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28: Drug Therapy for Hypertension

question

The client has a blood pressure of 165/100 mmHg. The nurse knows that this client would be in classified as which stage of hypertension? a) Normotensive b) Stage 1 c) Stage 2 d) Prehypertension
answer

Stage 2 Explanation: A client is diagnosed with Stage 2 hypertension when his or her systolic blood pressure is greater than or equal to 160 mm Hg OR the diastolic blood pressure is greater than or equal to 100 mm Hg.
question

A client is started on trandolapril (Mavik). The client should be instructed that which of the following is a common adverse effect of ACE inhibitor therapy? a) Rash b) Sedation c) Tachycardia d) Persistent cough
answer

Persistent cough Explanation: A persistent cough develops in approximately 10% to 20% of clients and may lead to stopping the drug.
question

Mr. Emmeott is seen by the physician for follow-up for diabetic nephropathy. The physician 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? a) Angiotensin II receptor blockers b) Selective aldosterone blockers c) Calcium channel blockers d) Antihyperlipidemic drugs
answer

Angiotensin II receptor blockers Explanation: Losartan is an angiotensin II receptor blocker (ARB) and is recommended for patients with diabetic renal disease because ARBs have been shown to reduce the rate of end-stage renal disease.
question

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which of the following antihypertensives can cause bradycardia? a) Labetalol b) Clonidine c) Diltiazem d) Enalapril
answer

Diltiazem Explanation: Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol’s adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine’s adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness
question

What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension? a) Diltiazem (Cardizem) b) Metoprolol (Lopressor) c) Aliskiren (Tekturna) d) Atenolol (Tenormin)
answer

Diltiazem (Cardizem)The calciumchannel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and verapamil (Calan SR). Aliskiren (Tekturna) is a rennin inhibitor. Atenolol (Tenormin) and Metoprolol (Lopressor) are beta blockers, not calcium channel blocker.
question

A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact? a) For three weeks b) For four weeks c) For two weeks d) For one week
answer

For one week Explanation: The nurse should ensure that the transdermal patch is intact for a period of one week. A clonidine transdermal patch should be applied to a hairless area over the torso for one week. If the patch loosens before seven days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.
question

When deciding which drug to use to treat a patient with hypertension, the physician may choose to order an ARB (angiotensin II receptor blocker) over an ACE inhibitor. The rationale for this choice of drug therapy may be based on the fact that an ARB is less likely to cause what adverse effects? a) Palpitations b) Bradycardia c) Orthostatic hypotension d) Hyperkalemia
answer

Correct response: Hyperkalemia Explanation: ARBs are less likely to cause hyperkalemia than ACE inhibitors. They are not generally less likely to cause orthostatic hypotension, palpitations, or bradycardia.
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Your 71-year-old male patient has recently been diagnosed with hypertension. Which of the following measurements is a partial indication of effective treatment and management? a) Systolic blood pressure above 140 mm Hg b) Diastolic blood pressure below 100 mm Hg c) Systolic blood pressure below 160 mm Hg d) Diastolic blood pressure below 90 mm Hg
answer

Successful treatment involves reducing blood pressure below hypertensive levels. In adults, this is typically defined as a systolic pressure below 140 mm Hg and a diastolic pressure below 90 mm Hg.
question

You are a clinic nurse who is assessing a new patient prior to their seeing the physician. The patient has a history of hypertension and tells you they are taking benazepril (Lotensin) to control their disease process. A priority nursing assessment in this patient would be to assess them for a history of what? a) Hepatic disease b) Peptic ulcer disease c) Mental illness d) Renal disease
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Renal disease Explanation: Benazepril is an ACE inhibitor and these drugs are contraindicated in the presence of impaired renal function. Mental illness, hepatic, or peptic ulcer disease is not a contraindication with this drug.
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A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient’s nurse should recognize that the therapeutic effect of this drug is achieved in what way? a) By blocking the movement of calcium ions into arterial smooth muscles b) By blocking aldosterone from binding to mineralocorticoid receptors c) By inhibiting the transformation of angiotensin I to angiotensin II d) By directly relaxing vascular smooth muscle
answer

By inhibiting the transformation of angiotensin I to angiotensin II Explanation: Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.
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Once a client develops primary hypertension, therapy should last for how long? (Choose one) a) 5 years b) One year c) Until blood pressure is 120/80 mmHg d) Lifelong
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Lifelong Explanation: Once primary hypertension develops, management of the disorder becomes a lifetime task.
question

A 46-year-old man with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension by his primary care provider after serial blood pressure readings. The clinician has opted to begin the patient on captopril (Capoten). The patient’s nurse should recognize that the therapeutic effect of this drug is achieved in what way? a) By blocking aldosterone from binding to mineralocorticoid receptors b) By inhibiting the transformation of angiotensin I to angiotensin II c) By directly relaxing vascular smooth muscle d) By blocking the movement of calcium ions into arterial smooth muscles
answer

By inhibiting the transformation of angiotensin I to angiotensin II Explanation: Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.
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Choice Multiple question – Select all answer choices that apply. A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately which of the following can occur? Select all that apply: a) Damage to the pancreas b) Damage to the kidneys c) Damage to the gall bladder d) Damage to the eyes e) Damage to the heart
answer

• Damage to the heart • Damage to the kidneys • Damage to the eyes Explanation: A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.
question

The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following? a) Hypercalcemia b) Hypocalcemia c) Hyperkalemia d) Hypokalemia
answer

Hyperkalemia Explanation: When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.
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Choice Multiple question – Select all answer choices that apply. The nurse should notify the physician when any of the following occur while a client is receiving an antihypertensive. Select all that apply: a) Headache b) Edema c) Insomnia d) Weight gain of 2 lb or more per day. e) Sedation
answer

• Weight gain of 2 lb or more per day. • Edema Explanation: The nurse should notify the physician if a client has a 2 lb or more weight gain per day or edema of the hands, fingers, feet, legs, or sacral area.
question

The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which of the following antihypertensives can cause bradycardia? a) Diltiazem b) Labetalol c) Clonidine d) Enalapril
answer

Diltiazem Explanation: Diltiazem is a calcium channel blocker that can cause atrioventricular block and bradycardia. Labetalol’s adverse reactions include fatigue, drowsiness, insomnia, and hypotension. Clonidine’s adverse reactions include drowsiness, dizziness, dry mouth, and constipation. Clients on enalapril can experience headache and dizziness.
question

Which of the following questions would be most important for a nurse to ask a female patient who is starting on an angiotensin II receptor blocker for hypertension? a) “Have you always weighed 150 pounds?” b) “When was your last menstrual period?” c) “How much physical exercise do you get?” d) “Do you eat something when you take your medications?”
answer

“When was your last menstrual period?” Explanation: It would be important to know when the patient’s LMP occurred and that the patient 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 patient who is beginning angiotensin II receptor blocker therapy.
question

The client is to start on lisinopril for hypertension. Prior to administration of the medication, the blood pressure is 112/76 mm Hg. What is the nurse’s most appropriate action? a) Administer the medication. b) Retake the blood pressure in 30 minutes. c) Hold the medication. d) Notify the health care provider.
answer

Notify the health care provider. Explanation: The client’s blood pressure is within the normal range. It is important that the nurse notify the provider of the client’s blood pressure so that the need can be further evaluated. The nurse should not hold the medication; the provider must determine the best course of action.