Hypertension – Flashcards
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What physiological event is responsible for the most damage to organs with malignant hypertension?
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Damage to the small arterioles.
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How does high blood pressure increase the workload of the heart?
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Damages the arteries and causes increased resistance of the arterioles to the flow of blood.
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What is the most distinguishing feature of malignant hypertension?
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Arteriolitis; inflammation to the arterioles of the eyes.
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Hypertension or high blood pressure occurs when a sustained elevation of:
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Systolic arterial pressure of 140 mmHg or higher.Diastolic arterial pressure of 90 mmHg or greater.Both.
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Define pre, stage one, and stage two hypertension.
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Pre-hypertension is 120-139/80- 89
Stage I Hypertension 140-159/90-99
Stage II Hypertension >160/>100
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Systolic blood pressure is
caused by...
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the contraction of the left ventricle.
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Diastolic blood pressure occurs
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during the relaxation phase between heartbeats.
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The most common factor in Hypertension is ...
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vasoconstriction or narrowing of the peripheral blood vessels
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The cause of primary (essential) hypertension?
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It is unknown. Constitutes 90% to 95% of all cases of hypertension
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What are some non-modifiable risk factors for primary (essential) hypertension?
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Age: risk increases past 30 years.
Race: Risk twice as high in African-Americans as in whites
Gender: men more at risk than women.
Family history: risk increases with positive family history.
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What are some modifiable risk factors for primary (essential) hypertension?
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Smoking: nicotine causes vasoconstriction.
Obesity: associated with increased blood volume.
High sodium diet: increases water retention thereby increases blood volume.
Elevated serum cholesterol leads to narrowing of the blood vessels.
Oral contraceptives/estrogen therapy: May contribute to elevated blood pressure.
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What're some conditions associated with secondary hypertension?
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Smoking: nicotine causes vasoconstriction.
Obesity: associated with increased blood volume.
High sodium diet: increases water retention thereby increases blood volume.
Elevated serum cholesterol leads to narrowing of the blood vessels.
Oral contraceptives/estrogen therapy: May contribute to elevated blood pressure.
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What is malignant hypertension and who does it most commonly affect?
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Severe, rapidly progressing elevation in blood pressure: diastolic > 120 mmHg; Black males under 40 y/o
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Why does hypertension often go untreated?
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It is frequently asymptomatic until target organ damage begins.
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What are some drugs used to treat uncomplicated hypertension?
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Diuretics: thiazides, loop diuretics, and potassium sparring.
Beta Blockers: metoprolol (Lopressor).
Angiotensin-Converting Enzyme (ACE) inhibitors: lisinopril (Prinivil, Zestril).
Angiotensin II Receptor Blockers: valsartan (Diovan).
Calcium Channel Blockers: diltiazem (Cardizem).
Alpha-Agonist: clonidine
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What class of medication is used in treating hypertension?
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Antihypertensives which include, ACE inhibitors, calcium channel blocker, diuretics, beta-blockers, Alpha-Agonist and Angiotensin II Receptor Blockers.
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what are some side effects to taking a hypertensive?
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CNS: headache.
CV: hypotension, bradycardia, tachycardia.
GI: nausea, vomiting
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what should you continually look for in a pt taking a hypertensive?
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angioedema,Cerebral vasospasm,
Heart Failure, Angina, Arrhythmias and signs of CHF:
peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention.
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What do Beta Blockers and Calcium Channel Blockers do?
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Decrease frequency and severity of angina attacks.
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A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the most correct response?
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a. "This therapy should last for about 3 months."
b. "For about a year."
c. "Until your symptoms disappear."
d. "Therapy for high blood pressure is usually life-long."
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What is an adrenergicand what does it do?
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potent vasodilator; improves myocardial contraction and reduces pulmonary congestion. It manages mild to moderate hypertension.
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What is an example of an adrenergic?
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clonidine (Catapres).
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When a patient is taking an adrenergic drug, the nurse should expect to observe which of the following effects?
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a. Increased heart rate.
b. Bronchial constriction.
c. Peripheral vasodilation.
d. Increased intestinal peristalsis.
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What is an Angiotensin-converting enzyme (ACE) inhibitor and what does it do?
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Blocks the conversion of angiotensin I to the vasoconstrictor angiotensin II (vasoconstriction), prevents the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation.
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What are some examples of ACE inhibitors?
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-pril ending drugs:benazepril (Lotensin).captopril (Capoten).enalapril (Vasotec).fosinopril (Monopril).lisinopril (Prinivil; Zestril). quinapril (Accupril). univasc (Moexipril).vamipril (Altace).
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What are some possible sisde effects of ACE inhibitors?
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CNS: dizziness, fatigue, headache, vertigo, weakness.
Resp: cough.
CV: hypotension, chest pain.
GI: taste disturbances, abdominal pain, diarrhea, nausea, vomiting.
GU: proteinuria, impaired renal function.
Derm: rashes.
F and E: hyperkalemia.
Misc: ANGIOEDEMA.
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A patient who has just begun taking an ACE inhibitor telephones the nurse and reports feeling very dizzy when standing up and wonders if she should discontinue the medication. How should the nurse respond?
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a. "Stop taking the medication immediately."
b. "Rise to a sitting or standing position slowly; your symptoms will resolve."
c. "I will schedule you to visit the health care provider today."
d. "Cut the pill in half and take a reduced dosage."
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What are Angiotensin II Receptor Antagonists and what do they do?
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Hypertensive that blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites including vascular smooth muscle and the adrenal glands.Used as treatment of type 2 diabetes and hypertension, management of CHF in pts who cannot tolerate ACE inhibitors, and reduces risk of stroke in patients with CHF and left ventricular hypertrophy.
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What are some examples of Angiotensin II Receptor Antagonists?
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-artan ending drugs: iosartan (Cozaar). irbesartan (Avapro). valsartan (Diovan).
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Possible side effects of Angiotensin II Receptor Antagonists...
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CNS: dizziness, fatigue, headache.
CV: hypotension.
GI: diarrhea.
F and E: hyperkalemia.
GU: impaired renal function.
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Which nursing assessment confirms that the angiotensin II receptor antagonist a patient is taking is effective?
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a. Weight loss >2 lb per week.
b. LDL cholesterol levels have decreased.
c. Urinary output is increased.
d. Blood pressure has decreased
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What do beta-blockers do?
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Manage of hypertension, angina pectoris, tachyarrhythmias, hypertrophic subaortic stenosis, migraine headache (prophylaxis), MI (prevention), glaucoma (ophthalmic), CHF, and hyperthyroidism by competing with adrenergic (sympathetic) neurotransmitters for adrenergic receptor sites.
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What are some examples of beta-blocking medications?
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-ol ending drugs: acebutolol HCI (Sectral). atenol(Tenormin).carvedilol (Coreg). esmolol HCI (Brevibloc). metoprolol (Lopressor).
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What are some possible side effects of beta-blockers?
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CV: orthostatic hypotension, bradycardia, CHF, blood dyscrasias.
Resp: bronchospasm.
GI: diarrhea, nausea, vomiting
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Propranolol (Inderal), a beta adrenergic blocker, controls hypertension by:
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a. blocking alpha receptors throughout the body.
b. increasing the diuretic response in the renal tubules.
c. blocking the beta receptor stimulation in cardiac muscle.
d. inhibiting the conversion of angiotensin I to angiotensin II.
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What do calcium channel blockers do and what are they used for?
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Inhibit the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.Used
alone or with other agents in the management of hypertension, angina pectoris, and vasospastic (Prinzmetal's) angina.
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Possible side effects of calcium channel bolckers...
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CNS: headache, dizziness, fatigue.
CV: dysrhythmia, peripheral edema, angina, bradycardia, hypotension, palpitations.
Derm: flushing
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A client is taking amlodipine (Norvasc) for control of hypertension. The nurse would give the client which of the following instructions about its use?
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a. Take the dose with breakfast, preferably with grapefruit juice.
b. Take the dose with a source of protein.
c. Take the dose every other day, with a diuretic on the alternate days.
d. Take the dose on an empty stomach
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What are the subgroups of diuretics and what group are sulfonamides a part of?
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Loop.Thiazide. or Thiazide-like. Sulfonamides are loop diuretics.
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What are some sulfonamide drugs?
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-ide ending drugs: Thiazides: chlorothiazide (Diuril) and hydrochlorothiazide (hydroDIURIL).
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On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates his lungs and notes bilateral crackles throughout both fields. In addition, he has bilateral +2 edema of his lower extremities. The nurse anticipates his health care provider will prescribe:
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furosemide (Lasix); Diuretics are the mainstays of treatment in heart failure and hypertension.
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Possible side effects of vasodilators?
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Derm: itching, rash, sweating.
Hemat: anemia.
Local: injection site reactions.
MS: back pain, leg cramps.
Neuro: paresthesia, tremor.
Misc: fever.
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The nurse places highest priority on attending to which of the following adverse effects experienced by a client receiving nesiritide (Natrecor)?
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a. Dizziness.
b. Nausea.
c. Ventricular dysrhythmias.
d. Back pain.
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Antihypertensive drug therapy for a "newly" diagnosed, stage 1 hypertensive African-American patient would most likely include which of the following?
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a. Vasodilators alone.
b. ACE inhibitors alone.
c. Calcium channel blockers with thiazide diuretic.
d. Beta-blockers with thiazide diuretic.
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How is hypertension diagnosed?
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Diagnosis is not based on a onetime reading, but an average of two or more.
question
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