Hypertension/Cardiac – Flashcards
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Drugs that are most commonly used to treat hypertensive crises include
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Nitroglycerin (Tridil) and sodium nitroprusside (Nipride
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During treatment of a patient with a BP of 210/148 mmHg, the nurse titrates the medication to
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Decrease the mean arterial pressure (MAP) no more than 42 mmHg in the first hour
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A nursing responsibility in the management of the patient with a hypertensive urgency often includes
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Instructing the patient to follow up with a health care professional 24 hours after outpatient treatment
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A patient would be diagnosed with a hypertensive emergency when experiencing
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A sudden rise in BP accompanied by neurologic impairment
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A 38 yo man is treated for hypertension with amiloride/hydrochlorothiazide (Maxide) and metaprolol (Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels and he admits he has not beentaking his medication regularly. The best response by the nurse is:
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"The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area?"
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A patient with stage 2 hypertension who is taking hydrochlorothiazide (HydroDiuril) and lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. It is most important for the nurse to teach the patient to
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Change position slowly and monitor for fluid retention
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Teaching to include dietary sources of potassium is indicated for the hypertensive patient taking
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Hydrochlorothiazide (hydroDiuril)
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The patient with primary hypertension is likely to report
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No symptoms
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Secondary hypertension is differentiated from primary hypertension in that secondary hypertension
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Has a specific cause, such as renal disease, that often can be corrected by medicine or surgery
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A patient with newly diagnosed hypertension has a BP of 158/98 mmHg after 6 months of exercise and diet modifications. Which management strategy will be a priority for this patient?
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Medication will be required because the BP is still not at goal
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In teaching a patient with hypertension about controlling the condition, the nurse recognizes that:
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Lifestyle modifications are indicated for all persons with elevated BP
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While obtaining subjective assessment data from ta patient with hypertension, the nurse recognizes that a modifiable risk factor for:
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Excessive alcohol consumption
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Which BP regulating mechanism(s)is a result in the development of hypertension if defective (select all that apply)?
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Release of norepinephrine Stimulation of the sympathetic nervous system Activation of the renin-angiotensin-aldosterone system
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Which client assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker?
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A. The workload in the heart should be decreased with the vasodilatation from the calcium channel blocker. With less strain, the client should have fewer incidences of angina as afterload is decreased
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The nurse is monitoring a client taking digoxin (Lanoxin) for treatment of heart failure. Which assessment finding indicates a therapeutic effect of the drug?
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B. Digoxin (Lanoxin) has a negative chronotropic effect (decreased heart rate). The heart rate should become slower and stronger.
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A client's serum digoxin level is drawn, and it is 0.4 ng/mL. What is the nurse's priority action? A) a. Administer ordered dose of digoxin. B) b. Hold future digoxin doses. C) c. Administer potassium. D) d. Call the health care provider
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Therapeutic serum digoxin levels are 0.5-2 ng/mL. The client should receive the next dose to bring the level into therapeutic range.
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Which assessment finding will alert the nurse to suspect early digitalis toxicity? A) a. Loss of appetite with slight bradycardia B) b. Blood pressure 90/60 mm Hg C) c. Heart rate 110 beats per minute D) d. Confusion and diarrhea
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A. Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia
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A client taking prazosin has a blood pressure of 140/90. The client is complaining of swollen feet. What is the nurse's best action? A) a. Hold the medication. B) b. Call the health care provider. C) c. Determine the client's history. D) d. Weigh the client
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C. The desired therapeutic effect of prazosin may not fully occur for 4 weeks. The nurse does not know how long the client has been on this medication
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An older adult client is receiving furosemide (Lasix) for treatment of peripheral edema. Which nursing assessment data identify that the client is at risk for falling? A. Dry oral mucous membranes B. Orthostatic blood pressure changes C. Pulse rate of 72 beats/min and bounding D. Serum potassium level of 4.0 mEq/L
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Orthostatic blood pressure changes
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A client's blood pressure is consistently around 156/90 mm Hg. What is the client's blood pressure classification? A. Normal B. Prehypertension C. Stage 1 hypertension D. Stage 2 hypertension
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ANS: C The new classification for adult blood pressure stage 1 hypertension includes systolic values of 140 to 159 mm Hg and diastolic values of 90 to 99 mm Hg.
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A client diagnosed with essential hypertension asks how this type of hypertension develops. What is the nurse's best response? A. "There is no known cause for this type of hypertension." B. "You have an underlying condition that caused your hypertension." C. "The steroids you were taking may have caused your hypertension." D. "You were born with a congenital narrowing of the aorta that caused your hypertension."
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ANS: A Although risk factors for essential hypertension have been identified, there is no known cause of essential hypertension. The remaining choices refer to causes of secondary hypertension.
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The client has been diagnosed with Cushing's syndrome. What assessment should the nurse perform to detect vascular complications of this illness? A. Auscultate heart and lung sounds. B. Assess blood pressure regularly. C. Daily weighing should be done using the same scale. D. Monitor urine output every 24 hours.
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ANS: B Dysfunction of the adrenal medulla or the adrenal cortex can cause secondary hypertension. In Cushing's syndrome, excessive glucocorticoids are excreted from the adrenal cortex.
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What additional physical assessment parameter should be included in the examination of a client diagnosed with hypertension? A. Skin examination for telangiectasis B. Otoscopic examination of the inner ear C. Funduscopic examination of the retina D. Neurologic examination of the cranial nerves
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ANS: C The physical examination of a client with hypertension should include examination of the retina, because the appearance of the retina is a reliable index of the severity of the hypertension.
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When a person's blood pressure drops, the kidneys respond by A. secreting renin. B. producing aldosterone. C. slowing the release of ADH. D. secreting ANP
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A. Juxtaglomerular cells in the kidneys secrete renin in response to low blood flow or a low sodium level. The eventual effect of renin secretion is an increase in blood pressure.
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A client is to begin taking hydrochlorothiazide for control of hypertension. What instructions should be given to this client before beginning therapy? A. "You may develop a slower pulse rate." B. "You may notice some swelling in your feet." C. "You may develop shortness of breath or a cough." D. "Your diet should include foods high in potassium."
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ANS: D Diuretics such as hydrochlorothiazide promote the loss of potassium while preventing sodium and water reabsorption. Therefore, the client should incorporate foods high in potassium into the diet and may even require potassium supplementation
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Which statement by a client undergoing drug therapy for hypertension indicates a need for further clarification? A. "Losing weight may reduce my need for blood pressure medication." B. "Keeping my blood pressure under control reduces my risk for a heart attack." C. "When my blood pressure becomes normal, I will no longer need to take medication." D. "When I get out of bed in the morning, I should first sit for a few moments and then stand."
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ANS: C Compliance with antihypertensive therapy is difficult for two reasons. First, often clients have no distressing symptoms associated with hypertension and may not believe they have a problem. Second, many clients believe that once blood pressure is brought back into the normal range, they are "cured" and no longer need to take medication.
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An elderly client is prescribed to begin receiving lisinopril as part of the treatment for hypertension. What side effect should the nurse be most alert for? A. Pedal edema B. Orthostatic hypotension C. Elevated serum potassium levels D. Hypotension within 30 minutes of administration
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ANS: B Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, can cause severe hypotension with initial use. Instruct the client to get out of bed slowly to avoid the severe hypotensive effects of this class of drugs.
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A nurse is about to administer the first dose of captopril to a client with hypertension. What nursing intervention would be most appropriate at this time? A. Take the client's apical pulse for 1 full minute before drug administration. B. Place the client in the Trendelenburg position to facilitate blood flow to the heart. C. Instruct the client to remain in bed for 3 hours after drug administration. D. Instruct the client to drink 3 L of fluid daily when taking this medication.
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ANS: C ACE inhibitors such as captopril can cause severe hypotension with initial use. This is often referred to as first-dose effect. The client is advised to remain in bed for 3 to 4 hours after administration of the first dose of the medication to prevent hypotension-induced falls.
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A client with hypertension has been prescribed oral clonidine hydrochloride. What instructions should the nurse give to this client? A. "Take this medication at bedtime." B. "Call your health care provider if a rash develops." C. "You will need to have your blood counts monitored regularly." D. "Take this medication by puncturing the capsule and placing the liquid contents under the tongue."
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ANS: A Sedation is a common side effect of central alpha-adrenergic agonist. Therefore, the client should be instructed to take this medication at bedtime.
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Which client would most likely benefit from receiving treatment for hypertension with an ACE inhibitor and a calcium channel blocker? A. 78-year-old African American man B. 40-year-old white woman C. 52-year-old white man D. 60-year-old Asian woman
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ANS: A The International Society on Hypertension in Blacks guidelines state that most African American clients need at least two medications to achieve blood pressure control. Drug combinations recommended include an ACE inhibitor and calcium channel blocker.
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A loud S3 heart sound, when heard in older adults, often signifies: a. Emphysema b. Valve rupture c. Heart failure d. Pulmonary hypertension
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Heart failure
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Hypocalcemia and hypomagnesemia would MOST likely result in: a. Decreased cardiac conduction b. Increased myocardial irritability c. A decrease in cardiac contractility d. Decreased myocardial automaticity
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Increased myocardial irritabili
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Which of the following drugs would be MOST effective when treating a patient with hypotension secondary to vasodilation? a. Dopamine b. Propranolol c. Isoproterenol d. Norepinephrine
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Dopamine
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Common complaints in patients experiencing an acute coronary syndrome (ACS) include all of the following EXCEPT: a. Fatigue b. Headache c. Chest pain d. Palpitations
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Palpitations
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Cardiac-related chest pain often palliated by: a. Stress b. Exertion c. Nitroglycerin d. Mild exercise
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Nitroglycerin
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Paroxysmal nocturnal dyspnea (PND) is MOST accurately defined as: a. Dyspnea that is brought on by excessive movement during sleep b. Sitting upright in a chair in order to facilitate effective breathing c. The inability to function at night due to severe difficulty breathing d. Acute shortness of breath that suddenly awakens a person from sleep
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Acute shortness of breath that suddenly awakens a person from sleep
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A patient with orthopnea a. Experiences dyspnea during periods of exertion b. Prefers a semi sitting position to facilitate breathing c. Experiences worsened dyspnea while lying down d. Sleeps in a recliner due to severe right heart failure
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Experiences worsened dyspnea while lying down
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In the context of cardiac compromise, syncope occurs due to: a. An increase in vagal tone b. A drop in cerebral perfusion c. A sudden cardiac dysrhythmia d. An acute increase in heart rate
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A drop in cerebral perfusion
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Spironolacton is a/an: a. Beta blocker b. Vasodilator c. Diuretic d. Antiarrhythmic
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Diuretic
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A cardiac patient with respiratory distress should be assumed to be experiencing: a. Severe pain and anxiety b. Heart failure with pulmonary edema c. Bronchospasm due to lower airway constriction d. Cor pulmonale due to pulmonary hypertension
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Severe pain and anxiety
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Jugular venous distension in a patient sitting at a 45 degree angle a. Is not clinically significant b. Is a sign of reduced preload c. Suggests left side heart failure d. Indicates right heart compromise
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Indicates right heart compromise
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Which of the following clinical findings is LEAST suggestive of left side heart failure? a. An S3 gallop b. Sacral edema c. Crackles in the lungs d. Shortness of breath
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Sacral edema
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Myocardial ischemia occurs when the heart muscle: a. Is deprived of oxygen because of a blocked coronary artery b. Undergoes necrosis because of prolonged oxygen deprivation c. Suffers oxygen deprivation secondary to coronary vasodilation d. Experiences a decreased oxygen demand and an increased supply
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Is deprived of oxygen because of a blocked coronary artery
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Secondary hypertension is differentiated from primary hypertension in that secondary hypertension a. has a more gradual onset than primary hypertension. b. does not cause the target-organ damage that occurs with primary hypertension. c. has a specific cause, such as renal disease, that often can be corrected by medicine or surgery. d. is caused by age-related changes in BP regulatory mechanisms in individuals over 65 years of age.
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c. Rationale: Secondary hypertension has an underlying cause that can often be treated, in contrast to primary or essential hypertension, which has no single known cause. Isolated systolic hypertension occurs when the SBP is consistently elevated over 160 mm Hg, but the DBP remains less than 90 mm Hg, which is more prevalent in older adults. The only type of hypertension that does not cause target organ damage is pseudohypertension.
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The patient with stage 2 hypertension is likely to report a. no symptoms. b. cardiac palpitations. c. dyspnea on exertion. d. dizziness and vertigo
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a. Rationale: Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the "silent killer." The absence of symptoms often leads to noncompliance with medical treatment and a lack of concern about the disease in patients. With severe hypertension, symptoms usually occur and may include a morning occipital headache, fatigability, dizziness, palpitations, angina, and dyspnea
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Most organ damage that occurs from hypertension is related to a. increased fluid pressure exerted against organ tissue. b. atherosclerotic changes in vessels that supply the organs. c. erosion and thinning of blood vessels from constant pressure. d. increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces.
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b. Rationale: Elevated BP causes the entire inner lining of arterioles to become thickened from hyperplasia of connective tissues in the intima and affects coronary circulation, cerebral circulation, peripheral vessels, and renal and retinal blood vessels. The narrowed vessels lead to ischemia and, ultimately, to damage of these organs
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The organ that is damaged most directly as a result of high SVR is the a. brain. b. heart. c. retina. d. kidney.
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b. Rationale: The increased SVR of hypertension directly increases the workload of the heart, and heart failure occurs when the heart can no longer pump effectively against the increased resistance. The heart may be indirectly damaged by atherosclerotic changes in the blood vessels, as are the brain, retina, and kidney
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Identify the significance of the following laboratory test results found in patients with hypertension. a. Blood urea nitrogen (BUN): 48 mg/dl (17.1 mmol/L); creatinine: 4.3 mg/dl (380 mol/L) b. Serum K: 3.1 mEq/L (3.1 mmol/L) c. Fasting blood sugar (FBS): 183 mg/dl (10.2 mmol/L) d. Serum uric acid: 9.2 mg/dl (547 mol/L) e. Low-density lipoproteins (LDL): 154 mg/dl (4.0 mmol/L)
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a. Elevated blood urea nitrogen (BUN) and creatinine may indicate destruction of glomeruli and tubules of the kidney resulting from hypertension. b. Serum potassium levels are decreased when hypertension is associated with hyperaldosteronism. c. Fasting glucose levels are elevated when hypertension is associated with glucose intolerance and insulin resistance. d. An increased uric acid level may be caused by diuretics used to treat hypertension. e. An elevated low-density lipoprotein level (LDL) indicates an increased risk for atherosclerotic changes in the patient with hypertension.
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A patient does not respond to treatment of stage 1 hypertension with lifestyle modifications within 1 year. Initial drug therapy that would be indicated for the patient includes a. a thiazide diuretic. b. a B-adrenergic blocker and an angiotensin-converting enzyme (ACE) inhibitor. c. a loop diuretic and a direct-acting vasodilator. d. a calcium-channel blocker and an a-adrenergic blocker
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a. Rationale: The recommendation for initial pharmacologic management of hypertension is monotherapy with either a diuretic or a B-blocker. Other drugs used for initial monotherapy include calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, a-adrenergic blockers, and the combined a-/B-adrenergic blockers. If the BP is not controlled in a few months with monotherapy, the dose of the first-line drug can be increased, a second drug from a different class can be substituted, or a second drug from a different class can be added
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Teaching to include dietary sources of potassium is indicated for the hypertensive patient taking a. enalapril (Vasotec). b. labetalol (Normodyne). c. spironolactone (Aldactone). d. hydrochlorothiazide (HydroDiuril).
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d. Rationale: Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidney. High-potassium foods should be included in the diet, or potassium supplements used, to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone, and potassium supplements should not be used by patients taking these drugs. As a combined a, B-blocker, labetalol does not affect potassium levels
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A patient with stage 2 hypertension who is taking hydrochlorothiazide (HydroDiuril) and lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. It is most important for the nurse to teach the patient to a. weigh every morning to monitor for fluid retention. b. change position slowly and avoid prolonged standing. c. use sugarless gum or candy to help relieve dry mouth. d. take the pulse daily to note any slowing of the heart rate.
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b. Rationale: Prazosin is an a-adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention, dry mouth occurs with diuretic use, and centrally acting a-blockers and B-blockers may cause bradycardia
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A patient would be diagnosed with a hypertensive emergency when experiencing a. a systolic BP >200 mm Hg and a diastolic BP >120 mm Hg. b. a sudden rise in BP accompanied by neurologic impairment. c. symptoms of a stroke with an elevated BP. d. a severe elevation of BP that occurs over several days or weeks.
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b. Rationale: Hypertensive emergency, a type of hypertensive crisis, is a situation that develops over hours or days in which a patient's BP is severely elevated with evidence of acute target-organ damage, especially to the central nervous system (CNS). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke. Hypertensive crises are defined by the degree of organ damage and how rapidly the BP must be lowered, not by specific BP measurements. A hypertensive urgency is a less severe crisis in which a patient's BP becomes severely elevated over days or weeks, but there is no evidence of target-organ damage
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What does remodeling (thickening of the heart walls, chambers and ventricles) and dilation of the ventricles do to contractility?
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decreases contractility
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In HF you see ventricular remodeling which means there is increased afterload, BP and HR which does what?
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venous constriction which makes the heart work harder, heart cells become hypertrophic bc they are working so hard
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Activation of baroreceptors activates the SNS which activates the RAA system which does what?
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Brings up BP
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If you have decreased oxygen supply the demand will go up with CHF, how should we respond as nurses?
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Give O2 and provide rest
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The clinical manifestations of right ventricle not ejecting sufficient amts of blood and backing up into venous system point to?
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right sided heart failure
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The clinical manifestations of left ventricle not pumping blood effectively to the body and pulmonary venous pressure increases point to?
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left sided heart failure
