly to avoid lightheadedness or falls. A persistent cough is a common side effect of ACE inhibitors. It is not necessary to increase dietary potassium intake when taking this drug. Shortness of breath may occur in individuals with asthma who are taking beta blockers.

A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient? A. A persistent cough is a known side effect of this drug. B. Eat foods rich in potassium while taking this drug. C. Move slowly from sitting to standing when taking this drug. D. Report shortness of breath while taking this drug.

A. Notify the provider and ask about adding a beta blocker medication. Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common side effect of lowering blood pressure, caused by the baroreceptor reflex. The patient's blood pressure is responding to the medications, but the tachycardia warrants treatment. Reminding the patient to move slowly from sitting to standing is appropriate with any blood pressure medication, but this patient has reflex tachycardia, which must be treated. An electrocardiogram is not indicated.

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 per minute. What will the nurse do? A. Notify the provider and ask about adding a beta blocker medication. B. Reassure the patient that the medications are working. C. Remind the patient to move slowly from sitting to standing. D. Request an order for an electrocardiogram.

C. muscle pain. Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis. Daptomycin also can cause myopathy and therefore should be used with caution in patients concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the nurse as much concern as the likelihood of myopathy.

A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). The nurse should be concerned if the patient complains of: A. nausea. B. tiredness. C. muscle pain. D. headache.

A. Distended neck veins, muffled heart sounds, and narrow pulse pressure Minoxidil-induced fluid retention may result in cardiac tamponade; signs of tamponade include muffled heart sounds, distended neck veins and narrow pulse pressure (as systolic BP decreases, diastolic pressure increases)

A patient with severe hypertension is prescribed minoxidil. The nurse should contact the prescriber STAT if assessment findings include what? A. Distended neck veins, muffled heart sounds, and narrow pulse pressure B. Exertional dyspnea, 1+ ankle edema, and anxiety C. Headache, dizziness, and blurred vision D. Shift of point of maximal impulse (PMI) 2 cm to left and bruits over carotid arteries

C. Review the baseline liver function test results. Before administering rosuvastatin, the nurse should review the results of the baseline liver function tests (LFTs). Statins can be used by patients with liver disease but not by those with alcoholic or viral hepatitis. Administering the drug before obtaining baseline LFT results would not allow for an accurate baseline. The patient clearly already has liver disease.

A prescriber has ordered rosuvastatin (Crestor) for a patient with non-alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse before administration of this drug? A. Question the order, because rosuvastatin is contraindicated in patients with liver disease. B. No intervention is necessary; just administer the drug as ordered. C. Review the baseline liver function test results. D. Assess the patient for liver disease.

D. Reach levels twice as high in Asians as in Caucasians, resulting in a greater chance of hepatotoxicity Rosuvastatin reaches abnormally high levels in people of Asian heritage. Consequently, hepatotoxicity may occur more often in Asian patients because of the high level of the drug in the blood. Rosuvastatin does not cause renal or pancreatic toxicity. Rosuvastatin does not cause renal failure. Rosuvastatin does not create myoglobin in the urine.

An Asian patient comes to the clinic. Upon assessment, the nurse notes a slight yellow tint to the skin and sclera, edema, and hepatomegaly. The drug history reveals that the patient has been taking rosuvastatin (Crestor) for 6 months. The nurse is concerned, because rosuvastatin (Crestor) has been shown to do what? A. Cause renal and pancreatic toxicity specifically in Asian patients B. Cause renal failure C. Create myoglobin in the urine D. Reach levels twice as high in Asians as in Caucasians, resulting in a greater chance of hepatotoxicity

veins (venous system)

Calcium channel blockers (CCBs) differ from nitrates in that they do not cause vasodilation of __________________.

arterioles (blood vessels)

Dihydropyridine CCBs primarily affect _________________.

11 mL/h

Diltiazem is prescribed for IV infusion for a patient in atrial fibrillation. A dose of 5 mg/h has been prescribed. The pharmacy has supplied the drug in a concentration of 0.45 mg/mL. How many mL/h will the nurse program into the IV infusion pump?

to slow the heart when reflex tachycardia occurs

Drugs with the suffix -lol are used ______

C. "I will weigh myself weekly." Patients need not weigh themselves weekly when taking cholestyramine. Cholestyramine should be taken at least 1 hour before other medications. When taken with other medications, cholestyramine can inhibit the absorption of the other drugs. Constipation is the principal complaint with cholestyramine. It can be minimized by increasing dietary fiber and fluids. Regular blood pressure checks are a good idea. The patient is taking cholestyramine because of high cholesterol, which contributes to hypertension.

During discharge instruction, a nurse wants to assess a patient's understanding of treatment with cholestyramine (Questran). Which statement made by the patient best demonstrates a need for additional teaching? A. "I will take cholestyramine (Questran) 1 hour before my other medications." B. "I will increase fluids and fiber in my diet." C. "I will weigh myself weekly." D. "I will have my blood pressure checked weekly."

C. Postmenopausal African American woman

Hypertension in which patient would be classified as primary hypertension? A. Diabetic in end-stage renal failure B. Hyperthyroid adult C. Postmenopausal African American woman D. Young adult male with an adrenal tumor

B. Apical pulse In the SA node, calcium channel blockade can cause bradycardia; in the AV node, blockade can cause partial or complete AV bloke; and in the myocardium, blockade can decrease contractility

In addition to assessing blood pressure, what is the priority assessment before administering diltiazem? A. Ankle edema B. Apical pulse C. Peripheral pulses D. Respiratory rate

A. They affect adherence. Antihypertensive drugs can cause a number of adverse effects, ranging from sedation to sexual dysfunction; it is hard to convince people who feel well to take rugs that may make them feel worse

It is important for the nurse to discuss adverse effects of the antihypertensive drugs that are prescribed because the nurse knows what about the drugs' adverse effects? A. They affect adherence. B. They are life-threatening. C. They are necessary if the antihypertensive is at a dose that is effective. D. They reflect the cause of hypertension.

D. Temperature 101°F (38.3°C) If an SLE-like reaction occurs, hydralazine should be withdrawn. approximately 50% of patients have constitutional symptoms of fever, weight loss, and fatigue. Reporting fever as a priority over fatigue is important, as those with an SLE-like reaction may also develop pericarditis, of which low-grade fever is a sign

Laboratory test results on a patient receiving hydralazine include elevated antinuclear antibodies (ANA). When notifying the prescriber of these lab results, it is a priority to include which assessment finding? A. Fatigue B. Headache C. Respirations 22/min D. Temperature 101°F (38.3°C)

A. "Take lovastatin with your evening meal." Patients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach.

Lovastatin (Mevacor) is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? A. "Take lovastatin with your evening meal." B. "Take this medicine before breakfast." C. "You may take lovastatin without regard to meals." D. "Take this medicine on an empty stomach."

C. "Take mevacor with your evening meal." Patients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach

Mevacor is prescribed for a patient for the first time. The nurse should provide the patient with which instruction? A. "Take this medicine before breakfast." B. "You may take mevacor without regard to meals." C. "Take mevacor with your evening meal." D. "Take this medicine on an empty stomach."

C. Patients with familial hypercholesterolemia

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are indicated for: A. Patients who cannot tolerate statins B. Patients with type 2 diabetes mellitus C. Patients with familial hypercholesterolemia D. Primary treatment of patients with atherosclerotic heart conditions

A. Upper abdominal pain and nausea People with very high triglyceride levels are at increased risk for developing pancreatitis

Recent laboratory results for a patient include HDL 85 mg/dL, LDL 145 mg/dL, and triglycerides 630 mg/dL. The nurse should assess the patient for what? A. Upper abdominal pain and nausea B. Chest pain and shortness of breath C. Rash and pruritus D. Tachycardia and diaphoresis

within minutes of

The effects of an intravenous (IV) infusion of nitroprusside end ______ stopping the infusion.

A. True

The lowering of blood pressure and improvement of arterial blood flow to the heart counteract the negative effects of reduced heart rate and reduced force of contraction caused by verapamil. A. True B. False

A. Verapamil ER caps produces maximal effects in the morning when most cardiac events occur.

The nurse is administering time-released verapamil ER caps. The patient states she takes all of her medications in the morning when she awakens. The nurse's response should be based on what knowledge? A. Verapamil ER caps produces maximal effects in the morning when most cardiac events occur. B. Verapamil ER caps are given at night so the drug peaks during sleep to prevent orthostatic hypotension. C. Verapamil ER caps should not be administered with any other medication. D. Verapamil ER caps should be taken at night because they cause sedation.

C. Sacral area

The nurse is caring for a nonambulatory patient who is receiving hydralazine. When monitoring for adverse effects, the nurse would expect that edema would first appear where? A. Around the medial malleolus of the ankle B. Fingers C. Sacral area D. Dorsal aspect of the feet

A. Crackles or pulmonary edema C. Shortness of breath E. Weight gain of 3 lb in 24 hours Verapamil can exacerbate cardiac dysfunction in patients with bradycardia, sick sinus syndrome, HF, and AV block. beta blockers can intensify the adverse cardiac effects of verapamil

The nurse is caring for a patient who is scheduled to receive verapamil and atenolol, a β1-adrenergic blocker, at 0900. It is important for the nurse to assess for what critical adverse effects based on the combination of these two drugs before administration? (Select all that apply.) A. Crackles or pulmonary edema B. Muscle pain C. Shortness of breath D. Urinary output of at least 45 mL/h E. Weight gain of 3 lb in 24 hours

A. Decrease in cardiac work Vasodilators that dilate capacitance vessels, or veins, lead to a decrease in venous return to the heart, which reduces preload and the force of ventricular contraction. The resultant effect is a decrease in cardiac work. With a decrease in ventricular contraction, cardiac output is reduced, as is tissue perfusion. Dilation of veins causes a decrease in venous return.

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? A. Decrease in cardiac work B. Increase in cardiac output C. Increase in tissue perfusion D. Increase in venous return

B. Hydralazine (Apresoline) The drug of choice for lowering blood pressure in a patient with severe preeclampsia is hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of their potential for fetal harm.

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? A. Angiotensin-converting enzyme (ACE) inhibitor B. Hydralazine (Apresoline) C. Magnesium sulfate D. Sodium nitroprusside

C. Start a second intravenous site and administer the nitroprusside sodium using a separate intravenous pump. No other drugs should be mixed with nitroprusside solution

The nurse is preparing to administer IV nitroprusside sodium. The patient has an IV of 5% dextrose with 20 mEq of potassium running at 75 mL/hr. What would be the best action by the nurse? A. Connect the nitroprusside sodium to the Y-port of the primary line above the intravenous pump and run both fluids simultaneously. B. Disconnect the primary intravenous line and administer the nitroprusside sodium, then reconnect the primary line. C. Start a second intravenous site and administer the nitroprusside sodium using a separate intravenous pump. D. Stop the primary fluid infusion and connect the nitroprusside sodium to a port below the intravenous pump.

A. Administer the medication.

The nurse is preparing to administer nitroprusside sodium. The solution has just been prepared in the pharmacy, but has a faint brown discoloration. What should the nurse do? A. Administer the medication. B. Consult the prescriber before administering the solution. C. Discard the solution and get a new bag from the pharmacy. D. Warm the IV bag and reassess to see if the brown color clears.

20 mg is the safe dose for this patient

The recommended initial dose of diltiazem IV push is 0.25 mg/kg for adult patients. What is the recommended safe dose for a patient who weighs 178 lb?

-ine

The suffix of the generic name of dihydropyridine CCBs is ________________.

vasodilation; reduced arterial pressure; increase coronary perfusion

The three net effects of the CCBs verapamil and diltiazem on the heart are _______, ___________ __________ _________, and __________ ______________ _____________.

dilating aterioles

Verapamil lowers blood pressure by ___________________.

0.1

When a patient is receiving nitroprusside, the nurse would report a thiocyanate level greater than ___ mg/mL

D. Shortness of breath Minoxidil may lead to volume expansion so severe as to cause cardiac decompensation

When caring for a patient who is prescribed minoxidil, it is most important for the nurse to assess for what? A. Abnormal hair growth B. Bradycardia C. Fluid volume deficit D. Shortness of breath

A. Angina of effort B. Cardiac dysrhythmias C. Essential hypertension Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in patients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in patients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor.

Which are therapeutic uses for verapamil? (Select all that apply.) A. Angina of effort B. Cardiac dysrhythmias C. Essential hypertension D. Sick sinus syndrome E. Suppression of preterm labor

B. Cardiac dysrhythmias D. Essential hypertension E. Angina of effort Verapamil is used to treat both vasospastic angina and angina of effort. It slows the ventricular rate in patients with atrial flutter, atrial fibrillation, and paroxysmal supraventricular tachycardia. It is a first-line drug for the treatment of essential hypertension. It is contraindicated in patients with sick sinus syndrome. Nifedipine has investigational uses in suppressing preterm labor.

Which are therapeutic uses of verapamil? (Select all that apply.) A. Suppression of preterm labor B. Cardiac dysrhythmias C. Sick sinus syndrome D. Essential hypertension E. Angina of effort

B. Erythematous, oozing vesicles on the chin and inside of elbows A rash is a common side effect of diltiazem; serious reactions include erythema multiforme, exfoliative dermatitis, and acute generalized pustulosis

Which dermatologic finding in an older adult would warrant consultation with the prescriber regarding administration of diltiazem? A. Burrows and erythematous papules between the fingers B. Erythematous, oozing vesicles on the chin and inside of elbows C. Silvery, scaling plaques on the elbows D. White, cheesy plaque on the tongue

C. Diuretic

Which drug class is recommended as first-line treatment for an African American patient with hypertension? A. ACE inhibitor B. Calcium channel blocker C. Diuretic D. Vasodilator

B. Furosemide

Which drug is commonly prescribed for patients with heart failure when prescribed hydralazine because of the adverse effect of sodium retention? A. Atenolol B. Furosemide C. Isosorbide dinitrate D. Minoxidil

C. Prazosin (Minipress) D. Captopril (Capoten) E. Losartan (Cozaar) Postural, or orthostatic, hypotension is defined as a fall in blood pressure related to a change in position. Minoxidil and diltiazem dilate arterioles; therefore, they are not likely to cause postural hypotension. Prazosin, captopril, and losartan all reportedly can cause orthostatic hypotension.

Which medications are most likely to cause postural hypotension? (Select all that apply.) A. Minoxidil B. Diltiazem (Cardizem) C. Prazosin (Minipress) D. Captopril (Capoten) E. Losartan (Cozaar)

C. An older adult D. A 5-year-old child E. A 1-month-old infant Hydralazine may be used in infants as young as 1 month of age, in children, and in older adults. Hydralazine is labeled pregnancy category C and data is lacking regarding transmission of hydralazine in breast-feeding women, so benefits should outweigh risks

Which patients may receive hydralazine to treat hypertension? (Select all that apply.) A. A mother breast-feeding a newborn B. A pregnant woman C. An older adult D. A 5-year-old child E. A 1-month-old infant

B. Consult the prescriber before stopping the drug.

Which teaching would most likely prevent the most serious effect when a patient is prescribed clonidine for hypertension? A. Change positions slowly. B. Consult the prescriber before stopping the drug. C. Exercise regularly. D. Use sugar-free candy.

A. Hydrochlorothiazide and nadolol When using two or more drugs to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are both vasodilators. Spironolactone and amiloride are both potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics.

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions? A. Hydrochlorothiazide and nadolol B. Hydralazine and minoxidil C. Spironolactone and amiloride D. Trichlormethiazide and hydrochlorothiazide

C. Pulse 120 beats/min Principle adverse effects of hydralazine are hypotension, tachycardia; the risk of orthostatic hypotension is low

Which would be a priority to report to the prescriber of hydralazine? A. Ankle edema B. Blood pressure (BP) 150/80 mm Hg C. Pulse 120 beats/min D. 10 mm Hg drop in BP when sitting up from a reclining position

Orthostatic

____ hypotension is more likely to occur when a patient is receiving a drug that dilates veins than one that dilates arterioles.

Hydralazine

____ reduces the work of the heart by reducing afterload

alpha and beta blockers

what class of antihypertensive drug causes blood pressure reduction resulting from dilation of arterioles and veins; reduction of heart rate and contractility; and suppression of renin release.

Non-dihydropyridine CCBs

what class of antihypertensive drug have direct suppressant effects on the heart, reducing reflex tachycardia.

Aldosterone antagonists

what class of antihypertensive drug promotes renal excretion of sodium and water, and renal retention of potassium.

Potassium-sparing diuretics

what class of antihypertensive drug, because of their ability to conserve potassium, play an important role in an antihypertensive regimen

Direct-acting vasodilators

what class of antihypertensive drug, because venous dilation is minimal, has a low risk of orthostatic hypotension?

Direct renin inhibitors

what class of antihypertensive drugs act directly on renin to inhibit conversion of angiotensinogen into angiotensin I

Centrally acting α2 agonists

what class of antihypertensive drugs act within the brainstem to suppress sympathetic outflow to the heart and blood vessels

β-adrenergic blockers

what class of antihypertensive drugs are less effective in African Americans than whites

Thiazide diuretics

what class of antihypertensive drugs are the first-line for hypertension.

Adrenergic neuron blockers

what class of antihypertensive drugs deplete norepinephrine from postganglionic sympathetic nerve terminals.

Calcium channel blockers (CCBs)

what class of antihypertensive drugs fall into two groups: dihydropyridines and non-dihydropyridines

Angiotensin receptor blockers (ARBs)

what class of antihypertensive drugs have low incidence of inducing cough.

α1 blockers

what class of antihypertensive drugs prevent sympathetically mediated vasoconstriction

Loop diuretics

what class of antihypertensive drugs produce much greater diuresis than the thiazides.

Angiotensin-converting enzyme inhibitors (ACEIs)

what type of antihypertensive drugs prevent formation of angiotensin II, thereby preventing angiotensin II-mediated vasoconstriction and aldosterone-mediated volume expansion

A. Bradycardia at rest

β-adrenergic blockers that have intrinsic sympathomimetic activity decrease the incidence of what adverse effect? A. Bradycardia at rest B. Bronchoconstriction C. Heart block D. Hypoglycemia