mastery quiz ch 43
The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Amlodipine Candesartan Enalapril Clonidine
Clonidine Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route.
A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Photosensitivity GI irritation Cough Constipation
Cough Explanation: Fosinopril is associated with an unrelenting cough that can lead clients to discontinue the drug. Constipation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. GI irritation is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug. Photosensitivity is an adverse effect of ACE inhibitors, but would not necessarily lead a client to discontinue the drug.
When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to: Increased stroke volume Increased cardiac output Decreased heart rate Decreased venous return
Decreased venous return Explanation: Pooling of blood in the periphery results in decreased venous return. Decreased venous return results in decreased stroke volume and decreased cardiac output. Decreased cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue perfusion. The heart rate increases in an attempt to meet the demands of the body
The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition? Diabetes mellitus Asthma Glaucoma Unstable angina pectoris
Diabetes mellitus ACE inhibitors are considered first-line antihypertensive agents for clients with diabetes mellitus because they reduce proteinuria and slow the progression of renal impairment.
A 71-year-old male client is being treated for hypertension. Which measurement is a partial indication of effective treatment and management? Systolic blood pressure above 140 mm Hg Systolic blood pressure below 160 mm Hg Diastolic blood pressure below 90 mm Hg Diastolic blood pressure below 100 mm Hg
Diastolic blood pressure below 90 mm Hg Explanation: Successful treatment involves reducing blood pressure below hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
A client develops a severe elevation in blood pressure. The physician orders an ACE inhibitor to be given intravenously. Which agent would be most likely? Lisinopril Enalaprilat Captopril Enalapril
Enalaprilat Explanation: Enalaprilat is an ACE inhibitor that is administered intravenously. Captopril, enalapril, and lisinopril are administered orally.
An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect? Infection Acute confusion Falls Impaired oxygenation
Falls Explanation: Initiation of antihypertensive therapy creates a risk of acute hypotension and consequent falls. Infection, confusion, or impaired oxygenation is much less likely.
A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question? "He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." "He's in shock because his heart rate is too low. The drug will help by increasing his heart rate significantly." "He's in shock because his heart can't pump effectively. This drug will help by increasing his heart rate significantly." "He's in shock because his blood vessels have dilated so severely. The drug will help by reversing that dilation."
He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." Explanation: Cardiogenic shock is caused by the myocardium's inability to contract efficiently and maintain an adequate cardiac output. Dobutamine is prescribed for treatment because it acts mainly on beta1receptors in the heart to increase the force of myocardial contraction. It is less vasoactive than some other drugs and it causes a minimal increase in heart rate.
Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases risk of colorectal carcinoma. Hypertension increases risk of liver disease Hypertension increases the workload of the heart.
Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart.
A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency? Monitor the client's level of consciousness. Administer antiemetic medication. Implement interventions to lower blood pressure. Assess the level of head pain.
Implement interventions to lower blood pressure. Explanation: Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs. While appropriate, none of the other options have priority over decreasing the blood pressure.
When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition? Activity Intolerance Social Isolation Ineffective Tissue Perfusion Excess Fluid Volume
Ineffective Tissue Perfusion Explanation: Hypovolemic shock is caused by the loss of intravascular fluids, including blood. Therefore, of the four options, the only choice relevant to hypovolemic shock is Ineffective Tissue Perfusion.
The RAAS is associated with which? Intense vasoconstriction and BP elevation Blood flow through the kidneys Production of surfactant in the lungs Release of aldosterone from the adrenal cortex Retention of sodium and water in the kidneys Liver production of fibrinogen
Intense vasoconstriction and BP elevation Blood flow through the kidneys Release of aldosterone from the adrenal cortex Retention of sodium and water in the kidneys
A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response? "It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." "Decreases the cardiac output by diuresis of sodium and water." "Increases client's perception of pain and decreases the heart rate." "Blocks conversion of angiotensin I to angiotensin II."
"It inhibits the influx of calcium ions across cardiac and smooth muscle, dilating the coronary arteries." Amlodipine inhibits the influx of calcium ions across cardiac and smooth muscle during depolarization, resulting in relaxation and vasodilation. This leads to lowered blood pressure. Diuretics decrease the cardiac output by diuresis of sodium and water. This medication does not increase pain or affect the heart rate. ACE inhibitors block the conversion of angiotensin I to angiotensin II.
Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? "How much physical exercise do you get?" "When was your last menstrual period?" "Have you always weighed 150 pounds?" "Do you eat something when you take your medications?"
"When was your last menstrual period?" Explanation: It would be important to know when the patient's LMP occurred and that the client is not pregnant. These drugs are category C for the first trimester and category D for the second and third trimesters of pregnancy and should not be used in pregnancy unless the benefits outweigh the risks. The other questions provide good assessment information but would provide no specific insights regarding the client who is beginning angiotensin II receptor blocker therapy.
A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information? Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced. ACE inhibitor therapy can continue during pregnancy. ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy. ACE inhibitors are contraindicated during pregnancy because they are teratogenic.
ACE inhibitors are contraindicated during pregnancy because they are teratogenic. Explanation: It is important to instruct women of childbearing age to take measures to prevent pregnancy while taking captopril or other ACE inhibitors because the drugs are teratogenic. This therapy must be discontinued if pregnancy occurs.
A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Lisinopril Verapamil Diltiazem Furosemide
Lisinopril Explanation: Angiotensin-converting enzyme inhibitors (ACEIs) act primarily for suppress the renin-angiotensin-aldosterone system, and lisinopril is an ACEI. Verapamil and diltiazem are calcium channel blockers and furosemide is a diuretic.
A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? Select all that apply. Losartan Olmesartan Ramipril Quinapril Atenolol
Losartan Olmesartan Angiotensin II receptor antagonists (ARBs), such as losartan and olmesartan, lower blood pressure by blocking the binding of angiotensin II at receptor sites in vascular smooth muscle and adrenal glands. Ramipril and quinapril are ACEIs, and atenolol is a beta blocker.
A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? Select all that apply. Losartan Olmesartan Ramipril Quinapril Atenolol
Losartan Olmesartan Angiotensin II receptor antagonists (ARBs), such as losartan and olmesartan, lower blood pressure by blocking the binding of angiotensin II at receptor sites in vascular smooth muscle and adrenal glands. Ramipril and quinapril are ACEIs, and atenolol is a beta blocker.
A diabetic patient with hypertension has come to the clinic with vague reports of "just not feeling well." Physical assessment shows that this patient does not have well-controlled hypertension. The nurse practitioner changes the patient's medication regimen from Lisinopril, 10 mg/qd to Accuretic, 10/12.5 mg/qd. What is the rationale for choosing this drug to better control the patient's hypertension? ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients. ARBs, combined with a thiazide diuretic, decreases proteinuria and slows the development of nephropathy in diabetic patients. ACE inhibitors, combined with a thiazide diuretic, decrease glucosuria and slows the development of neuropathy in diabetic patients. Beta-blockers, combined with a thiazide diuretic, decrease diabetic retinopathy.
ACE inhibitors, combined with a thiazide diuretic, decrease proteinuria and slow the development of nephropathy in diabetic patients. Explanation: ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. Although the drugs can cause or aggravate proteinuria and renal damage in non-diabetic people, they decrease proteinuria and slow the development of nephropathy in diabetic patients.
The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse's best response? Arterial lumen dilation Increased risk for hepatic damage Myocardium hypertrophy Decreased risk of thrombosis
Myocardium hypertrophy Explanation: Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
Pressure within the vascular system is determined by which? Peripheral resistance Stroke volume Sodium load Heart rate Total intravascular volume Rate of erythropoietin release
Peripheral resistance Stroke volume Heart rate Total intravascular volume
A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Peripheral vascular resistance Pulse pressure Renal function Force of myocardial contraction
Peripheral vascular resistance Arterial blood pressure reflects the force exerted on arterial walls by blood flow. It does not reflect pulse pressure, renal function, or force of myocardial contraction.
A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? Antihyperlipidemic drugs Angiotensin II receptor blockers Selective aldosterone blockers Calcium channel blockers
Angiotensin II receptor blockers Explanation: Losartan is an angiotensin II receptor blocker (ARB) and is recommended for clients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease. Antihyperlipidemic drugs help to reduce cholesterol. Calcium channel blockers relax and widen blood vessels by affecting the muscle cells in the arterial walls, these are recommended with caution in pregnant women. Selective aldosterone blockers do not show reduction of end-stage renal disease but are effective in treating severe CHF.
The nursing instructor has completed a teaching session explaining the various antihypertensive drugs. The instructor determines additional training is needed when the students choose which drugs as an angiotensin-converting enzyme inhibitor? Enalapril Benazepril Pindolol Quinapril
Pindolol Explanation: Pindolol is a beta-adrenergic blocker. Benazepril, quinapril, and enalapril are ACEIs.
A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? Baseline renal function A temporary increase in renal function A sustained increase in renal dysfunction A sustained decrease in renal function
Baseline renal function Explanation: Antihypertensive drugs are frequently required by patients with renal impairment ranging from mild insufficiency to end-stage failure. It would be necessary to assess baseline renal function in these patients prior to beginning antihypertensive therapy.
A patient who is hypertensive becomes pregnant. Which is the safest medication for this patient? Angiotensin II receptor blocker ACE inhibitor Beta-blocker Calcium-channel blocker
Beta-blocker
The nurse is teaching a client with hypertension about losartan which the health care provider has prescribed. The nurse can explain that losartan exerts which action on the body? Blocks aldosterone receptors Prevents renin secretion Prevents conversion of angiotensin I Blocks angiotensin II receptors
Blocks angiotensin II receptors Explanation: Losartan is an angiotensin II receptor antagonist, acting to block the angiotensin II receptors. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. A new drug type—direct renin inhibitors—will inhibit renin and subsequently prevent the angiotensin conversion process. A second newer drug type is selective aldosterone receptor antagonists (SARAs), which blocks the angiotensin process by binding with aldosterone.
A client presents to the urgent care clinic reporting severe dizziness. On assessment, the nurse learns the client was recently prescribed losartan and quit taking it thinking it was responsible for the dizziness. Which assessment should the nurse prioritize? Rebound hypertension Anginal attacks Orthostatic hypotension Breathing difficulty
Rebound hypertension Explanation: Rebound hypertension will occur in clients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse reactions associated with antihypertensive drug usage and may not occur on stopping the drug.
A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation Focus on finding a different job
Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation
A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond? Restore and maintain adequate tissue perfusion. Resuscitate the client. Restore life to the patient. Replace fluids the patient has lost.
Restore and maintain adequate tissue perfusion. Explanation: The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.
The nurse is assessing a client with renal disease and discovers the client's blood pressure has increased since the last visit. The nurse suspects the client has developed which concern? Essential hypertension Secondary hypertension Hypertensive emergency Rebound hypertension
Secondary hypertension Explanation: In secondary hypertension, there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension, it is called essential hypertension. Rebound hypertension occurs when a client abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state, which has to be lowered immediately.
A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? Increase fluid intake for 48 hours before taking the first dose. Take the medication at bedtime. Start with a low dose and increase gradually over 2 to 3 weeks. Take the medication with a high-fat meal.
Take the medication at bedtime. Explanation: To prevent the first-dose phenomenon, first doses and first increased doses are taken at bedtime. Increased fluid and fats will not address this risk, and the medication is not typically increased gradually over several weeks.
A patient taking an ACE inhibitor is scheduled for surgery. Because this medication may be dangerous in the setting of general anesthesia, the nurse should stop the drug without discussing with the providers. alert the provider caring for the patient and mark the patient's chart prominently. cancel the surgery and consult with the prescriber. monitor fluid levels and make sure the fluids are restricted before surgery
alert the provider caring for the patient and mark the patient's chart prominently.
Hypertension is associated with loss of vision. strokes. atherosclerosis. all of the above.
all of the above.
The stepped-care approach to the treatment of hypertension includes lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake. use of a diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes. a combination of antihypertensive drug classes to achieve desired control. all of the above.
all of the above.
Essential hypertension is the most commonly diagnosed form of high BP. Essential hypertension is caused by a tumor in the adrenal gland. associated with no known cause. related to renal disease. caused by liver dysfunction.
associated with no known cause.
How does captopril contribute to a reduction of a client's blood pressure? increasing rebel excretion of sodium and water blocking the blood pressure-raising effects of angiotensin II dilating peripheral arteries and relaxing vascular smooth muscle blocking the conversion of angiotensin I to angiotensin II
blocking the conversion of angiotensin I to angiotensin II Explanation: ACE inhibitors such as captopril block the enzyme that normally converts angiotensin I to the potent vasoconstrictor angiotensin II. Calcium channel blockers dilate peripheral arteries and relax vascular smooth muscle. Angiotensin II receptor blockers mitigate the hypertensive effects of angiotensin II and diuretics increase water excretion.
A patient is admitted to the unit with problems controlling their serum glucose levels. The patient has hypertension as a co-morbidity, and the physician has ordered hydralazine for this patient. The nurse caring for this patient knows that hydralazine is a(n): indirect vasoconstrictor. indirect vasodilator. direct vasodilator. direct vasoconstrictor.
direct vasodilator. Explanation: If other drug therapies do not achieve the desired reduction in blood pressure, it is sometimes necessary to use a direct vasodilator. Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include diazoxide , hydralazine (generic), minoxidil , and nitroprusside .
A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do? Maintain the current dosage of the drug Discontinue the drug Decrease the dosage of the drug Increase the dosage of the drug
discontinue the drug
What should a client with newly diagnosed hypertension be counseled to do? Select all that apply. Lose weight Decrease exercise Increase sodium intake Reduce stress Stop smoking
lose weight reduce stress stop smoking
A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to: monitor the client's respiratory rate. weigh the client. question the client about her dietary intake. monitor the client's blood pressure.
monitor the client's blood pressure. Explanation: Monitoring of blood pressure would be the priority assessment in the care of this client. Questioning the client about her dietary intake and weighing her would be appropriate, but secondary in importance. It is unnecessary to monitor the client's respiratory rate.
When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? arterial lumen dilation hepatic damage increased venous tone myocardial hypertrophy
myocardial hypertrophy Explanation: Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls. The increased cardiac workload leads to myocardial hypertrophy as a compensatory mechanism, with eventual heart failure. Because of endothelial dysfunction and arterial changes (vascular remodeling), the arterial lumen narrows. Renal damage is associated with hypertension, while increased venous tone is a compensatory mechanism for hypotension.
A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? chest pain venous ulcers pulmonary edema palpitations
pulmonary edema Explanation: Pulmonary edema is one of the cardinal signs of left-sided heart failure. This health problem does not typically cause venous ulcers, chest pain, or palpitations.
A client has been taking the alpha-specific adrenergic agent midodrine for orthostatic hypotension. Which assessment finding(s) indicates to the nurse that the client is experiencing adverse effects of this medication? Select all that apply. rash vertigo nausea dizziness headache
rash vertigo dizziness headache
Baroreceptors are the most important factor in controlling fast changes in BP. Baroreceptors are evenly distributed throughout the body to maintain pressure in the system. sense pressure and immediately send that information to the medulla in the brain. sense changes in neurons and are directly connected to the sympathetic nervous system. sense hemoglobin changes and are as sensitive to oxygen levels as to pressure changes.
sense pressure and immediately send that information to the medulla in the brain.
Droxidopa, an antihypotensive drug, should be used only with patients who are confined to bed. in the treatment of acute shock. in patients with known pheochromocytoma. to treat orthostatic hypotension in patients whose lives are impaired by the disorder.
to treat orthostatic hypotension in patients whose lives are impaired by the disorder.
ACE inhibitors work on the RAAS to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in spontaneous pneumothorax. pneumonia. unrelenting cough. respiratory depression.
unrelenting cough.
