Chapter 22: Antihypertensive Drugs
The nurse is reviewing a medication history for a patient taking captopril. The nurse should contact the health care provider if the patient is also taking which medication? A) Furosemide B) Spironolactone C) Morphine sulfate D) Docusate sodium
B) Spironolactone
Which is an appropriate nursing intervention for a patient who is taking hydrochlorothiazide? A) Encourage intake of foods rich in potassium. B) Schedule the dose to be taken in the evening. C) Monitor serum calcium and sodium levels daily. D) Take the radial pulse for 1 full minute before administering the drug.
A) Encourage intake of foods rich in potassium. Hydrochlorothiazide is a potassium-wasting diuretic that can lead to hypokalemia if potassium is not replaced sufficiently to meet losses. For this reason, the nurse should encourage increased intake of foods high in potassium.
The health care provider's prescription reads: Administer hydralazine 1.25 mg/kg/day. The child weighs 22 pounds. How many mg/day should the nurse plan to administer? Round your answer to the nearest tenth.
12.5 mg/day
The nurse is teaching the patient why hypertension must be treated. What information should be included in the teaching plan? A) "Hypertension is a risk factor for stroke." B) "Hypertension is a risk factor for diabetes." C) "Hypertension is a risk factor for emphysema." D) "Hypertension is a risk factor for heart failure." E) "Hypertension is a risk factor for cardiovascular disease."
A) "Hypertension is a risk factor for stroke." D) "Hypertension is a risk factor for heart failure." E) "Hypertension is a risk factor for cardiovascular disease."
The nursing instructor determines that the student nurse understands the rationale for administration of an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension when the student makes which statement(s)? A) "They reduce afterload." B) "Angiotensin II is a potent vasodilator." C) "They promote sodium and water retention." D) "Systemic vascular resistance (SVR) is decreased." E) "ACE inhibitors modify the function of the sympathetic nervous system (SNS)."
A) "They reduce afterload." D) "Systemic vascular resistance (SVR) is decreased."
A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, uncomfortable, nonproductive cough that has persisted for several weeks. What is the nurse's priority action? A) Call the health care provider to switch the medication. B) Tell the patient that the cough will subside in a few days. C) Assess the patient for other symptoms of upper respiratory infection. D) Instruct the patient to take antitussive medication until the symptoms subside.
A) Call the health care provider to switch the medication.
The health care provider prescribes a sodium nitroprusside intravenous infusion to manage a patient's blood pressure of 230/120 mm Hg. Which action(s) should the nurse implement before starting the infusion? A) Evaluate the electrocardiogram. B) Perform a neurologic assessment. C) Assess oxygenation and ventilation. D) Obtain an intravenous infusion pump. E) Draw baseline serum electrolyte levels. F) Assess the patient for peripheral edema.
A) Evaluate the electrocardiogram. B) Perform a neurologic assessment. C) Assess oxygenation and ventilation. D) Obtain an intravenous infusion pump.
What assessment finding indicates a patient is having an adverse effect of adrenergic drug therapy for hypertension? A) Heart rate of 40 beats/min B) Temperature of 38° C (100.4° F) C) Blood pressure of 110/70 mm Hg D) Respiratory rate of 20 breaths/min
A) Heart rate of 40 beats/min
A patient is prescribed a nonselective beta blocker. What nursing intervention is a priority for this patient? A) Respiratory assessment B) Assessment of blood glucose levels C) Teaching about potential tachycardia D) Orthostatic blood pressure assessment
A) Respiratory assessment
A patient has been receiving a sodium nitroprusside infusion for the last 4 days for management of severe hypertension. Based on the duration of therapy, what is most essential for the nurse to evaluate? A) The serum cyanide level B) The fasting blood glucose level C) The 12-lead electrocardiogram (ECG) D) The hemoglobin and hematocrit levels
A) The serum cyanide level
The nurse is preparing to administer a first dose of an ACE inhibitor medication to a patient who is also being treated with lithium. What result should the nurse anticipate that from the interaction of the two drugs? A) Toxic level of lithium B) Decreased level of lithium C) Toxic level of the ACE inhibitor D) Decreased level of the ACE inhibitor
A) Toxic level of lithium
When teaching a patient about the drug atenolol, what information should the nurse include in the teaching plan? A) "Stop the medication if you feel tired." B) "Do not stop the medication abruptly." C) "If you have gastric upset, take the medication with an antacid." D) "Use a hot tub daily to help vasodilate so that the medication will work more effectively."
B) "Do not stop the medication abruptly."
A patient is receiving transdermal clonidine. What information does the nurse need to include in the teaching plan? A) "Take the medication on an empty stomach." B) "Remove the old patch before applying the new patch." C) "Stay in bed for at least an hour after receiving a new patch." D) "Keep the new patch on for 30 minutes before removing the old patch."
B) "Remove the old patch before applying the new patch."
A middle-aged male patient started antihypertensive drug therapy 3 months ago and is in the health care provider's office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with erectile dysfunction. Which would be the most appropriate response by the nurse? A) "Don't worry. Eventually, tolerance will develop." B) "The physician can work with you on changing the dose or medications." C) "Sexual dysfunction happens with this therapy, and you will learn to accept it." D) "This is an unusual occurrence, but it is important to stay on your medications."
B) "The physician can work with you on changing the dose or medications."
Which effect indicates that a patient is experiencing an adverse effect of enalapril? A) Persistent dry mouth B) A dry, hacking cough C) Serum potassium of 4.2 mEq/L D) Serum sodium of 147 mEq/L
B) A dry, hacking cough
The nurse is caring for several patients. Which patient will need teaching about treatment for hypertension? A) A patient with a diastolic pressure of 70 mm Hg B) A patient with a systolic pressure consistently above 140 mm Hg C) A patient with a diastolic blood pressure of 80 mm Hg after exercise D) A patient with a blood pressure of 140/90 mm Hg after walking up two flights of stairs
B) A patient with a systolic pressure consistently above 140 mm Hg
A patient with hypertension is prescribed a diuretic as first-line drug therapy after lifestyle changes have been ineffective. Which type of diuretics should the nurse anticipate will be used? A) A loop diuretic B) A thiazide diuretic C) An osmotic diuretic D) A potassium-sparing diuretic
B) A thiazide diuretic
The nurse administers lisinopril to a hypertensive patient with heart failure. Which parameter should the nurse evaluate to determine the therapeutic effectiveness of lisinopril in this patient? A) Mental status B) Breath sounds C) Peripheral pulses D) Serum potassium
B) Breath sounds
When giving antihypertensive medications, the nurse should plan to administer a first dose at bedtime for which drug? A) Enalapril B) Doxazosin C) Furosemide D) Hydralazine
B) Doxazosin
The nurse is caring for a patient who needs medication to treat hypertension and to improve survival after experiencing a myocardial infarction. The nurse should anticipate that the patient will be prescribed which medication? A) Bosentan B) Eplerenone C) Treprostinil D) Sodium nitroprusside
B) Eplerenone
The nurse is administering minoxidil to a patient. What should the nurse anticipate administering if toxicity is suspected? A) Calcium chloride B) Intravenous fluids C) Antianxiety medication D) Potassium supplements
B) Intravenous fluids
A patient taking methyldopa is found to have liver disease. What is the best action by the nurse? A) Change the patient's diet. B) Notify the health care provider. C) Immediately stop the medication. D) Document the finding and continue care.
B) Notify the health care provider.
A patient with coronary artery disease and diabetes mellitus has resistant hypertension despite therapy with benazepril. Which antihypertensive agent should the nurse avoid administering to this patient? A) Felodipine B) Propranolol C) Candesartan D) Hydrochlorothiazide
B) Propranolol
A patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor. During a review of the patient's list of current medications, which medication(s) should alert the nurse for a possible interaction with this new prescription? A) Warfarin, 5 mg by mouth daily B) Spironolactone, 25 mg by mouth daily C) Ibuprofen, 400 mg by mouth twice daily D) Alprazolam, 0.25 mg by mouth twice daily E) Potassium chloride, 20 mEq by mouth daily
B) Spironolactone, 25 mg by mouth daily C) Ibuprofen, 400 mg by mouth twice daily E) Potassium chloride, 20 mEq by mouth daily
A patient has been receiving hydralazine. What findings indicate the patient is experiencing adverse effects of this medication therapy? A) The patient is constipated. B) The patient complains of being dizzy. C) The patient has a "pounding headache." D) The patient has been vomiting and has diarrhea. E) The patient is disoriented to person, place, and time. F) The patient is having difficulty walking to the bathroom.
B) The patient complains of being dizzy. C) The patient has a "pounding headache." D) The patient has been vomiting and has diarrhea.
The nurse is administering several medications at 8:00 am. Which medication will decrease vasoconstriction by blocking angiotensin II receptor sites? A) Enalapril B) Valsartan C) Metoprolol D) Furosemide
B) Valsartan
The nurse is providing teaching to an elderly patient who has been prescribed extended-release doxazosin. What should the nurse include? A) "A glass of wine a few times a week should not be a problem." B) "You may develop a nonproductive, dry cough from this medication." C) "Do not be concerned if you see the matrix of the capsule in your stool." D) "Be especially careful when changing position after your first dose of the medication." E) "The medication is contraindicated if you develop benign prostatic hypertrophy (BPH)."
C) "Do not be concerned if you see the matrix of the capsule in your stool." D) "Be especially careful when changing position after your first dose of the medication."
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What should the nurse teach this patient? A) "Change the patch daily at the same time." B) "Remove the patch before taking a shower or bath." C) "Get up slowly from a sitting to a standing position." D) "Do not take other antihypertensive medications while using this patch."
C) "Get up slowly from a sitting to a standing position."
Which patient receiving losartan needs to be monitored closely while receiving this therapy? A) A patient with constipation B) A patient with a heart rate of 90 beats/min C) A patient with an elevated creatinine level D) A patient with a potassium level of 3.4 mEq/L
C) A patient with an elevated creatinine level
The nurse administers clonidine. What finding indicates the medication is therapeutic? A) Absence of chest pain B) Increased urinary output C) Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg D) Heart rate decrease from 100 beats/min to 40 beats/min
C) Blood pressure decrease from 150/100 mm Hg to 110/70 mm Hg
A community health nurse is providing education on clonidine to an elderly patient during a home visit. Which adverse effect should be emphasized as most concerning to this patient? A) Dry mouth B) Restlessness C) Hypotension D) Constipation
C) Hypotension
A patient receiving the adrenergic medication clonidine reports experiencing constipation. What should be included in the plan of care for this patient? A) Restrict dietary fiber intake. B) Limit fluids to 1000 mL/day. C) Increase the amount of fruits and vegetables in the diet. D) Inform the patient that this is a common adverse effect of the medication. E) Discuss incorporation of psyllium-based products in the plan of care with the health care provider.
C) Increase the amount of fruits and vegetables in the diet. D) Inform the patient that this is a common adverse effect of the medication. E) Discuss incorporation of psyllium-based products in the plan of care with the health care provider.
The patient's blood pressure is 200/120 mm Hg, and the health care provider prescribes sodium nitroprusside. What is the nurse's priority action? A) Measure hourly output. B) Administer with a full glass of water. C) Monitor blood pressure continuously. D) Make certain the patient does not crush the pill.
C) Monitor blood pressure continuously.
A patient has developed toxicity while receiving lisinopril. What action should the nurse expect to implement? A) Administer aspirin. B) Insert a Foley catheter. C) Send the patient for hemodialysis. D) Administer potassium chloride intravenously.
C) Send the patient for hemodialysis.
The nurse is caring for a patient who needs antihypertensive medication to treat pulmonary artery hypertension related to severe heart failure. Which medication should the nurse anticipate that the patient will be prescribed? A) Bosentan B) Eplerenone C) Treprostinil D) Sodium nitroprusside
C) Treprostinil
What should the nurse assess within an hour after administering a diuretic? A) Weight B) Heart rate C) Urinary output D) Blood pressure E) Neurologic status
C) Urinary output D) Blood pressure
What should the nurse teach the patient to ensure patient understanding of pharmacologic therapy for hypertension? A) "Urinary output determines blood pressure." B) "Blood pressure is determined by heart contraction." C) "Sympathetic stimulation causes blood pressure to decrease." D) "Blood pressure is a product of cardiac output and vascular resistance."
D) "Blood pressure is a product of cardiac output and vascular resistance."
The nurse demonstrates knowledge of use of calcium-channel blockers (CCBs) for management of hypertension by making which statement to the patient? A) "CCBs promote excretion of water." B) "CCBs block reabsorption of sodium." C) "CCBs increase blood return to heart." D) "CCBs relax vascular smooth muscle."
D) "CCBs relax vascular smooth muscle."
A patient taking adrenergic drugs for hypertension is being given discharge teaching about the therapy. What information should be included in this teaching plan? A) "This therapy will cause bruising." B) "Take this medication after dinner." C) "Take this medication before dinner D) "Do not drink alcohol when using this therapy."
D) "Do not drink alcohol when using this therapy."
Which comment by the patient indicates understanding about the use of enalapril for treatment of hypertension? A) "I cannot go out in the sun while on this therapy." B) "I should stop the drug if I have ringing in my ears." C) "If I feel tired, I should call the health care provider." D) "If I develop a chronic cough, I need to notify my health care provider."
D) "If I develop a chronic cough, I need to notify my health care provider."
The nurse is teaching a patient about idiopathic hypertension. What statement should be included in the teaching plan? A) "This type of hypertension is not treatable." B) "Once you have surgery, this will go away." C) "This type of hypertension has a definitive cause." D) "The cause of your hypertension is unknown, but treatable."
D) "The cause of your hypertension is unknown, but treatable."
The nurse is teaching a patient about the reason for the administration of calcium channel blockers. What statement should be included in the teaching plan? A) "This medication will help your body to get rid of sodium." B) "This medication will work to cause your body to get rid of fluid." C) "This medication will help you to lose weight to lower your blood pressure." D) "This medication will vasodilate your blood vessels to lower your blood pressure."
D) "This medication will vasodilate your blood vessels to lower your blood pressure."
A patient is scheduled to receive a first dose of extended-release doxazosin. Which instruction should the nurse provide to the patient before administering the dose? A) "You will get a headache the first time you take this medication." B) "Some people get a feeling of chills for a few hours after the first dose." C) "Nausea and vomiting are common but can be helped by eating crackers." D) "You will see the capsule shell in your stool, but don't worry, the drug has been absorbed."
D) "You will see the capsule shell in your stool, but don't worry, the drug has been absorbed."
The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? A) A patient who has been on beta blockers for 1 day B) A patient who is taking a beta blocker and furosemide C) A patient who is on a beta blocker and a thiazide diuretic D) A patient who has stopped taking a beta blocker because of cost
D) A patient who has stopped taking a beta blocker because of cost
The nurse administers candesartan to a patient. Which patient assessment finding should the nurse use as a clinical indicator of therapeutic effectiveness of the medication? A) Cool, dry, pale extremities B) Serum sodium of 140 mEq/L C) Serum potassium of 3.8 mEq/L D) Blood pressure of 120/72 mm Hg
D) Blood pressure of 120/72 mm Hg
The nurse is administering amlodipine. What assessment finding requires immediate action? A) Calcium level of 8 mEq/dL B) Potassium level of 5 mEq/dL C) Apical pulse of 100 beats/min D) Blood pressure of 80/60 mm Hg
D) Blood pressure of 80/60 mm Hg
The nurse is caring for a patient who is hypertensive and has liver dysfunction. The nurse should anticipate that the patient will most likely be placed on which antihypertensive drug? A) Losartan B) Ramipril C) Enalapril D) Captopril
D) Captopril
A patient is admitted to the hospital for an intestinal obstruction and has been placed on strict nothing by mouth (NPO) status. The nurse is reconciling the patient's home medications and notes that the patient's daily dose of the antihypertensive lisinopril has not been prescribed by the health care provider. Which action should the nurse take? A) Address hypertensive episodes only when they arise. B) Obtain a prescription to administer the lisinopril intravenously. C) Obtain a prescription for the daily lisinopril and give with a sip of water. D) Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed.
D) Collaborate with the health care provider to determine whether intravenous enalapril can be prescribed.
A patient with heart failure and hypertension is being treated with a positive inotrope and an angiotensin-converting enzyme (ACE) inhibitor. Despite pharmacotherapy, the patient develops pulmonary edema. The patient is adherent to pharmacologic and nonpharmacologic management of the disease processes. Which action should the nurse take if the patient refuses to take additional medication? A) Instruct the patient to reduce dietary sodium. B) Ask the patient to perform a 24-hour dietary recall. C) Suggest the patient drink diuretic beverages such as tea. D) Collaborate with the health care provider to find a combination ACE inhibitor and diuretic.
D) Collaborate with the health care provider to find a combination ACE inhibitor and diuretic.
A patient has been prescribed an angiotensin II receptor blocker to treat hypertension. The patient is also being treated with a nonsteroidal antiinflammatory drugs. What result should the nurse anticipate from the interaction of these drugs? A) Increased effect of the nonsteroidal antiinflammatory drug B) Increased effect of the angiotensin II receptor blocker drug C) Decreased effect of the nonsteroidal antiinflammatory drug D) Decreased effect of the angiotensin II receptor blocker drug
D) Decreased effect of the angiotensin II receptor blocker drug
Which antihypertensive medications are most likely to cause tachycardia? A) Aliskiren B) Valsartan C) Lisinopril D) Diazoxide E) Eplerenone F) Hydralazine
D) Diazoxide F) Hydralazine
A patient with hypertension receives ramipril and consequently develops a potassium level of 5.6 mEq/liter. Which medication when administered concurrently with ramipril can improve the patient's metabolic condition? A) Eplerenone B) Metoprolol C) Spironolactone D) Hydrochlorothiazide
D) Hydrochlorothiazide
The nurse is caring for an adult male patient who is hypertensive and is being treated with transdermal clonidine patches. Which is the most appropriate site for the patient to use in applying the patches? A) Chest B) Forearm C) Lower leg D) Upper arm
D) Upper arm