chap 43 prepU – Flashcards
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Once a client develops primary hypertension, therapy should last for how long? (Choose one)
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Lifelong Once primary hypertension develops, management of the disorder becomes a lifetime task.
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During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which of the following is the most likely consequence of renal impairment?
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Secondary hypertension 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
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After receiving the results of his echocardiogram, your patient has many questions regarding results and their impact on his lifestyle. He is a 57-year-old Hispanic man with a 10-year history of hypertension. Disturbed by all the dietary changes proposed by the cardiologist, he questions what effect hypertension has on his heart. What is your reply?
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Myocardium hypertrophy As a result of increased cardiac workload from cardiac wall sclerosis, the myocardium hypertrophies as a compensatory mechanism and heart failure eventually occurs.
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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?
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Stage 2 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
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A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify which of the following as an example of an angiotensin II receptor blocker?
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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.
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A patient is experiencing orthostatic hypotension that is due to his antihypertensive therapy. Which nursing diagnosis would be most appropriate?
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Risk for injury 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
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The nurse has admitted a client with type 1 diabetes mellitus who has been prescribed captopril for treatment of hypertension. The nurse knows this medication is used in clients with diabetes for what reason?
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It reduces proteinuria. Captopril is an ACE inhibitor, and it is used to treat hypertension in clients with type 1 diabetes mellitus because it reduces proteinuria and slows progression of renal impairment
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A nurse checks a client's blood pressure and finds it to be 130/82. This client should be classified as having which stage of hypertension?
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Prehypertension Prehypertension is defined as a systolic pressure between 120 and 130 mmHg or a diastolic pressure between 80 and 89 mmHg.
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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?
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Hydrochlorothiazide 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
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When preparing a plan of care for a client in hypovolemic shock, which of the following partial nursing diagnoses might be relevant to the patient's condition?
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Ineffective Tissue Perfusion Hypovolemic shock is caused by the loss of intravascular fluids, including blood. Therefore, of the four options, the only choice relevant to hypovolemic shock is Ineffective Tissue Perfusion
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The nurse recognizes that which of the following medications may be used to treat a hypertensive crisis?
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Nitroprusside Nitroprusside is administered during a hypertensive crisis intravenously. Hydralazine and minoxidil are used for severe hypertension, and amlodipine is also administered for hypertension
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Most clients with Stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially? (Choose one)
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2 Most clients with stage 2 hypertension will require 2 medications to lower their blood pressure to goal initially.
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A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which of the following modes of action helps losartan to bring about its antihypertensive effect?
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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
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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?
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By inhibiting the transformation of angiotensin I to angiotensin II 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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A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme inhibitor (ACE inhibitor)?
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Persistent cough A persistent cough can develop with the use of ACE inhibitors. Sedation, tachycardia, and rash are not noted with ACE Inhibitors.
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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?
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Diastolic blood pressure below 90 mm Hg 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
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The nurse knows that what physiologic changes will effect a client's stroke volume?
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Changes in heart contraction 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
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A client is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect?
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Persistent cough 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
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A patient has had multiple blood pressure readings that indicate he is hypertensive. How is hypertension defined?
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Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg 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
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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 physician regarding her medication regimen. What would the nurse expect the physician to do?
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Discontinue the drug 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.
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A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?
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Restore and maintain adequate tissue perfusion. The goal of adrenergic drug therapy in hypotension and shock is to restore and maintain adequate tissue perfusion, especially to vital organs.
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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?
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"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." 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
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A nurse is educating a group of nursing students on the mechanism of actions of angiotensin converting enzyme inhibitors (ACEI). Which of the following should the nurse explain as the hormone produced by the adrenal cortex?
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Aldosterone 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
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The nurse is teaching a client how to take his diltiazem. Which instruction would be most appropriate?
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"Swallow the drug whole with a large glass of water." 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.
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A client receiving an ACE inhibitor reports a problem with coughing. The nurse would ask the client if he is receiving which of the following?
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Benazepril Benazepril is associated with an unrelenting cough. Ramipril, lisinopril, and quinapril are not associated with this adverse effect.
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A patient is receiving candesartan. The nurse understands that this drug acts in which manner?
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Selectively binds with angiotensin II receptors in the vascular smooth muscle Candesartan is an angiotensin II receptor blocker. ACE inhibitors prevent ACE from converting angiotensin I to angiotensin II. Calcium channel blockers inhibit calcium ion movement across muscle cells of the heart and arterial muscle cells. Diuretics increase the excretion of sodium and water from the kidney
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Key behavioral determinants of blood pressure are related to what factor?
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Dietary consumption of calories and salt 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
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A 26-year-old white male patient has been prescribed captopril for hypertension. A nurse has been assigned to the patient to provide education regarding the use of this drug. The nurse will advise the patient that
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a persistent, dry cough may occur; however, it is not serious.
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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?
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Angiotensin II receptor blockers 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
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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?
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It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.
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A client with a blood pressure of 165/95 mmHg would be in classified as which stage of hypertension? (Choose one)
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Stage 2 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
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A patient who is malnourished and has hypertension is being treated with losartan (Cozaar). How should the dose of the medication be adjusted in this patient?
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The dose should be lower than normal. 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
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The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition?
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Diabetes mellitus ACE inhibitors are considered first-line antihypertensive agents for clients with diabetes mellitus because they reduce proteinuria and slow the progression of renal impairment.
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A patient is receiving fosinopril. Which adverse effect would the nurse caution the patient about to help to promote compliance?
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Cough Fosinopril is associated with an unrelenting cough that can lead patients to discontinue the drug
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The nurse is educating a client with hypertension about dietary changes that help to decrease blood pressure. Which of the following menu selections indicates the need for further client education?
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Ham sandwich with mustard, carrots and cheesy dip 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
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Which of the following to lower blood pressure primarily via suppression of the rennin-angiotensin-aldosterone system? (Choose one)
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Lisinopril (Prinivil) 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
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Primary hypertension comprises 90% to 95% of hypertensive cases. It is hypertension for which no cause can be found. Which drug groups are used in the management of primary hypertension? Select all that apply.
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• ACE inhibitors • Antiadrenergics • Angiotensin II receptor blockers Drugs used in the management of primary hypertension belong to several different groups, including angiotensin-converting enzyme (ACE) inhibitors; angiotensin II receptor blockers (ARBs), and antiadrenergics. They decrease blood pressure by decreasing cardiac output or peripheral vascular resistance
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A patient with diabetes mellitus is prescribed captopril (Capoten) to treat hypertension. What electrolyte imbalance might the patient be prone to develop?
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Hyperkalemia
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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:
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• Damage to the eyes • Damage to the kidneys • Damage to the heart A hypertensive emergency if not recognized and treated quickly can result in damage to target organs including the heart, kidneys, and eyes.
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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?
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Left ventricle 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
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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?
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Monitoring for complications and side effects of treatment 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
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A clinic nurse has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient 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
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monitor the patient's blood pressure. 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
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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
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falls. 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
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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?
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"When was your last menstrual period?" 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
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A patient with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the physician concludes that losartan alone is not adequately controlling the hypertension. What would the physician likely add to the regimen to improve control?
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A diuretic 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
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A patient is diagnosed with hypertension and is being treated with captopril (Capoten). Which of the following patients should be administered captopril as the first-line treatment?
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A patient with diabetes mellitus Captopril (Capoten) is the first-line agent for treating hypertension in diabetic patients, particularly those with type 1 diabetes. Captopril can be used for hypertension in patients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus
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A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor?
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Aliskiren Aliskiren is a renin inhibitor. Mecamylamine is a ganglionic blocker. Candesartan is an angiotensin II receptor blocker; captopril is an ACE inhibitor.
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You are caring for a patient at risk of shock. What physiologic response would you know to look for while assessing for shock?
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Hypoperfusion of tissues 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
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A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which of the following conditions should the patient be assessed?
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Hypotensive crisis 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
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A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which of the following is the appropriate action by the nurse?
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Slow the rate of the infusion Administering nitroprusside too quickly can result in abdominal pain, apprehension, diaphoresis, dizziness, headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort.
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A client who has been receiving verapamil for several months comes to the clinic reporting significant dizziness, lightheadedness, and fatigue. He also reports frequent episodes of nausea and swelling of his ankles. Drug toxicity is suspected. Which question would be critical to ask the client?
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"Have you been drinking any grapefruit juice lately?" Verapamil, like other calcium channel blockers, interacts with grapefruit juice, increasing the concentration of calcium channel blockers and leading to toxicity
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A nurse is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the nurse assess before beginning drug therapy?
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Serum potassium levels
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A patient is prescribed losartan (Cozaar). The medication alone is not effective in controlling blood pressure. What medication will increase the effectiveness to control blood pressure in this patient?
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Hydrochlorothiazide (HCTZ) If losartan alone does not control blood pressure, a low dose of diuretic may be added. Hydrochlorothiazide is a diuretic agent. Atorvastatin calcium is not a diuretic agent. Hydralazine is not a diuretic agent. Digoxin is not a diuretic agent.
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Your patient, a 37-year-old woman, presents with a blood pressure of 118/86 mm Hg. She exercises regularly, is weight-appropriate for her height, and indicates no use of tobacco or alcohol. According to the 2003 guidelines, what would her blood pressure classify?
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Prehypertension Prehypertension = systolic 120 to 139 mm Hg or diastolic 80 to 89 mm Hg.
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Losartan is frequently prescribed for hypertension management. For which patient would the physician write a smaller starting dose of the medication, based on medical history and age?
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Nick, age 35, who is suffering from hepatic impairment Patients who have impaired liver function have increased bioavailability of losartan because metabolism is impaired. They should be given a lower starting dose of the drug and be monitored for therapeutic and adverse effects.
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When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. As an ICU nurse caring for a patient in circulatory shock, you know that the pooling of blood in the periphery leads to what?
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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. Option C is incorrect; heart rate increases in an attempt to meet the demands of the body
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When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies which of the following as the action brought about by aldosterone?
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Causes sodium and water retention.
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The squad brought a 48-year-old man to your ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the patient reports severe headache and drowsiness. He becomes disoriented and vomits. What is your primary goal in this hypertensive emergency?
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Lower blood pressure as quickly as possible Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs.
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A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing you mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would you best answer her question?
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"He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." Cardiogenic shock is caused by the myocardium's inability to contract efficiently and maintain an adequate cardiac output. Dobutamine is prescribed for treatment because it acts mainly on beta1 receptors in the heart to increase the force of myocardial contraction. It is less vasoactive than some other drugs and it causes a minimal increase in heart rate
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A patient is receiving a diuretic for the treatment of hypertension. For which of the following conditions should the nurse monitor for in patients taking diuretics?
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Hyponatremia 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
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A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent which of the following?
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Excessive hypotension Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
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A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of which of the following?
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Absent reflexes Manifestations of cyanide toxicity include absent reflexes, dilated pupils, dyspnea, headache, vomiting, dizziness, ataxia, loss of consciousness, imperceptible pulse, pink color, distant heart sounds, and shallow breathing. Hair growth is an adverse effect of minoxidil. Chest pain is an adverse effect associated with vasodilator therapy related to changes in blood pressure
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When describing the adverse effects associated with ACE inhibitors, which of the following would the nurse include? Select all that apply.
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• Constipation • Proteinuria • Photosensitivity • Cough
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Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect?
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Mark, who is suffering from impaired renal function
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After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker?
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Valsartan Valsartan is an angiotensin II receptor blocker.
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Which of the following agents would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites?
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Prazosin 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
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A 39-year-old African-American male is 25 pounds overweight and has been diagnosed with hypertension after three consecutive above-normal blood pressure readings. The most likely initial drug therapy for this patient will be
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a diuretic. The patient would most likely be prescribed a diuretic in combination with diet and other lifestyle changes. African-American men are at increased risk for developing hypertension and tend to respond differently to antihypertensive therapy. The research shows that African-American men are most responsive to single-drug therapy and diuretics.
