Chapter 43- Hemodynamics Flashcards
(104 cards)
1
Q
Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.)
A
a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis
ANS: A, B, E
2
Q
A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:
A
a. cardiac afterload. b. cardiac preload. c. myocardial contractility. d. venous return.
ANS: C
3
Q
A nurse is caring for a patient who is receiving a drug that causes constriction of arterioles. The nurse expects to observe which effect from this drug? a. Decreased stroke volume b. Increased stroke volume c. Decreased myocardial contractility d. Increased myocardial contractility
A
A
4
Q
A patient with a history of hypertension is admitted for a procedure. If the patient’s arterial pressure decreases, which clinical manifestation would the nurse expect to see? a. Decreased heart rate b. Increased heart rate c. Decreased blood pressure d. Syncope
A
B
5
Q
A nurse is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for further teaching?
a.
“Constriction of small muscles in the venous wall increases venous pressure.”
b.
“Negative pressure in the left atrium draws blood toward the heart.”
c.
“Skeletal muscles relax to allow the free flow of blood.”
d.
“Venous valves help prevent the backflow of blood.”
A
C
6
Q
A nurse is assessing a patient who has heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of:
a.
decreased force of ventricular contraction.
b.
increased force of ventricular contraction.
c.
decreased ventricular filling.
d.
increased ventricular filling.
A
A
7
Q
A patient is taking a drug that interferes with venous constriction. The nurse will tell the patient to: a. ask for assistance when getting out of bed. b. expect bradycardia for a few days. c. notify the provider if headache occurs. d. report shortness of breath.
A
A
8
Q
A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient’s chart before administering the medication will be most concerned about which other disease process? a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis
A
D
9
Q
A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do?
a.
Instruct the patient not to get up without assistance.
b.
Make sure the patient takes a potassium supplement.
c.
Report the presence of a dry cough to the prescriber.
d.
Request an order for a diuretic to counter the side effects of the ACE inhibitor.
A
A
10
Q
A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient’s medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse’s response?
a.
“ACE inhibitors can prevent or reverse pathologic changes in the heart’s structure.”
b.
“ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol.”
c.
“ACE inhibitors increase venous return to the heart, improving cardiac output.”
d.
“ACE inhibitors regulate electrolytes that affect the cardiac rhythm.”
A
A
11
Q
A prescriber orders ramipril [Altace] for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching?
a.
“I am less likely to develop diabetic nephropathy when taking this medication.”
b.
“I should check my blood sugar more often, because hyperglycemia is a side effect of this drug.”
c.
“Taking this medication helps reduce my risk of stroke and heart attack.”
d.
“This medication will probably prevent the development of diabetic retinop
A
C
12
Q
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?
a.
It indicates that a serious side effect has occurred.
b.
It is a common side effect that occurs in almost all patients taking the drug.
c.
It may be uncomfortable enough that the drug will need to be discontinued.
d.
It occurs frequently in patients taking the drug but will subside over time.
A
C
13
Q
A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?
a.
Administer the captopril and monitor for adverse effects.
b.
Hold the dose and notify the provider.
c.
Request an order to administer fosinopril instead of captopril.
d.
Reassure the patient that this is not a serious side effect.
A
B
14
Q
A nurse is reviewing a patient’s medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?
a.
Furosemide [Lasix] and enalapril [Vasotec]
b.
Amlodipine [Norvasc] and spironolactone [Aldactone]
c.
Captopril [Capoten] and spironolactone [Aldactone]
d.
Metoprolol [Lopressor] and furosemide [Lasix]
A
C
15
Q
A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?
a.
“I can use acetaminophen for analgesia if needed.”
b.
“I should stop taking the Lasix about a week before starting the Capoten.”
c.
“I should take this medication on a full stomach.”
d.
“I will need to have blood tests done every 2 weeks for a few months.”
A
C
16
Q
A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication? a. Angioedema b. Cough c. Hyperkalemia d. Renal failure
A
C
17
Q
A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?
a.
“If I get pregnant, I should stop taking this drug by the second trimester.”
b.
“If I take this drug with a high-fat meal, it will be more effective.”
c.
“I should restrict my potassium intake while taking this drug.”
d.
“I should take this medication 1 hour before sitting down to a meal.”
A
D
18
Q
A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do?
a.
Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests.
b.
Explain that this drug binds with receptors for steroid hormones, causing this effect.
c.
Report this side effect to the provider and request another medication for this patient.
d.
Teach the patient to report any associated cough, which may indicate a more severe side effect.
A
B
19
Q
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?
a.
The fetus most likely will have serious congenital defects.
b.
The fetus must be monitored closely while the patient is taking this drug.
c.
The patient’s prescriber probably will change her medication to an ARB.
d.
The patient should stop taking the medication and contact her provider immediately.
A
D
20
Q
A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for: a. AV blockade. b. gingival hyperplasia. c. migraine headaches. d. reflex tachycardia.
A
A
21
Q
A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to: a. reduce flushing. b. minimize gingival hyperplasia. c. prevent constipation. d. prevent reflex tachycardia.
A
D
22
Q
A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug’s side effects. Which statement by the patient indicates understanding of the teaching?
a.
“I may become constipated, so I should increase fluids and fiber.”
b.
“I may experience a rapid heart rate as a result of taking this drug.”
c.
“I may have swelling of my hands and feet, but this will subside.”
d.
“I may need to increase my digoxin dose while taking this drug.”
A
A
23
Q
A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?
a.
“I will check to see when the last dose of the beta blocker was given.”
b.
“I will monitor vital signs closely to assess for hypotension.”
c.
“I will monitor the heart rate frequently to assess for reflex tachycardia.”
d.
“I will prepare to administer intravenous norepinephrine if necessary.”
A
C
24
Q
A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate:
a.
administering intravenous norepinephrine (NE) and atropine and glucagon.
b.
assisting with direct-current (DC) cardioversion.
c.
placing the patient in an upright position.
d.
preparing to administer a beta blocker.
A
A
25
A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed?
a.
“I can expect dizziness and facial flushing with nifedipine.”
b.
“I should notify the provider if I have swelling of my hands and feet.”
c.
“I will need to take a beta blocker to prevent reflex tachycardia.”
d.
“I will need to take this drug once a day.”
C
26
```
Which are therapeutic uses for verapamil? (Select all that apply.)
a.
Angina of effort
b.
Cardiac dysrhythmias
c.
Essential hypertension
d.
Sick sinus syndrome
e.
Suppression of preterm labor
```
A b c
27
```
A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?
a.
Decreased cardiac preload
b.
Decreased cardiac output
c.
Increased tissue perfusion
d.
Increased ventricular contraction
```
C
28
A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:
a.
caution the patient not to get up abruptly.
b.
encourage the patient to increase fluid intake.
c.
tell the patient to report shortness of breath.
d.
warn the patient about the possibility of bradycardia.
A
29
A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse’s teaching about this drug?
a.
“I will need to ask for assistance when getting up out of a chair.”
b.
“I will also take a beta blocker medication with this drug to prevent rapid heart rate.”
c.
“I may develop joint pain, but this side effect will decrease over time.”
d.
“This drug may cause excessive hair growth on my face, arms, and back.”
B
30
```
The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?
a.
Decrease in cardiac work
b.
Increase in cardiac output
c.
Increase in tissue perfusion
d.
Increase in venous return
```
A
31
A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?
a.
“Baroreceptors in the aortic arch stimulate the heart to beat faster.”
b.
“Reflex tachycardia can negate the desired effects of vasodilators.”
c.
“Reflex tachycardia is more likely to occur when beta blockers are given.”
d.
“Venous dilation must occur for reflex tachycardia to occur.”
B
32
A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?
a.
“Baroreceptors in the aortic arch stimulate the heart to beat faster.”
b.
“Reflex tachycardia can negate the desired effects of vasodilators.”
c.
“Reflex tachycardia is more likely to occur when beta blockers are given.”
d.
“Venous dilation must occur for reflex tachycardia to occur.”
A
33
```
A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to:
a.
administer a beta blocker.
b.
administer a drug that dilates veins.
c.
reduce the dose of hydralazine.
d.
give the patient a diuretic.
```
A
34
```
A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient?
a.
Evaluating ankle edema
b.
Monitoring for nausea and vomiting
c.
Noting the presence of hypertrichosis
d.
Obtaining a blood glucose
```
A
35
```
A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?
a.
Captopril PO
b.
Hydralazine [Apresoline] 25 mg PO
c.
Minoxidil 20 mg PO
d.
Sodium nitroprusside [Nitropress] IV
```
D
36
```
A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent:
a.
cyanide poisoning.
b.
fluid retention.
c.
rebound hypertension.
d.
reflex tachycardia.
```
C
37
```
Which medications are most likely to cause postural hypotension? (Select all that apply.)
a.
Minoxidil
b.
Diltiazem [Cardizem]
c.
Prazosin [Minipress]
d.
Captopril [Capoten]
e.
Losartan [Cozaar]
```
C,D,E
38
```
Which patients may receive hydralazine to treat hypertension? (Select all that apply.)
a.
A 1-month-old infant
b.
A 5-year-old child
c.
A pregnant woman
d.
A mother breast-feeding a newborn
e.
An older adult
```
A.B,E
39
```
A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient’s diagnostic tests are all normal. The nurse will expect this patient’s provider to order:
a.
a beta blocker.
b.
a loop diuretic and spironolactone.
c.
a thiazide diuretic.
d.
counseling on lifestyle changes.
```
C
40
```
A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?
a.
ACE inhibitors
b.
Beta blockers
c.
Direct-acting vasodilators
d.
Thiazide diuretics
```
A
41
```
A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient’s BP?
a.
Hypertension
b.
Isolated systolic hypertension
c.
Normal
d.
Prehypertension
```
A
42
A nurse checks a patient’s vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?
a.
Instruct the patient to consume a low-sodium diet.
b.
Prepare the patient for an electrocardiogram and blood tests.
c.
Recheck the patient’s blood pressure in the other arm.
d.
Request an order for a thiazide diuretic.
C
43
A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:
a.
ACE inhibitors and calcium channel blocker medications.
b.
the DASH diet, sodium restriction, and exercise.
c.
increased calcium and potassium supplements.
d.
thiazide diuretics and lifestyle changes.
B
44
A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do?
a.
Notify the provider and ask about adding a beta blocker medication.
b.
Reassure the patient that the medications are working.
c.
Remind the patient to move slowly from sitting to standing.
d.
Request an order for an electrocardiogram.
A
45
A patient has been taking chlorthalidone to treat hypertension. The patient’s prescriber has just ordered the addition of spironolactone to the patient’s drug regimen. Which statement by the patient indicates a need for further teaching?
a.
“I should continue following the DASH diet when adding this drug.”
b.
“I should not take an ACE inhibitor when adding this drug.”
c.
“I will need to take potassium supplements when adding this drug.”
d.
“I will not experience a significant increase in diuresis when adding this drug.”
C
46
A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?
a.
“Beta blockers block the actions of angiotensin II.”
b.
“Beta blockers decrease heart rate and contractility.”
c.
“Beta blockers decrease peripheral vascular resistance.”
d.
“Beta blockers decrease the release of renin.”
A
47
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?
a.
A persistent cough is a known side effect of this drug.
b.
Eat foods rich in potassium while taking this drug.
c.
Move slowly from sitting to standing when taking this drug.
d.
Report shortness of breath while taking this drug.
C
48
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?
a.
A persistent cough is a known side effect of this drug.
b.
Eat foods rich in potassium while taking this drug.
c.
Move slowly from sitting to standing when taking this drug.
d.
Report shortness of breath while taking this drug.
C
49
A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?
a.
Beta blockers can reverse these side effects.
b.
Discontinue the medication immediately and notify the provider.
c.
Drink extra fluids and avoid driving when drowsy.
d.
Notify the provider if symptoms persist after several weeks.
C
50
A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her?
a.
Controlling her blood pressure will decrease her risk of preeclampsia.
b.
Ask the provider about changing to an ARB during pregnancy.
c.
Continue taking the ACE inhibitor during her pregnancy.
d.
Discuss using methyldopa instead while she is pregnant.
D
51
A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?
a.
Notify the provider and discuss ordering a beta blocker for this patient.
b.
Notify the provider and suggest a thiazide diuretic as initial therapy.
c.
Order a diet low in sodium and high in potassium for this patient.
d.
Recheck the patient’s blood pressure in 4 hours to verify the result.
A
52
```
Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?
a.
Hydrochlorothiazide and nadolol
b.
Hydralazine and minoxidil
c.
Spironolactone and amiloride
d.
Trichlormethiazide and hydrochlorothiazide
```
A
53
A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching?
a.
“Multi-drug therapy often means that drugs may be given in lower doses.”
b.
“Some agents are used to offset adverse effects of other agents.”
c.
“Treatment of hypertension via different mechanisms increases success.”
d.
“Two or more drugs will lower blood pressure more quickly.”
D
54
A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient’s initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient’s blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:
a.
adding a calcium channel blocker to this patient’s drug regimen.
b.
lowering doses of the antihypertensive medications.
c.
ordering a high-potassium diet.
d.
adding spironolactone to the drug regimen.
A
55
A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child’s parents, the nurse will expect to:
a.
perform a detailed health history on the child.
b.
provide teaching about antihypertensive medications.
c.
reassure the parents that their child may outgrow this condition.
d.
teach the parents about lifestyle changes and a special diet.
A
56
```
The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?
a.
Angiotensin-converting enzyme (ACE) inhibitor
b.
Hydralazine (Apresoline)
c.
Magnesium sulfate
d.
Sodium nitroprusside
```
B
57
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?
a.
“I may experience serious long-term problems even if I am not having symptoms.”
b.
“I should report side effects to the provider since other drugs may be substituted.”
c.
“I will need to take medications on a long-term basis.”
d.
“When my symptoms subside, I may discontinue the medications.”
D
58
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?
a.
“I may experience serious long-term problems even if I am not having symptoms.”
b.
“I should report side effects to the provider since other drugs may be substituted.”
c.
“I will need to take medications on a long-term basis.”
d.
“When my symptoms subside, I may discontinue the medications.”
C
59
A female patient who is not taking any other medications is prescribed aliskiren [Tekturna], a direct renin inhibitor (DRI). The nurse reviews medication information with the patient. Which statement by the patient indicates understanding of the teaching?
a.
“If I get pregnant, I should stop taking this drug by the second trimester.”
b.
“If I take this drug with a high-fat meal, it will be more effective.”
c.
“I should restrict my potassium intake while taking this drug.”
d.
“I should take this medication 1 hour before sitting down to a meal.”
D
60
A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will:
a.
caution the patient not to get up abruptly.
b.
encourage the patient to increase fluid intake.
c.
tell the patient to report shortness of breath.
d.
warn the patient about the possibility of bradycardia.
A
61
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?
a.
A persistent cough is a known side effect of this drug.
b.
Eat foods rich in potassium while taking this drug.
c.
Move slowly from sitting to standing when taking this drug.
d.
Report shortness of breath while taking this drug.
C
62
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?
a.
“I may experience serious long-term problems even if I am not having symptoms.”
b.
“I should report side effects to the provider since other drugs may be substituted.”
c.
“I will need to take medications on a long-term basis.”
d.
“When my symptoms subside, I may discontinue the medications.”
C
63
A nurse has provided education for a patient newly diagnosed with hypertension who is just beginning therapy with antihypertensive medications. Which statement by the patient indicates a need for further teaching?
a.
“I may experience serious long-term problems even if I am not having symptoms.”
b.
“I should report side effects to the provider since other drugs may be substituted.”
c.
“I will need to take medications on a long-term basis.”
d.
“When my symptoms subside, I may discontinue the medications.”
D
64
```
The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?
a.
Angiotensin-converting enzyme (ACE) inhibitor
b.
Hydralazine (Apresoline)
c.
Magnesium sulfate
d.
Sodium nitroprusside
```
B
65
A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three separate visits. Ambulatory blood pressure monitoring confirms that the child has hypertension. As an initial intervention with the child’s parents, the nurse will expect to:
a.
perform a detailed health history on the child.
b.
provide teaching about antihypertensive medications.
c.
reassure the parents that their child may outgrow this condition.
d.
teach the parents about lifestyle changes and a special diet.
A
66
A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient’s initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient’s blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:
a.
adding a calcium channel blocker to this patient’s drug regimen.
b.
lowering doses of the antihypertensive medications.
c.
ordering a high-potassium diet.
d.
adding spironolactone to the drug regimen.
A
67
A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension. Which statement by the student indicates a need for further teaching?
a.
“Multi-drug therapy often means that drugs may be given in lower doses.”
b.
“Some agents are used to offset adverse effects of other agents.”
c.
“Treatment of hypertension via different mechanisms increases success.”
d.
“Two or more drugs will lower blood pressure more quickly.”
D
68
```
Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?
a.
Hydrochlorothiazide and nadolol
b.
Hydralazine and minoxidil
c.
Spironolactone and amiloride
d.
Trichlormethiazide and hydrochlorothiazide
```
A
69
A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg. The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?
a.
Notify the provider and discuss ordering a beta blocker for this patient.
b.
Notify the provider and suggest a thiazide diuretic as initial therapy.
c.
Order a diet low in sodium and high in potassium for this patient.
d.
Recheck the patient’s blood pressure in 4 hours to verify the result.
A
70
A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to become pregnant. She asks whether she should continue taking the medication while she is pregnant. What will the nurse tell her?
a.
Controlling her blood pressure will decrease her risk of preeclampsia.
b.
Ask the provider about changing to an ARB during pregnancy.
c.
Continue taking the ACE inhibitor during her pregnancy.
d.
Discuss using methyldopa instead while she is pregnant.
D
71
A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?
a.
Beta blockers can reverse these side effects.
b.
Discontinue the medication immediately and notify the provider.
c.
Drink extra fluids and avoid driving when drowsy.
d.
Notify the provider if symptoms persist after several weeks.
C
72
A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?
a.
A persistent cough is a known side effect of this drug.
b.
Eat foods rich in potassium while taking this drug.
c.
Move slowly from sitting to standing when taking this drug.
d.
Report shortness of breath while taking this drug.
C
73
A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?
a.
“Beta blockers block the actions of angiotensin II.”
b.
“Beta blockers decrease heart rate and contractility.”
c.
“Beta blockers decrease peripheral vascular resistance.”
d.
“Beta blockers decrease the release of renin.”
A
74
A patient has been taking chlorthalidone to treat hypertension. The patient’s prescriber has just ordered the addition of spironolactone to the patient’s drug regimen. Which statement by the patient indicates a need for further teaching?
a.
“I should continue following the DASH diet when adding this drug.”
b.
“I should not take an ACE inhibitor when adding this drug.”
c.
“I will need to take potassium supplements when adding this drug.”
d.
“I will not experience a significant increase in diuresis when adding this drug.”
C
75
A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats per minute. What will the nurse do?
a.
Notify the provider and ask about adding a beta blocker medication.
b.
Reassure the patient that the medications are working.
c.
Remind the patient to move slowly from sitting to standing.
d.
Request an order for an electrocardiogram.
A
76
A patient who does not consume alcohol or nicotine products reports a strong family history of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a normal weight and body mass index for height and age. The nurse will expect to teach this patient about:
a.
ACE inhibitors and calcium channel blocker medications.
b.
the DASH diet, sodium restriction, and exercise.
c.
increased calcium and potassium supplements.
d.
thiazide diuretics and lifestyle changes.
B
77
A nurse checks a patient’s vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?
a.
Instruct the patient to consume a low-sodium diet.
b.
Prepare the patient for an electrocardiogram and blood tests.
c.
Recheck the patient’s blood pressure in the other arm.
d.
Request an order for a thiazide diuretic.
C
78
```
A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient’s BP?
a.
Hypertension
b.
Isolated systolic hypertension
c.
Normal
d.
Prehypertension
```
A
79
```
A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?
a.
ACE inhibitors
b.
Beta blockers
c.
Direct-acting vasodilators
d.
Thiazide diuretics
```
A
80
```
A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient’s diagnostic tests are all normal. The nurse will expect this patient’s provider to order:
a.
a beta blocker.
b.
a loop diuretic and spironolactone.
c.
a thiazide diuretic.
d.
counseling on lifestyle changes.
```
C
81
```
Which patients may receive hydralazine to treat hypertension? (Select all that apply.)
a.
A 1-month-old infant
b.
A 5-year-old child
c.
A pregnant woman
d.
A mother breast-feeding a newborn
e.
An older adult
```
A.B,E
82
```
Which medications are most likely to cause postural hypotension? (Select all that apply.)
a.
Minoxidil
b.
Diltiazem [Cardizem]
c.
Prazosin [Minipress]
d.
Captopril [Capoten]
e.
Losartan [Cozaar]
```
C,D,E
83
```
A nursing student asks a nurse why a patient in hypertensive crisis is receiving both intravenous sodium nitroprusside [Nitropress] and oral hydralazine. The nurse will explain that this is done to prevent:
a.
cyanide poisoning.
b.
fluid retention.
c.
rebound hypertension.
d.
reflex tachycardia.
```
C
84
```
A patient is admitted with severe hypertensive crisis. The nurse will anticipate administering which medication?
a.
Captopril PO
b.
Hydralazine [Apresoline] 25 mg PO
c.
Minoxidil 20 mg PO
d.
Sodium nitroprusside [Nitropress] IV
```
D
85
```
A nurse is obtaining a medication history on a newly admitted patient, who reports taking minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial assessment for this patient?
a.
Evaluating ankle edema
b.
Monitoring for nausea and vomiting
c.
Noting the presence of hypertrichosis
d.
Obtaining a blood glucose
```
A
86
```
A female patient with essential hypertension is being treated with hydralazine 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96 beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order to:
a.
administer a beta blocker.
b.
administer a drug that dilates veins.
c.
reduce the dose of hydralazine.
d.
give the patient a diuretic.
```
A
87
A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?
a.
“Baroreceptors in the aortic arch stimulate the heart to beat faster.”
b.
“Reflex tachycardia can negate the desired effects of vasodilators.”
c.
“Reflex tachycardia is more likely to occur when beta blockers are given.”
d.
“Venous dilation must occur for reflex tachycardia to occur.”
A
88
A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing students. Which statement by a student indicates understanding of this phenomenon?
a.
“Baroreceptors in the aortic arch stimulate the heart to beat faster.”
b.
“Reflex tachycardia can negate the desired effects of vasodilators.”
c.
“Reflex tachycardia is more likely to occur when beta blockers are given.”
d.
“Venous dilation must occur for reflex tachycardia to occur.”
B
89
```
The nurse is caring for a patient who is taking a vasodilator that dilates capacitance vessels. The nurse will expect which effect in this patient?
a.
Decrease in cardiac work
b.
Increase in cardiac output
c.
Increase in tissue perfusion
d.
Increase in venous return
```
A
90
A nurse is caring for a patient who will begin taking hydralazine to treat hypertension. Which statement by the patient indicates understanding of the nurse’s teaching about this drug?
a.
“I will need to ask for assistance when getting up out of a chair.”
b.
“I will also take a beta blocker medication with this drug to prevent rapid heart rate.”
c.
“I may develop joint pain, but this side effect will decrease over time.”
d.
“This drug may cause excessive hair growth on my face, arms, and back.”
B
91
```
A nurse is administering a vasodilator that dilates resistance vessels. The nurse understands that this drug will have which effect on the patient?
a.
Decreased cardiac preload
b.
Decreased cardiac output
c.
Increased tissue perfusion
d.
Increased ventricular contraction
```
C
92
```
Which are therapeutic uses for verapamil? (Select all that apply.)
a.
Angina of effort
b.
Cardiac dysrhythmias
c.
Essential hypertension
d.
Sick sinus syndrome
e.
Suppression of preterm labor
```
A b c
93
A patient who has been taking verapamil [Calan] for hypertension complains of constipation. The patient will begin taking amlodipine [Norvasc] to avoid this side effect. The nurse provides teaching about the difference between the two drugs. Which statement by the patient indicates that further teaching is needed?
a.
“I can expect dizziness and facial flushing with nifedipine.”
b.
“I should notify the provider if I have swelling of my hands and feet.”
c.
“I will need to take a beta blocker to prevent reflex tachycardia.”
d.
“I will need to take this drug once a day.”
C
94
A patient who took an overdose of verapamil has been treated with gastric lavage and a cathartic. The emergency department nurse assesses the patient and notes a heart rate of 50 beats per minute and a blood pressure of 90/50 mm Hg. The nurse will anticipate:
a.
administering intravenous norepinephrine (NE) and atropine and glucagon.
b.
assisting with direct-current (DC) cardioversion.
c.
placing the patient in an upright position.
d.
preparing to administer a beta blocker.
A
95
A nurse is preparing to assist a nursing student to administer intravenous verapamil to a patient who also receives a beta blocker. The nurse asks the nursing student to discuss the plan of care for this patient. Which statement by the student indicates a need for further teaching?
a.
“I will check to see when the last dose of the beta blocker was given.”
b.
“I will monitor vital signs closely to assess for hypotension.”
c.
“I will monitor the heart rate frequently to assess for reflex tachycardia.”
d.
“I will prepare to administer intravenous norepinephrine if necessary.”
C
96
A nurse is teaching a patient who will begin taking verapamil [Calan] for hypertension about the drug’s side effects. Which statement by the patient indicates understanding of the teaching?
a.
“I may become constipated, so I should increase fluids and fiber.”
b.
“I may experience a rapid heart rate as a result of taking this drug.”
c.
“I may have swelling of my hands and feet, but this will subside.”
d.
“I may need to increase my digoxin dose while taking this drug.”
A
97
```
A patient begins taking nifedipine [Procardia], along with metoprolol, to treat hypertension. The nurse understands that metoprolol is used to:
a.
reduce flushing.
b.
minimize gingival hyperplasia.
c.
prevent constipation.
d.
prevent reflex tachycardia.
```
D
98
```
A nurse is caring for a patient who is receiving verapamil [Calan] for hypertension and digoxin [Lanoxin] for heart failure. The nurse will observe this patient for:
a.
AV blockade.
b.
gingival hyperplasia.
c.
migraine headaches.
d.
reflex tachycardia.
```
A
99
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?
a.
The fetus most likely will have serious congenital defects.
b.
The fetus must be monitored closely while the patient is taking this drug.
c.
The patient’s prescriber probably will change her medication to an ARB.
d.
The patient should stop taking the medication and contact her provider immediately.
D
100
A female patient who begins taking spironolactone [Aldactone] as an adjunct to furosemide [Lasix] complains that her voice is deepening. What will the nurse do?
a.
Contact the provider to obtain an order for a complete blood count (CBC) and liver function tests.
b.
Explain that this drug binds with receptors for steroid hormones, causing this effect.
c.
Report this side effect to the provider and request another medication for this patient.
d.
Teach the patient to report any associated cough, which may indicate a more severe side effect.
B
101
```
A patient who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) medication. Which side effect of ACE inhibitors will not occur with an ARB medication?
a.
Angioedema
b.
Cough
c.
Hyperkalemia
d.
Renal failure
```
C
102
A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?
a.
Administer the captopril and monitor for adverse effects.
b.
Hold the dose and notify the provider.
c.
Request an order to administer fosinopril instead of captopril.
d.
Reassure the patient that this is not a serious side effect.
B
103
A nurse is reviewing a patient’s medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?
a.
Furosemide [Lasix] and enalapril [Vasotec]
b.
Amlodipine [Norvasc] and spironolactone [Aldactone]
c.
Captopril [Capoten] and spironolactone [Aldactone]
d.
Metoprolol [Lopressor] and furosemide [Lasix]
C
104
A patient who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nurse is providing information about the drug. Which statement by the patient indicates a need for further teaching?
a.
“I can use acetaminophen for analgesia if needed.”
b.
“I should stop taking the Lasix about a week before starting the Capoten.”
c.
“I should take this medication on a full stomach.”
d.
“I will need to have blood tests done every 2 weeks for a few months.”
C
