Pharmacology Chapter 43

A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?

2

The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug specific adverse effect will the nurse include in the drug teaching?

Persistent cough

A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?

Potassium

An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified?

prehypertension

A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following?

130/80 mm Hg

Key behavioral determinants of blood pressure are related to what factor?

Dietary consumption of calories and salt

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 blood pressure.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition?

myocardial hypertrophy

A 37-year-old client presents with a blood pressure of 118/86 mm Hg. What advice should the nurse provide to this client?

"Be aware of your salt intake and limit hidden salt."

A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response?

"It dilates peripheral arteries and relaxes vascular smooth muscle."

The patient was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2 of the stepped-care management of hypertension plan, an angiotensin-converting enzyme inhibitor was ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the provider will order what?

A diuretic

The nurse recognizes blood pressure is determined by three elements including what?

A) Peripheral resistance

The patient is diagnosed with secondary hypertension. What will be the focus of nursing care to treat this patient?

Administering epinephrine

A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex?

Aldosterone

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect?

By blocking the angiotensin II receptors

No antihypertensive medication is safe during pregnancy but if the benefit for the mother outweighs the risk to the fetus, what classification of medication can the nurse administer to the hypertensive pregnant woman?

Calcium channel blocker

When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone?

Causes sodium and water retention.

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?

Clonidine

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?

Diastolic blood pressure below 90 mm Hg

A patient has been started on losartan (Cozaar), an angiotensin IIreceptor blocker (ARB), for hypertension. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the patient's hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this patient's hypertension?

Hydrochlorothiazide (Hyzaar)

The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching?

Hyperkalemia

The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances?

Hypertensive emergencies

The nurse provides drug teaching to the patient prescribed captopril (Capoten). What statement made by the patient does the nurse interpret to mean teaching has been effective?

I will call my doctor if I bruise easily or become extremely tired.

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.

The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the priority nursing assessment related to this drug?

Renal disease

A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include?

Report onset of a cough or fever to health care provider.

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.

A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?

Risk for injury

A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension?

Stage 2

An older adult patient is taking a sustained-release antihypertensive drug. What is the nurse's priority teaching point about this medication?

Swallow the drug whole and do not to cut, crush, or chew it

A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?

The ingestion of grapefruit juice

When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic would the nurse expect to administer?

Thiazide

What is the nurse's priority to assess before giving a female patient her prescription for an angiotensin IIreceptor blocker (ARB)?

When was your last menstrual period (LMP)?

Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure?

bronchiole

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):

direct vasodilator.

Which nursing interventions should a nurse specifically perform for a client prescribed losartan? Select all that apply.

-Review allergy history. -Obtain blood pressure -Discuss lifestyle changes. -Assess laboratory values.

A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response?

"Many clients require two or more drugs for high blood pressure."

The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."

What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension?

A diuretic

While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Select all that apply.)

A) Heart rate B) Stroke volume D) Total peripheral resistance

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?

Angiotensin II receptor blockers

The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug might the nurse administer that will both treat his hypertension and reduce myocardial oxygen consumption?

Diltiazem

What drug is a safe and effective calcium channel blocker only if the nurse administers them as sustained-release or extended-release preparations to treat hypertension?

Diltiazem (Cardizem)

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?

Enalaprilat

The nurse provides dietary teaching to the patient with hypertension and determines the patient understood the information when what meal is selected?

Grilled chicken, green salad with dressing, and baked apple

A patient is admitted to the intensive care unit in shock with hypotension. What is an appropriate nursing diagnosis for this patient?

Ineffective peripheral tissue perfusion

The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?

Monitoring for complications and side effects of treatment

How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)

Monitoring for drug effects Promoting compliance with the prescribed lifestyle modifications Promoting compliance with the prescribed pharmacologic modifications

Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age?

Nick, age 35, who is suffering from hepatic impairment

A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. In which step of a stepped-care management approach will the nurse teach about these changes in lifestyle?

Steps 1, 2, 3, and

A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors?

persistent cough

The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply.

-If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. -A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. -Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects.

The nurse works in a clinic that has many African American patients. What would the nurse need to consider when caring for patients with hypertension? (Select all that apply.)

A) African American men are at highest risk for hypertension. B) African Americans respond best to single-drug therapy. D) Increased adverse effects occur when using thiazide and thiazide-like diuretics.

The patient does not want to take medication to treat his or her hypertension if he or she can avoid it and asks the nurse if there is anything else he or she can do? What lifestyle changes will the nurse recommend? (Select all that apply.)

A) Increase time spent exercising. D) Lose some weight. E) Try meditation.

The nurse is caring for a patient who has been noncompliant with treatment for hypertension. The nurse explains that untreated hypertension increases the risk of what? (Select all that apply.)

A) Renal disease B) Cerebral infarction C) Heart failure

The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patient's prescription to losartan with hydrochlorothiazide (Hyzaar). What benefits does the nurse anticipate this patient will receive from this drug therapy? (Select all that apply.)

A) Slows progression of diabetic nephropathy in type 2 diabetes B) Increases excretion of fluid and sodium resulting in lower blood volume

The pediatric nurse examines a child with mildly elevated blood pressure who is 10% above the upper weight limits for his or her age. What is the nurse's priority teaching point?

Encourage activity and begin weight loss diet.

A patient who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is the nurse's priority assessment?

Excessive sweating on the job

The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial hypertension. What single indicator would the nurse use to evaluate the effectiveness of this medication?

Exercise tolerance

The nurse evaluates the patient's lifestyle for factors that are contributing to his or her diagnosis of hypertension and then addresses the need to change what factor?

Exposure to high-frequency noise

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?

Fall

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?

Implement interventions to lower blood pressure.

The nurse is caring for a patient who takes ramipril (Altace) to treat hypertension. What would be an appropriate nursing diagnosis to include in this patient's care plan?

Ineffective tissue perfusion related to changes in cardiac output

The nurse is caring for a patient newly prescribed iloprost (Ventavis). What is the nurse's priority teaching point about this medication?

Inhale this drug six to nine times a day during waking hours.

After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?

Left ventricle

A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?

Losartan

The nurse works with the patient, diagnosed with hypertension, and the patient's family to determine the goal of drug therapy for the patient taking an antihypertensive medication is what?

Maintaining the blood pressure within normal limits

A patient newly diagnosed with hypertension has just been given a prescription for medication. Along with promoting safety, what is the other goal of the nurse's teaching plan?

Medication compliance

The nurse is caring for an obese child with hypertension and slightly elevated serum glucose levels. What would the nurse anticipate will be ordered if lifestyle changes do not return blood pressure to an acceptable limit?

Mild diuretic

After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply?

Myocardium hypertrophy

A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for?

Peripheral edema and bradycardia

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

A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse?

Slow the rate of the infusion

The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client's systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first?

Stop the infusion and administer diluted phentolamine.