ch 26 - HTN

A patient has had great difficulty controlling hypertension with standard drug therapy. She says, "My neighbor couldn't get her blood pressure down until the doctor started her on hydralazine (Apresoline). Which response, by the nurse, is indicated? Select all that apply. 1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 2. "Your neighbor must be over age 70." 3. "Your lupus diagnosis keeps us from using that drug." 4. "You should not use that drug because you have rheumatoid arthritis." 5. "We try to avoid using hydralazine (Apresoline) because it causes constant coughing."

1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 3. "Your lupus diagnosis keeps us from using that drug." Rationale 1: Rheumatic heart disease is a contraindication to use of hydralazine (Apresoline). Rationale 2: There is no correlation between hydralazine (Apresoline) use and age. Rationale 3: Lupus is a contraindication to use of hydralazine (Apresoline). Rationale 4: There is no correlation between hydralazine (Apresoline) use and presence of rheumatoid arthritis. Rationale 5: There is no correlation between hydralazine (Apresoline) use and coughing.

A patient says, "Since I started taking metoprolol (Lopressor), I have been having problems having sex. I think I am going to stop taking it." What nursing responses are indicated? Select all that apply. 1. "Sexual dysfunction is a common problem with this drug." 2. "Perhaps it would be better if you took atenolol (Tenormin)." 3. "I cannot stop you from discontinuing the drug." 4. "Stopping the drug all at once may make your blood pressure get higher." 5. "Try taking the drug early in the morning."

1. "Sexual dysfunction is a common problem with this drug." 4. "Stopping the drug all at once may make your blood pressure get higher." Rationale 1: One of the major causes of noncompliance is the effect beta blockers have on male sexual function. Rationale 2: Atenolol (Tenormin) is also a beta blocker. Rationale 3: While this is true, it does not address the issue. Rationale 4: Abrupt cessation of beta-blocker therapy can result in rebound HTN. Rationale 5: Time of administration is not likely to change overall effects of the drug.

Which statement is accurate in regard to secondary hypertension? 1. There is no known cause. 2. It can result from chronic renal impairment. 3. It is also known as idiopathic. 4. It accounts for 90% of all hypertensive cases.

2. It can result from chronic renal impairment. Rationale 1: Primary hypertension has no known cause. Rationale 2: Secondary hypertension has an identifiable cause. Rationale 3: Primary hypertension is known as idiopathic. Rationale 4: Secondary hypertension accounts for 10% of all cases.

The nurse is caring for an African American male who has just been diagnosed with hypertension and mild heart failure. The nurse anticipates that this patient will be started on which medications? Select all that apply. 1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) 3. An ACE inhibitor like enalapril (Vasotec) 4. A beta-adrenergic antagonist like atenolol (Tenormin) 5. An angiotensin-II receptor blocker like clonidine (Catapres)

1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) Rationale 1: The combination drug BiDil, a fixed dose combination of hydralazine and isosorbide dinitrate is used to treat heart failure African American patients appear to show an enhanced response to this medication. Rationale 2: Calcium channel blockers seem to provide the greatest blood pressure reduction in this population. Rationale 3: Monotherapy with ACE inhibitors does not reduce blood pressure as effectively in African Americans as in other groups. Rationale 4: Monotherapy with beta-adrenergic antagonists does not reduce blood pressure as effectively in African Americans as in other groups. Rationale 5: Monotherapy with angiotensin-II receptor blockers does not reduce blood pressure as effectively in African Americans as in other groups.

A patient is brought to the emergency department in hypertensive crisis. The nurse plans care to protect which bodily systems that are most implicated in compensating for this crisis? Select all that apply. 1. Cardiac 2. Respiratory 3. Integumentary 4. Gastrointestinal 5. Renal

1. Cardiac 5. Renal Rationale 1: The heart responds to hypertension by decreasing heart rate and stroke volume. Rationale 2: The respiratory system does not help regulate blood pressure. Rationale 3: The integumentary system does not help regulate blood pressure. Rationale 4: The gastrointestinal system does not help regulate blood pressure. Rationale 5: The kidney responds to hypertension by increasing urine output to decrease blood volume

A young female patient is being treated for hypertension. The nurse would be most concerned if the patient became pregnant while taking which drug? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)

1. Enalapril (Vasotec) Rationale 1: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed. Rationale 2: Potassium supplements are Pregnancy Category A drugs. Rationale 3: Doxazosin (Cardura) is a Pregnancy Category B drug. Rationale 4: HCTZ is a Pregnancy Category B drug.

The patient has been recently diagnosed with hypertension with a sustained blood pressure of 144/90 mmHg. The patient is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this patient? Select all that apply. 1. Kidney damage 2. Stroke 3. Liver failure 4. Heart failure 5. Blindness

1. Kidney damage 2. Stroke 4. Heart failure 5. Blindness Rationale 1: The kidneys are affected by hypertension. Rationale 2: Stroke is a common effect of hypertension. Rationale 3: Liver failure is not commonly associated with hypertension. Rationale 4: The heart is affected by hypertension. Rationale 5: The retina is affected by hypertension.

Which interventions would be indicated and take highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? 1. Smoking-cessation program 2. Diuretic therapy 3. Weight-loss program 4. Stress management

1. Smoking-cessation program Rationale 1: Smoking cessation is the priority. Rationale 2: This patient is not necessarily a candidate for drug therapy, given that she is in the prehypertension class. Rationale 3: Although weight management is very important, this patient has a normal body mass index of 20. Rationale 4: There is nothing provided in the question that indicates the woman is suffering from stress.

The nurse is caring for a patient recently diagnosed with hypertension. The patient asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include Select all that apply. 1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). 3. beta-adrenergic antagonists. 4. direct-acting vasodilators. 5. peripheral adrenergic antagonists.

1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). Rationale 1: Diuretics are considered a primary antihypertensive agent and should be discussed with this patient. Rationale 2: ARBs are considered a primary antihypertensive agent and should be discussed with this patient. Rationale 3: Beta-adrenergic antagonists are considered second line drugs for treatment of hypertension. Rationale 4: Direct-acting vasodilators are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response. Rationale 5: Peripheral adrenergic antagonists are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response.

The patient is receiving hydrochlorothiazide (Microzide) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant? 1. ALT level of 35 units/L 2. Sodium level of 140 mEq/L 3. Potassium level of 2.9 mEq/L 4. BUN level of 20 mg/dl

3. Potassium level of 2.9 mEq/L Rationale 1: This ALT level is within normal range. Rationale 2: The concern is not sodium levels; this sodium level is within normal range. Rationale 3: Hypokalemia caused by hydrochlorothiazide (Microzide) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. Rationale 4: The concern is not kidney function, and this BUN is within normal range.

The patient receives hydrochlorothiazide (Microzide). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? 1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." Rationale 1: Hydrochlorothiazide (Microzide) does not enhance kidney function. Rationale 2: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (Microzide) decrease blood pressure by decreasing total blood volume. Rationale 3: Hydrochlorothiazide (Microzide) does not dilate blood vessels. Rationale 4: Hydrochlorothiazide (Microzide) does not increase heart rate

A patient has been prescribed nifedipine (Adalat CC) as treatment for hypertension. The nurse would evaluate medication instruction as effective if the patient makes which statements? Select all that apply. 1. "If I drink alcohol while taking this medication, I will get very sick to my stomach." 2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." 4. "I should no longer drink sports drinks with caffeine in them." 5. "I should stop taking my vitamin C supplement."

2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." Rationale 1: Alcohol may potentiate the effects of nifedipine (Adalat CC), but this combination does not cause gastric irritation. Rationale 2: Concurrent use with melatonin may increase blood pressure and heart rate. Rationale 3: Grapefruit juice may enhance absorption of nifedipine (Adalat CC). Rationale 4: Caffeine is not contraindicated when taking nifedipine (Adalat CC). Rationale 5: Vitamin C supplements are not contraindicated when taking nifedipine (Adalat CC).

For the last 3 months, the nurse has been working with a group of patients who have been using nonpharmacological methods to try to manage their hypertension. The nurse anticipates that which patients will require the addition of a pharmacological intervention? Select all that apply. 1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy. 2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 3. A 56-year-old woman whose blood pressure is 135/84 who also has Cushing's disease. 4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy.

2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy. Rationale 1: Hypertension in this age group of healthy adults is considered to be 140/90 mmHg. Rationale 2: Since this 61-year-old has both hypertension and diabetes, pharmacotherapy is indicated. Rationale 3: This patient's blood pressure is no longer in the range of hypertension. Rationale 4: Since there are no other compelling illnesses, this patient's hypertension does not need pharmacological intervention. Rationale 5: Blood pressure over 150/90 mmHg requires treatment in those over age 60.

A patient who is in hypertensive crisis will be given the calcium channel blocker clevidipine (Cleviprex). The nurse should prepare for which interventions? Select all that apply. 1. Monitoring bowel sounds 2. Administering the drug intravenously 3. Continuous blood pressure monitoring 4. Crushing caplets for administration 5. Infusing normal saline at 125 mL/hr

2. Administering the drug intravenously 3. Continuous blood pressure monitoring Rationale 1: There is no particular reason that bowel sounds should be monitored more frequently than normally done. Rationale 2: Clevidipine (Cleviprex) is administered intravenously. Rationale 3: Clevidipine (Cleviprex) has an ultrashort half-life so blood pressure will be monitored continuously. Rationale 4: This drug is not supplied in caplet form. Rationale 5: Infusing normal saline at this rate would be contraindicated in hypertensive emergency.

Changes in which level would be sensed by baroreceptors and relayed to the vasomotor center? 1. Oxygenation 2. Blood pressure 3. Carbon dioxide 4. Blood pH

2. Blood pressure Rationale 1: Chemoreceptors recognize levels of oxygen. Rationale 2: Baroreceptors sense and relay changes in blood pressure. Rationale 3: Chemoreceptors recognize levels of carbon dioxide. Rationale 4: Chemoreceptors recognize pH levels.

Which lists include the three factors that make up blood pressure? 1. Blood volume, heart rate, and stroke volume 2. Cardiac output, blood volume, and peripheral vascular resistance 3. Age, weight, and race 4. Body mass index, diet, and genetics

2. Cardiac output, blood volume, and peripheral vascular resistance Rationale 1: Heart rate is not specifically involved except in its role in cardiac output. Rationale 2: Although many factors can contribute to blood pressure, such as diet and weight, it is a person's cardiac output, blood volume, and peripheral vascular resistance that create the pressure. Rationale 3: Age, weight, and race do not specifically control blood pressure. Rationale 4: Body mass index, diet, and genetics do not specifically control blood pressure

The patient with hypertension is receiving nifedipine (Procardia XL). The nurse determines that the patient needs additional medication education when the patient selects which menu for breakfast? 1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice 2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice 3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice 4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice Rationale 1: There is no food-drug interaction with calcium channel blockers and whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice. Rationale 2: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. Rationale 3: There is no food-drug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. Rationale 4: There is no food-drug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient? Select all that apply. 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking

2. Restricting salt intake 4. Increasing activity 5. Stopping smoking Rationale 1: Increasing the intake of alcohol, including wine, is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of alcohol. Rationale 2: Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Rationale 3: Increasing the intake of saturated fat is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of red meat and other sources of saturated fat. Rationale 4: Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Rationale 5: Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension.

What is a priority nursing intervention for a patient who has just begun antihypertensive treatment with enalapril (Vasotec)? 1. Monitor the patient for headaches. 2. Take the patient's blood pressure. 3. Order a sodium-restricted diet for the patient. 4. Review the patient's lab results for hypokalemia.

2. Take the patient's blood pressure. Rationale 1: Although headache is a side effect, it is not the priority. Rationale 2: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Rationale 3: Enalapril (Vasotec) does not affect sodium levels. Rationale 4: Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia.

The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include? Select all that apply. 1. Blood pressures tend to decrease as people age, due to decreased blood volume. 2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. 4. The vasomotor center, located in the limbic system of the brain, helps regulate blood pressure. 5. Hypertension is diagnosed when the blood pressure is greater than 145/95 mmHg.

2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. Rationale 1: Blood pressures tend to rise as people age. Rationale 2: The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. Rationale 3: Anger and stress can cause blood pressure to rise. Rationale 4: The vasomotor center is located in the medulla oblongata. Rationale 5: According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg.

The nurse is teaching the patient about lifestyle modifications to help manage the patient's hypertension. The nurse determines that teaching has been effective when the patient makes which statement? 1. "I need to get started on my medications right away." 2. "My father had hypertension, did nothing, and lived to be 90-years-old." 3. "I know I need to give up my cigarettes and alcohol." 4. "I won't be able to run in the marathon race anymore."

3. "I know I need to give up my cigarettes and alcohol." Rationale 1: Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. Rationale 2: The fact that the patient's father had hypertension and lived to be 90-years-old does not mean that the patient will have the same experience; the patient is in denial. Rationale 3: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Rationale 4: Increasing physical activity is an important lifestyle modification for controlling hypertension.

The nurse completed medication education with the patient who receives hydrochlorothiazide (Microzide). The nurse determines that teaching has been effective when the patient makes which statement? 1. "I really need to avoid grapefruit juice when I take this medication." 2. "I need to avoid salt substitutes and potassium-rich foods." 3. "I take my medication early in the morning." 4. "If I develop a cough, I should call my doctor."

3. "I take my medication early in the morning." Rationale 1: Grapefruit juice inhibits the metabolism of the calcium channel blockers. Rationale 2: Hydrochlorothiazide (Microzide) is a potassium-excreting diuretic, and potassium supplementation is often necessary. Rationale 3: Taking hydrochlorothiazide (Microzide) early in the day will help prevent nocturia. Rationale 4: Development of a cough occurs with ACE inhibitors, not diuretics.

The patient is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurse's best response? 1. "It works by causing your kidneys to excrete more urine." 2. "It works by making your heart work more efficiently." 3. "It works by making your blood vessels expand." 4. "It works by decreasing the release of your stress hormones."

3. "It works by making your blood vessels expand." Rationale 1: Excreting more urine is an effect of diuretic medications. Rationale 2: Increasing the efficiency of the heart is not an effect of doxazosin (Cardura). Rationale 3: Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Rationale 4: Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

The patient comes to the emergency department with a blood pressure of 200/120 mmHg. The physician orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and hyperthermia 3. Hypotension and tachycardia 4. Hypotension and tachypnea

3. Hypotension and tachycardia Rationale 1: Direct vasodilators do not produce bradycardia. Rationale 2: Direct vasodilators do not affect body temperature. Rationale 3: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Rationale 4: Direct vasodilators do not affect respiratory rate.

A hospitalized patient has been started on enalapril (Vasotec). The nurse would hold this drug and discuss which findings with the prescriber? Select all that apply. 1. Cough 2. Light-headedness on ambulation 3. Swelling around the eyes 4. Sneezing 5. Difficulty swallowing

3. Swelling around the eyes 5. Difficulty swallowing Rationale 1: Cough is a common side effect of this drug. The nurse should discuss the finding with the prescriber, but there is no need to hold the medication. Rationale 2: Orthostatic hypotension is common at the beginning of therapy. The nurse would manage safety of the patient but would not hold the drug. Rationale 3: Swelling around the eyes may indicate angioedema, which is a serious adverse effect. Holding the drug is indicated. Rationale 4: Sneezing is not associated with enalapril (Vasotec). Rationale 5: Difficulty swallowing may indicate swelling in the throat related to angioedema. Holding the drug is indicated.

The nurse is taking the initial history of a patient admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the patient does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "When I have a migraine headache, I need to have the room darkened." 3. "My father died of a heart attack when he was 48-years-old." 4. "I have always had problems with my asthma."

4. "I have always had problems with my asthma." Rationale 1: There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers. Rationale 2: Beta-adrenergic blockers do not affect migraine headaches. Rationale 3: Having a father who died of a heart attack when he was young is significant but has no correlation to this patient and use of beta-adrenergic blockers. Rationale 4: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma.

The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nifedipine (Procardia). What is a priority assessment for the nurse? 1. Review recent lab results for hypokalemia. 2. Assess urinary output. 3. Assess level of orientation. 4. Auscultate breath sounds for crackles.

4. Auscultate breath sounds for crackles. Rationale 1: Calcium channel blockers do not cause hypokalemia. Rationale 2: Urinary output may be decreased with heart failure, but it is not a priority assessment at this time. Rationale 3: Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Rationale 4: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure.

The patient has been recently diagnosed with hypertension. Assessment data includeWt: 200 poundsHt: 5' 4"Diet: Mostly starchesAlcohol intake: 3 beers/weekStressors: Works 60 hours/weekIn planning care with this patient, what is the priority outcome? 1. Patient will eliminate alcohol from the diet. 2. Patient will decrease stress by limiting work to 40 hours/week. 3. Patient will balance diet according to the food pyramid. 4. Patient will achieve and maintain optimum weight.

4. Patient will achieve and maintain optimum weight. Rationale 1: Eliminating alcohol is important but not the priority outcome. Rationale 2: Decreasing stress is important but not the priority outcome. Rationale 3: A balanced diet is important but not the priority outcome. Rationale 4: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure.

Which laboratory test would be the priority for a patient with hypertension who takes a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium

4. Potassium Rationale 1: Magnesium level is not a priority. Rationale 2: Calcium level is not a priority. Rationale 3: Chloride level is not a priority. Rationale 4: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.