CH 43 Blood Pressure PREPU – Flashcards

Ham sandwich with mustard, carrots and cheesy dip Rationale: A ham sandwich with mustard and a cheesy dip has increased fat and sodium. The DASH diet includes whole grains, poultry, fish, and nuts and has reduced amounts of fats, red meats, sweets, and sugared beverages.

Myocardium hypertrophy Rationale: As a result of increased cardiac workload from cardiac wall sclerosis, the myocardium hypertrophies as a compensatory mechanism and heart failure eventually occurs.

2 Rationale: Most clients with stage 2 hypertension will require 2 medications to lower their blood pressure to goal initially.

Restore and maintain adequate tissue perfusion. Rationale: The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.

Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors. Rationale: Cost, dark skin, and prescribing multiple medications are not the reasons a beta blocker and a diuretic are used to treat hypertension in African American clients. Research has shown that the combination of a beta blocker and a diuretic treat hypertension in African Americans more effectively than other common hypertension medications.

Left ventricle Rationale: The area of highest pressure in the system is always the left ventricle during systole. This pressure propels the blood out of the aorta and into the system.

Dietary consumption of calories and salt Rationale: Key behavioral determinants of blood pressure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.

Decrease in the plasma renin level Rationale: The beta-blocking effect of labetalol results in a decrease in the plasma renin level. The alpha-blocking action causes orthostatic hypotension. The beta-blocking action prevents reflex tachycardia and elevations in blood pressure.

Losartan Rationale: 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.

Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications Monitoring for drug effects Rationale: Whether the client or another member of the household is taking antihypertensive medications, the home care nurse may be helpful in teaching about the drugs, monitoring for drug effects, and promoting compliance with the prescribed regimen (pharmacologic and lifestyle modifications). The nurse would not provide financial assistant with daily expenses though the nurse would help the client and family discover resources that might provide what is needed.

Prehypertension Rationale: Prehypertension is defined as a systolic pressure between 120 and 130 mmHg or a diastolic pressure between 80 and 89 mmHg.

Risk for injury Rationale: Risk for injury is appropriate because the changes in blood pressure with position changes increases the patient's risk for falls. Ineffective airway clearance would be appropriate if the patient has copious respiratory secretions or the unrelenting cough of ACE inhibitors. Impaired peripheral tissue perfusion would be appropriate if the patient was experiencing changes in the color or circulation to his extremities. Fluid volume deficit would be appropriate if the patient was dehydrated.

Changes in heart contraction Rationale: Stroke volume is the volume of blood ejected from the heart at each beat. If a heart contracts harder, more blood is ejected. If a heart cannot contract very well, then less blood is ejected and stroke volume falls. Heparin dose, walking patterns, and respiratory rate do not directly affect stroke volume.

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.

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.

Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg Rationale: Hypertension is defined as a systolic pressure above 140 mm Hg or a diastolic pressure above 90 mm Hg on multiple blood pressure measurements. The blood pressure of 160/110 is considered hypertensive but does not define hypertension. The blood pressure of 130/95 is hypertensive but does not define hypertension. The blood pressure of 150/100 is hypertensive but does not define hypertension.

It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. Rationale: Nitroprusside, which is used in hypertensive crisis, directly relaxes vascular smooth muscle, allowing the dilation of peripheral arteries and veins. Angiotensin II receptor blockers block the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. Selective aldosterone blockers bind selectively to the mineralocorticoid receptors, thereby blocking aldosterone from binding to these receptors, while calcium channel blockers inhibit the movement of calcium ions across cell membranes.

Persistent cough Rationale: A persistent cough can develop with the use of ACE inhibitors. Sedation, tachycardia, and rash are not noted with ACE Inhibitors.

Secondary hypertension Rationale: Secondary hypertension results as a consequence of renal impairment. In secondary hypertension there is usually a known cause for the development of hypertension. Renal disease is one of the causes of secondary hypertension. When there is no known cause of hypertension it is called essential hypertension. Rebound hypertension occurs when a patient abruptly stops taking antihypertensive medication. Hypertensive emergency is a high blood pressure state which has to be lowered immediately.

Multiple diastolic blood pressure readings <90 mm Hg Rationale: The diastolic blood pressure below 90 mm Hg is the most important outcome in this patient. Verbalization of understanding of the medical regime is a patient-related outcome that is important but not the most important outcome. Compliance with antihypertensive medications is important but does not confirm a decreased blood pressure. Compliance with a low-sodium diet will assist in decreasing blood pressure but will not confirm that the blood pressure is decreased.

Angiotensin II receptor blockers Rationale: 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.

Diastolic blood pressure below 90 mm Hg Rationale: 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.

Hydrochlorothiazide Rationale: Hydrochlorothiazide is a thiazide diuretic that promotes the loss of sodium as well as potassium from the body. Subsequently, the client is at risk for hypokalemia. Amiloride, spironolactone, and triamterene are potassium-sparing diuretics. The client using these diuretics would need to be monitored for hyperkalemia because potassium is not lost along with sodium.

Persistent cough Rationale: A persistent, nonproductive cough develops in approximately 10% to 20% of clients using ACE inhibitors and may lead to stopping the drug. Hyperkalemia can occur in some patients, such as those who have diabetes mellitus or renal impairment or who are taking nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics.

falls. Rationale: Angiotensin II receptor blockers such as losartan are associated with a risk of dizziness and a consequent risk for falls. This risk is more pronounced among older adults. Losartan is not associated with constipation, xerostomia, or depression.

"Have you been drinking any grapefruit juice lately?" Rationale: Verapamil, like other calcium channel blockers, interacts with grapefruit juice, increasing the concentration of calcium channel blockers and leading to toxicity. Calcium channel blockers do not interact with ibuprofen. Splitting or crushing the pills could lead to a release of the drug all at once, but this is more common when the drug is first taken. Asking about the time the client last took the drug might be important, but it would not address the problem associated with the significant adverse effects.

By blocking the angiotensin II receptors Rationale: 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.

Stage 2 Rationale: 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.

By inhibiting the transformation of angiotensin I to angiotensin II Rationale: 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.

Lifelong Rationale: Once primary hypertension develops, management of the disorder becomes a lifetime task.

The dose should be lower than normal. Rationale: Both losartan and the metabolite are highly bound to plasma albumin, and losartan has a shorter duration of action. Due to malnutrition, a low-dose of losartan should be prescribed. The dose should not be higher than normal due to possible toxicity. The dose should not be the same as normal due to possible toxicity. The medication will not be combined with a diuretic unless the blood pressure is not controlled.

"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." Rationale: Hypertension causes damage to blood vessels within the body that may lead to cardiovascular and kidney damage. Hypertension may be treated with or without medications. It is not within the scope of the nurse to decide whether or not the client needs medications, but to provide the education regarding the disease process and medications.

a persistent, dry cough may occur; however, it is not serious. Rationale: The nurse will advise the patient that the captopril may produce a persistent, dry cough that is not serious. Patients may want to discontinue therapy because of the cough, but the nurse should encourage the patient to continue therapy and help the patient minimize the cough. However, if the cough becomes intolerable, the patient should contact the prescriber. The patient should be instructed to take the first dose at bedtime to minimize the possibilities of injury from first-dose hypotension. The patient should be advised to notify the prescriber promptly if sore throat; fever; swollen hands or feet; irregular heartbeat; chest pain; swollen face, eyes, lips and tongue; difficulty breathing; or hoarseness occur. These effects could indicate angioedema, which can be life threatening. If the patient normally uses a salt substitute containing potassium or a potassium supplement, these substances may need to be discontinued to avoid possible hyperkalemia. Hypokalemia is not a concern.

Hypoperfusion of tissues Rationale: Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response.

Discontinue the drug Rationale: The FDA has issued a black box warning for ACE inhibitors and ARBs during pregnancy, because their use can cause injury and even death to a developing fetus.

• Relaxation of blood vessels. • Increase oxygen supply to the heart. • Reduce the workload on the heart. • Decrease blood pressure. Rationale: The use of calcium channel blockers results in relaxation of blood vessels, increase oxygen supply to the heart, reduce the workload on the heart, and decrease blood pressure.

Cough Rationale: Fosinopril is associated with an unrelenting cough that can lead patients to discontinue the drug. Constipation is an adverse effect of ACE inhibitors, but would not necessarily lead a patient to discontinue the drug. GI irritation is an adverse effect of ACE inhibitors, but would not necessarily lead a patient to discontinue the drug. Photosensitivity is an adverse effect of ACE inhibitors, but would not necessarily lead a patient to discontinue the drug.

Prehypertension Rationale: Prehypertension = systolic 120 to 139 mm Hg or diastolic 80 to 89 mm Hg.

Prazosin Rationale: Prazosin is an alpha-1 blocker that is used to treat hypertension. Labetalol and guanabenz are alpha- and beta blockers used to treat hypertension. Nadolol is a beta blocker used to treat hypertension.

Decreased venous return Rationale: 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. Option C is incorrect; heart rate increases in an attempt to meet the demands of the body.

"When was your last menstrual period?" Rationale: 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.

Aldosterone Rationale: The nurse should explain that aldosterone is the hormone produced by the adrenal cortex. Renin and angiotensin are hormones produced in the kidneys, and not by the adrenal cortex. Enalapril is not a hormone; it is an ACEI antihypertensive drug.

monitor the patient's blood pressure. Rationale: Monitoring of blood pressure would be the priority assessment in the care of this patient. Questioning the patient about her dietary intake and weighing her would be appropriate, but secondary in importance. It is unnecessary to monitor the patient's respiratory rate.

Serum potassium levels Rationale: Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy.

Hypertension will increase the risk of heart disease. Rationale: Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. Hypertension does not increase the risk of cancer. An increase in sodium in a patient's diet is not recommended with hypertension. Exercise will decrease the risk of hypertension.

Hyperkalemia Rationale: Hyperkalemia may develop in patients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in patients with diabetes mellitus. Hypernatremia is not risk in patients with diabetes who are taking captopril. Hypermagnesemia is not a risk in patients with diabetes who are taking captopril.

Lisinopril (Prinivil) Rationale: Angiotensin-converting enzyme inhibitors (ACEIs) act primarily for suppress the rennin-angiotensin-aldosterone system and lisinopril is an ACEI. Verapamil and diltiazem are calcium channel blockers and furosemide is a diuretic.

Limited alcohol intake Weight reduction Moderate sodium restriction Rationale: Nonpharmacologic management of hypertension should be tried alone or with drug therapy. For example, weight reduction, limited alcohol intake, moderate sodium restriction, and smoking cessation may be the initial treatment of choice if the client is hypertensive and overweight. The hot water in a hot tub may actually increase blood pressure.

Slow the rate of the infusion Rationale: Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort. The nurse should quickly inform the prescriber and slow the infusion. Symptoms quickly subside when the nitroprusside infusion is slowed or stopped, and usually do not return when the infusion resumes at a slower rate. Consulting the prescriber for a dose change would not help; the rate of drug administration is the issue. Continuing to give the nitroprusside at the ordered rate could be fatal.

An ongoing systematic assessment Rationale: Nursing care of patients with shock requires ongoing systematic assessment. Options A, B, and C are incorrect; basic nursing care of patients with shock does not require understanding the causes of shock, understanding the primary prevention of shock, or restoring intravascular volume.

"Swallow the drug whole with a large glass of water." Rationale: Diltiazem, like other calcium channel blockers, should be swallowed whole with a large glass of water. The tablet should not be split in half, crushed, or chewed.

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. Options A, C, and D are all correct answers; however, they are not more important functions of nursing care than monitoring for complications and side effects of treatment.

Aliskiren Rationale: Aliskiren is a renin inhibitor. Mecamylamine is a ganglionic blocker. Candesartan is an angiotensin II receptor blocker; captopril is an ACE inhibitor.

A diuretic Rationale: When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. (less)

Bradycardia Rationale: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

Hypotensive crisis Rationale: Hypotensive crisis may be seen in older patients on nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Thromboembolism, stroke, and blindness will not occur during nitroprusside therapy.

Increasing peripheral vascular resistance. Rationale: Drugs with alpha-adrenergic activity increase peripheral vascular resistance and raise blood pressure.

Hyponatremia Rationale: The nurse should assess for hyponatremia in patients receiving diuretics. Diuretic usage causes electrolyte disturbances such as hyponatremia and hypokalemia. The nurse should inform the primary healthcare provider if signs and symptoms of electrolyte imbalance occur. Hyperkalemia, hypomagnesemia, and hypocalcemia do not occur in patients taking diuretics.