2a2ntihypertensive Flashcards
(15 cards)
A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will include which instructions?
a.
“Weigh yourself daily, and report any weight loss to your prescriber.”
b.
“Increase your potassium intake by eating more bananas and apricots.”
c.
“The impaired taste associated with this medication usually goes away in 2 to 3 weeks.”
d.
“Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy.”
ANS: D
A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect.
A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?
a.
Captopril rarely causes first-dose hypotensive effects.
b.
Captopril has little effect on electrolyte levels.
c.
Captopril is a prodrug and is metabolized by the liver before becoming active.
d.
Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.
ANS: D
A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.
During a follow-up visit, the health care provider examines the fundus of the patient’s eye. Afterward, the patient asks the nurse, “Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!” What is the best response by the nurse?
a.
“We need to monitor for drug toxicity.”
b.
“We must watch for increased intraocular pressure.”
c.
“The provider is assessing for visual changes that may occur with drug therapy.”
d.
“The provider is making sure the treatment is effective over the long term.”
ANS: D
The physician would examine the fundus of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.
The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure?
a.
Cardiac output and systemic vascular resistance
b.
Heart rate and peripheral resistance
c.
Blood volume and renal blood flow
d.
Myocardial contractility and arteriolar constriction
ANS: A
Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect.
When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential problem? a. Impotence b. Bradycardia c. Increased libido d. Weight gain
ANS: A
Sexual dysfunction is a common complication of antihypertensive medications and may be manifested in men as decreased libido or impotence. The other options are incorrect.
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes? a. Vasodilators alone b. ACE inhibitors alone c. Calcium channel blockers with thiazide diuretics d. Beta blockers with thiazide diuretics
ANS: C
According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group.
The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Urge urinary incontinence d. Impaired memory
ANS: B
Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of antihypertensive drug therapy. The other nursing diagnoses are not appropriate.
A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long? a. 10 minutes b. 30 minutes c. 1 hour d. 24 hours
ANS: A
Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient’s blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient’s blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect.
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response?
a.
“This therapy will take about 3 months.”
b.
“This therapy will take about a year.”
c.
“This therapy will go on until your symptoms disappear.”
d.
“Therapy for high blood pressure is usually lifelong.”
ANS: D
There is no cure for the disease, and treatment will be lifelong. The other answers are not appropriate.
A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers
ANS: B
ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.
A pregnant woman is experiencing hypertension. The nurse knows that which drug is commonly used for a pregnant patient who is experiencing hypertension? a. Mannitol (Osmitrol) b. Enalapril (Vasotec) c. Hydrochlorothiazide (HydroDIURIL) d. Methyldopa (Aldomet)
ANS: D
Methyldopa is used in the treatment of hypertension during pregnancy. The other options are incorrect.
A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient? a. Cardioprotective effects b. Renal protective effects c. Reduces blood pressure d. Promotes fluid output
ANS: B
ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.
The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class? a. Calcium channel blockers b. Diuretics c. Nonsteroidal anti-inflammatory drugs d. Nitrates
ANS: C
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.
An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug? a. Dry mouth b. Restlessness c. Constipation d. Hypotension
ANS: D
The older adult patient is more sensitive to the blood pressure–lowering effects of vasodilators, and consequently experience more problems with hypotension, dizziness, and syncope. The other options are incorrect.
When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.)
a.
“You need to have your blood pressure checked once a week and keep track of the readings.”
b.
“If you notice that the symptoms have gone away, you should be able to stop taking the drug.”
c.
“An exercise program may be helpful in treating hypertension, but let’s check with your doctor first.”
d.
“If you experience severe side effects, stop the medicine and let us know at your next office visit.”
e.
“Most over-the-counter decongestants are compatible with antihypertensive drugs.”
f.
“Please continue taking the medication, even if you are feeling better.”
ANS: A, C, F
Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. Remind the patient not to stop taking the medication just because he or she is feeling better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often lifelong, even though symptoms may improve. Many over-the-counter drugs, especially decongestants, have serious interactions with antihypertensive drugs. The patient needs to consult his or her prescriber before taking any other medication.
