PrepU Chapter 43: Drugs Affecting Blood Pressure
A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance?
Cough
A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.)
Damage to the eyes Damage to the kidneys Damage to the heart Rationale: A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.
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:
Decreased venous return 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. Heart rate increases in an attempt to meet the demands of the body.
Key behavioral determinants of blood pressure are related to what factor?
Dietary consumption of calories and salt
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
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?
Discontinue the drug
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
Anaphylaxis kits for clients allergic to bee stings would contain which medication?
Epinephrine
A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow up the client's statement?
Explain that drugs like ramipril often cause a cough
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:
Falls
A patient newly diagnosed with hypertension has just been given a prescription for medication. What would be the most important outcome for this patient?
Having taken the first dose of medication
A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension?
Stage 2 Rationale: A client is diagnosed with Stage 2 hypertension when their systolic blood pressure is greater than or equal to 160 OR their diastolic blood pressure is greater than or equal to 100.
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 SBP is 88 mm. Which action would the nurse implement first?
Stop the infusion and administer diluted phentolamine
A client is newly diagnosed with hypertension. When explaining this diagnosis, the nurse would include information that hypertension increases the person's risk for which conditions? Select all that apply.
Heart failure Stroke Blindness Kidney disease
A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent?
Hydrochlorothiazide
When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?
Ineffective tissue perfusion
A teenage client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?
Instant bronchodilation Rationale: For acute asthma attacks, subcutaneous administration of epinephrine usually produces bronchodilation instantly; maximal effects may occur within 20 minutes helping to eventually decrease the respiratory rate.
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
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."
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?
"When was your last menstrual period?"
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."
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 Rationale: Most clients with stage 2 hypertension will require 2 medications to lower their blood pressure to goal initially.
A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:
A persistent, dry cough may occur; however, it is not serious
A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long?
Lifelong
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 Losartan is an example of an angiotensin II receptor blocker. Moexipril is an ACE inhibitor. Minoxidil is a vasodilator. Amlodipine is a calcium channel 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?
Losartan Olmesartan
What should a client with newly diagnosed hypertension be counseled to do? Select all that apply.
Lose weight Stop smoking Reduce stress
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 Rationale: General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. The other options are all correct answers; however, they are not more important functions of nursing care than monitoring for complications and side effects of treatment.
A 42-year-old client is seen by the health care provider for follow-up for diabetic nephrophathy. 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
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 client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors?
Persistent cough
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 Rationale: Prehypertension is defined as systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg.
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
How does captopril contribute to a reduction of a client's blood pressure?
Blocking the conversion of Angiotensin I to Angiotensin II
How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)
Promoting compliance with the prescribed lifestyle modifications Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications
Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure?
Bronchioles
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 Losartan brings about an antihypertensive effect by blocking the angiotensin II receptors. Losartan is an angiotensin II receptor antagonist. 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. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors
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 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?
Take the medication at bedtime
The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which?
Weight loss and decreased salt intake