Flashcards in Chapter 47 Deck (17):
1. 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.
This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists.
2. 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
ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
5. 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.
This patient has prehypertension without other risk factors. Lifestyle changes are indicated at this point. If blood pressure rises to hypertension levels, other measures, including drug therapy, will be initiated. Calcium and potassium supplements are not indicated.
6. 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.
Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common side effect of lowering blood pressure, caused by the baroreceptor reflex. The patient’s blood pressure is responding to the medications, but the tachycardia warrants treatment. Reminding the patient to move slowly from sitting to standing is appropriate with any blood pressure medication, but this patient has reflex tachycardia, which must be treated. An electrocardiogram is not indicated.
7. 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.”
Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Patients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis.
8. 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.”
Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin.
9. 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.
The most disturbing side effect of alpha blockers is orthostatic hypotension. Patients taking these drugs should be cautioned to stand up slowly to avoid lightheadedness or falls. A persistent cough is a common side effect of ACE inhibitors. It is not necessary to increase dietary potassium intake when taking this drug. Shortness of breath may occur in individuals with asthma who are taking beta blockers.
10. 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.
Clonidine can cause dry mouth and sedation; patients should be warned to drink extra fluids and avoid driving. Beta blockers do not reverse these drug side effects. Discontinuing clonidine abruptly can cause severe rebound hypertension. These are common side effects that do not abate over time.
11. 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.
Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.
12. 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.
Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI; beta blockers are indicated for patients with preexisting heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition.
13. 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
When two or more drugs are used to treat hypertension, each drug should come from a different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice is appropriate. Hydralazine and minoxidil are vasodilators. Spironolactone and amiloride are potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide diuretics.
14. 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.”
Multi-drug therapy does not lower blood pressure more quickly. Using more than one drug often means that doses can be decreased. Some agents can offset adverse effects of other agents. Treatment via different mechanisms increases the likelihood of success.
15. 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.
In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient’s blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated.
16. 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.
Because the incidence of secondary hypertension is much higher in children than adults, it is important to obtain an accurate health history to help uncover primary causes. Once the type of hypertension is established, the teaching interventions may be useful. Hypertension must be treated, and it is incorrect to reassure parents that their child may just outgrow the condition.
17. 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
The drug of choice for lowering blood pressure in a patient with severe preeclampsia is hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of their potential for fetal harm.
18. 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.”
Patients should be taught that hypertension treatment is lifelong and that medications must be continued even when symptoms subside. Long-term problems may still occur without symptoms. Reporting drug side effects is necessary so that other drugs may be tried if needed.