Pharm Ch. 35 – Flashcards
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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
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A patient is receiving a vasodilator that is available only in oral form. Which agent would the nurse most likely identify as being used?
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Minoxidil
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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
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Most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?
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2
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The physician prescribes captopril (Capoten) for a patient, and the nurse provides the patient with the appropriate patient education for this drug. What statement by the patient tells the nurse that teaching has been effective?
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"I will make sure that I rise slowly from a supine position."
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What drug is a safe and effective calcium channel blocker only if given as sustained-release or extended-release preparations to treat hypertension?
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Diltiazem (Cardizem)
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A patient has had multiple blood pressure readings that indicate the patient is hypertensive. How is hypertension defined?
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Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg
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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
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A patient is prescribed a potassium-sparing diuretic. What electrolyte imbalance would the patient be prone to develop?
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Hyperkalemia
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A male client 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
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A patient has been prescribed transdermal clonidine therapy. What potential adverse effects should the nurse warn the patient about?
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Dry mouth and dizziness
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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
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You are caring for a patient who has been diagnosed as having hypertension. You are responsible for teaching the patient about managing the condition with his newly prescribed medication (lisinopril) as well as with nonpharmacologic methods. What statement, made by your patient, suggests that your teaching has been effective?
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"I will make sure that I rise to a standing position slowly."
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A 71-year-old male patient has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?
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Diastolic blood pressure below 90 mm Hg
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You are caring for a 53-year-old patient being treated for hypertension. One of your responsibilities is teaching the patient about nonpharmacologic methods of managing hypertension. While discussing dietary management, which of the following might you offer as an example of an appropriate meal
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Grilled chicken, green salad, and iced tea
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A provider chooses to treat an African American client suffering from hypertension with a beta blocker and diuretic instead of an ACE inhibitor. The nurse knows that the provider did this for what reason?
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Research has shown beta blockers, in combination with diuretics, treat hypertension in African Americans better than ACE inhibitors.
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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
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The client taking antihypertensive medications is taught to notify the health care provider for which of the following findings?
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Weight gain of five pounds over a 2-day period
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The nurse teaches the client to not stop taking his antihypertensives abruptly because which of the following may occur?
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Rebound hypertension
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The nurse is educating a client with hypertension about dietary changes that help to decrease blood pressure. Which menu selection indicates the need for further client education?
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Ham sandwich with mustard, carrots and cheesy dip
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Your patient experienced an MI in 2007. He is a 48-year-old man who has frequent episodes of angina. He is tachycardic. What is the first drug of choice for treatment of his condition?
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Beta-blockers
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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
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Once a client develops primary hypertension, therapy should last for how long?
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Lifelong
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Which medications lower blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? (Select all that apply.)
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Losartan (Cozaar) Olmesartan (Benicar)
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The blood pressure goal for a client with diabetes is:
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130/80 mm Hg
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A nurse is educating a group of nursing students on the adverse effects of antihypertensive drugs. The nurse explains that orthostatic hypotension occurs initially in the therapy. Which of the following pressure changes in an upright position would indicate orthostatic hypotension?
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A fall in the systolic pressure by 10 mm Hg
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A patient has been admitted to a healthcare center for hypertension management. The physician has prescribed a transdermal patch of clonidine. To which area should the nurse apply the transdermal patch?
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Hairless area on the upper arm
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A clinic nurse is assessing a new patient prior to a patient seeing the physician. The patient has a history of hypertension and takes benazepril (Lotensin) to control the disease process. A priority nursing assessment in this patient would be to assess the patient for a history of:
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renal disease
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A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for?
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Peripheral edema and bradycardia
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A patient is taking a sustained release antihypertensive. The nurse knows that the patient teaching about this medication needs to include to:
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swallow the drug whole and do not cut, crush, or chew it.
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A client is started on trandolapril (Mavik). The client should be instructed that what is a common adverse effect of ACE inhibitor therapy?
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Persistent cough
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The goal of therapy for a patient taking antihypertensive medication is to maintain:
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the blood pressure within normal limits.
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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)
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Which question 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?"
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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.
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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
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The nurse knows that what physiologic changes will affect a client's stroke volume?
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Changes in heart contraction
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A client is receiving an antihypertensive medication that is only available in oral form. Which agent would the nurse identify as most likely being used?
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Carvedilol
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The client has elevated BUN and creatinine levels. The nurse would question the administration of which antihypertensive?
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Quinapril
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The nurse is teaching a client about hypertension. The nurse teaches that nonpharmacologic methods to decrease blood pressure would include:
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weight loss and decreased salt intake.
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The squad brought a 48-year-old man to the 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 the nurse's primary goal in this hypertensive emergency?
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Lower blood pressure as quickly as possible Explanation: Hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensive drugs to limit damage to target organs.
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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. 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.
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A patient is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n):
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Alpha- and beta-blocker
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When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.)
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Constipation Proteinuria Photosensitivity Cough
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Which drug is used to lower blood pressure primarily via suppression of the renin-angiotensin-aldosterone system
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Lisinopril (Prinivil)
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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 should the nurse explain is the hormone produced by the adrenal cortex?
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Aldosterone
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A nurse is educating a group of nursing students about the uses of hawthorn, a natural agent used in the treatment of hypertension. Which of the following conditions should the nurse explain as the other indications for hawthorn use? Select all that apply.
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Angina Arrhythmia Heart failure
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A patient has been started on losartan (Cozaar), an ARB (angiotensin II receptor blocker), for hypertension. After 6 weeks of therapy, it is decided that the Cozaar alone is not controlling the patient's hypertension. What can be added to the Cozaar regimen for better control of this patient's hypertension?
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Hydrochlorothiazide (Hyzaar) When losartan therapy is started, maximal effects on blood pressure usually occurs 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 (Hyzaar) is available.
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When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic is typically used to treat hypertension initially?
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Thiazide
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The incidence of hypertension in the United States is staggering. It is estimated that at least 20% of the people in the United States have hypertension, and many are unaware of it. What does hypertension increase the risk of? (Mark all that apply.)
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Renal disease Cerebral infarction Heart failure
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A community health nurse is providing a health promotion session to a group of seniors. Which is most important to instruct regarding hypertension?
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Hypertension will increase the risk of heart disease.
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When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a patient with hypertension?
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Grilled chicken, green salad, and apple
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A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?
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Frequent assessment of the patient's cardiac status
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The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia?
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Diltiazem
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A client taking nifedipine also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions?
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Bradycardia
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The client is to start on lisinopril for hypertension. Prior to administration of the medication, the blood pressure is 112/76 mm Hg. What is the nurse's most appropriate action?
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Notify the health care provider.
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Upon review of the lab findings, the nurse identifies the client's potassium level is 5.9 mEq/L. The nurse recognizes that which antihypertensive may be the cause?
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Aliskiren
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The client taking bisoprolol-hydrochlorothiazide (Ziac) states that he is sure the medication is not decreasing his blood pressure. He tells the nurse he is urinating all the time and he does not like this side effect of the medication. What is the nurse's best response?
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"Bisoprolol-hydrochlorothiazide (Ziac) works by decreasing the workload of your heart and increasing the excretion of fluid."
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The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?
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Hyperkalemia Explanation: When ACE inhibitors are combined with potassium-sparing diuretics, the client is at risk for elevated potassium levels. Therefore, hyperkalemia, not hypokalemia, is the risk. Calcium levels are not affected.
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The client has been prescribed amlodipine (Norvasc) for hypertension. His blood pressure upon a revisit remains elevated. The nurse inquires about the use of which alternative therapy?
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St. John's wort Explanation: When taken with a calcium channel blocker, the herb St. John's wort can cause a decrease in serum levels of the calcium channel blocker. Neither hawthorn, lavender, or prune juice are known to affect serum levels of calcium channel blockers.
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120/80
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Normal blood pressure
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Prehypertension
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120-139/80-89
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Stage 1 hypertension
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140-159/90-99
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Stage 2 hypertension
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>160/>100
