Pharmacology Adams/Holland Ch 26: Drugs for Heart Failure

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, 3

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, 4

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, 5

The nurse is caring for an African American male who has just been diagnosed with hypertension. The nurse anticipates that this patient will be started on which medications? Select all that apply. 1. A thiazide diuretic 2. A calcium channel blocker 3. An ACE inhibitor 4. A beta-adrenergic antagonist 5. An angiotensin-II receptor blocker

1. A thiazide diuretic 2. A calcium channel blocker

A patient is newly diagnosed with hypertension and diabetes. Which classes of drugs are likely to be prescribed? Select all that apply. 1. ACE inhibitors 2. Beta blockers 3. Thiazide diuretics 4. Calcium channel blockers 5. Angiotensin receptor blockers (ARBs)

1. ACE inhibitors 5. Angiotensin receptor blockers (ARBs)

A hypertensive female patient being treated with which of the following would be of primary concern if she became pregnant? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)

1. Enalapril (Vasotec)

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

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

1. Smoking-cessation program

The nurse is educating a patient who has been diagnosed with hypertension and explains that the criteria that will be used to determine medication management include the patient's Select all that apply. 1. risk factors. 2. comorbid medical conditions. 3. age. 4. degree of blood pressure elevation. 5. occupational status

1. risk factors. 2. comorbid medical conditions 4. degree of blood pressure elevation.

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).

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, 3

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, 3

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, 5

The patient receives hydrochlorothiazide (HydroDIURIL). 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 (HydroDIURIL) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (HydroDIURIL) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (HydroDIURIL) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2. "Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure."

The patient has a blood pressure reading of 126/84 mmHg. She asks the nurse if she has high blood pressure. What is the best response by the nurse? 1. "You have prehypertension, but it isn't really serious." 2. "You have prehypertension; let's discuss your lifestyle." 3. "You have prehypertension; unfortunately, this will progress to hypertension." 4. "You have prehypertension, and must begin medication."

2. "You have prehypertension; let's discuss your lifestyle."

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

2. Blood pressure

Diuretics are often used to lower blood pressure. Which factor do they affect most? 1. Cardiac output 2. Blood volume 3. Heart rate 4. Peripheral vascular resistance

2. Blood volume

Which of the following 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

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, Lucky Charms 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, Lucky Charms cereal, milk, and grapefruit juice

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.

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

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

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

The nurse educator is reviewing the body's control of blood pressure. In which order will the nurse explain the steps of this process? 1. Angiotension II is produced 2. Renin acts 3. Liver produces angiotensinogen 4. Angiotension I is produced 5. Vasoconstriction occurs

3, 2, 4, 1, 5

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, 5

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."

The nurse completed medication education with the patient who receives hydrochlorothiazide (HydroDIURIL/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."

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."

The patient has a nighttime cough related to taking enalapril (Vasotec). What is the best nursing intervention to promote rest in this patient? 1. Have the patient sit up at an 80-degree angle in a comfortable chair at night. 2. Contact the physician for an order for a cough-suppressant medication. 3. Have the patient sleep on two or three pillows at night. 4. Contact the physician for an order for a sedative-hypnotic medication.

3. Have the patient sleep on two or three pillows at night.

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

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

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

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."

The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nefedipine (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

Which laboratory test would be the priority for a hypertensive patient taking a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium

4. Potassium

According to the JNC-7, a patient with a blood pressure of 144/82 would be classified as 1. prehypertensive. 2. stage 2 hypertensive. 3. normal. 4. stage 1 hypertensive

4. stage 1 hypertensive