Ph. Ch 22 Drugs to Treat Hypertension

Question 1

a disease characterized by an elevation of the blood pressure

Answer 1

Hypertension

Question 2

the most common form of hypertension

Answer 2

Primary Hypertension

Question 3

drugs that bind to angiotensin II receptor sites

Answer 3

angiotensin II receptor blockers

Question 4

the difference between the systolic and diastolic pressure

Answer 4

Pulse Pressure

Question 5

drugs that cause volume depletion, sodium excretion, and vasodilation of peripheral arterioles

Answer 5

Diuretic

Question 6

the pressure in the blood vessels when the heart muscle relaxes between contractions

Answer 6

diastolic blood pressure

Question 7

drugs that cause arteriolar smooth muscle relaxation

Answer 7

direct vasodilators

Question 8

high blood pressure that occurs after the development of another disorder

Answer 8

secondary hypertension

Question 9

drugs that inhibit angiotensin I converting enzyme

Answer 9

ACE inhibitors

Question 10

drugs that inhibit cardiac response to sympathetic nerve stimulation by blocking beta receptors

Answer 10

Beta-adrenergic blockers

Question 11

the pressure with which the blood is pumped from the heart

Answer 11

Systolic Blood Pressure

Question 12

drugs that inhibit the movement of calcium ions across a cell membrane

Answer 12

Calcium Channel Blockers

Question 13

this accounts for 90% of all clinical cases of high blood pressure, cause unknown

Answer 13

Primary Hypertension

Question 14

this is determined by the stroke volume, heart rate, and venous capacitance

Answer 14

Cardiac Output

Question 15

the average pressure throughout each cycle of the heartbeat

Answer 15

Mean arterial pressure

Question 16

REVIEW QUESTIONS
Scenario #1: A 42-vear-old man came into the clinic
complaining of frequent headaches and was diagnosed
with stage 1 hypertension. He was referred to the
education specialist for further instructions on lifestyle
modification and initiation of drug therapy.

Obiective: Differentiate between primary and
secondary hypertension.
NCLEX item type: multiple choice
Cognitive skill: classify

A patient in the scenario #1 has a blood pressure read-
ing of 138/85 mm Hg. The nurse identifies this patient
as having which classification of hypertension? (355)
1. Normal
2. Stage 1
3. Stage 2
4. Elevated

Answer 16

Stage 1

Question 17

NCLEX item type: multiple choice
Cognitive skill: compare

A nurse discusses the difference between primary
and secondary hypertension with the patient in
scenario #1. Which response by the nurse would be
appropriate? (354)

1. “Primary hypertension is curable, while second-
   ary hypertension is only controllable.”
2. “There is no difference between primary and sec-
   ondary hypertension; both of them can be cured.”
3. “Primary hypertension occurs during adoles-
   cence, while secondary hypertension happens
   to people after they reach adulthood.”
4. “Primary hypertension occurs about 90% of the
   time and has no known cause, while secondary
   hypertension occurs after the development of
   another disorder.”

Answer 17

“Primary hypertension occurs about 90% of the
time and has no known cause, while secondary
hypertension occurs after the development of
another disorder.”

Question 18

NCLEX item type: multiple choice
Cognitive skill: explain

The nurse explains to the patient in scenario #1 that
systolic blood pressure is the pressure exerted by the
heart as blood is pumped out. How will the nurse
explain diastolic blood pressure? (353)

1. “This is the pressure throughout each cycle of
   the heartbeat.”
2. “This pressure occurs when the blood is
   pumped from the right ventricle through the
   pulmonary artery.”
3. “This is the pressure that is calculated by add-
   ing one-third of the pulse pressure to the arte-
   rial pressure.”
4. “This refers to when the heart muscle relaxes
   between contractions.”

Answer 18

“This refers to when the heart muscle relaxes between contractions.”

Question 19

NCLEX item type: multiple response
Cognitive skill: application

The nurse understands there are other conditions
that are identifiable as causes of hypertension. Which
conditions are possible? (Select all that apply.) (354)

1. Sleep apnea
2. Chronic kidney disease
3. Primarv aldosteronism
4. Marfan’s syndrome
5. Thyroid disease

Answer 19

1. Sleep apnea
2. Chronic kidney disease
3. Primarv aldosteronism
4. Thyroid disease

Question 20

Objective: Summarize nursing assessments and
interventions used for the treatment of hypertension.
NCLEX item type: multiple response
Cognitive skill: illustrate

What will the nurse do to measure a patient’s blood
pressure? (Select all that apply.) (354)

1. Use an appropriately sized cuff.
2. Verify reading in the opposite arm.
3. Support the arm at the same level as the heart
4. Sit the patient in a chair with feet dangling off the floor
5. Inflate the cuff 50 mm Hg above the point at
   which the radial pulse disappears.

Answer 20

1. Use an appropriately sized cuff.
2. Verify reading in the opposite arm.
3. Support the arm at the same level as the heart.

Question 21

NCLEX item type: multiple response
Cognitive skill: classify

The nurse reviews the drug therapy used when
starting patients on commonly prescribed antihyper-
tensive agents. Which classification of medications
are used for this purpose? (356)

1. Diuretics
2. ACE inhibitors
3. Alpha-1 adrenergic blocking agents
4. Angiotensin I receptor blockers
5. Calcium channel blockers

Answer 21

1. Diuretics
2. ACE inhibitors
3. Angiotensin I receptor blockers
4. Calcium channel blockers

Question 22

NCLEX item type: multiple response
Cognitive skill: application

The nurse will assess those patients who are diag-
nosed with hypertension, for further evaluation of
what? (Select all that apply.)

1. Any history of risk factors, such a family history
2. Any current medications to determine drug-
   drug interaction potential
3. Determine patient’s type of lifestyle; stress
   level, exercise routine, etc.
4. Current understanding of the drugs used for
   hypertension
5. Elevated serum lipid levels and renal function
   studies

Answer 22

1. Any history of risk factors, such a family history
2. Any current medications to determine drug-
   drug interaction potential
3. Current understanding of the drugs used for
   hypertension
4. Elevated serum lipid levels and renal function
   studies

Question 23

NCLEX item type: multiple response
Cognitive skill: ordering

The nurse reviews the renin angiotensin aldosterone
system (RAAS) to gain a better understanding of the
various types of antihypertensive agents and what
effect they have on this system. List in order the cor-
rect sequence of reactions that occur in the RAAS.
(364)

1. angiotensin I is converted by angiotensin I-converting enzyme to angiotensin II
2. aldosterone causes sodium retention
3. angiotensinogen is converted by renin to
   form angiotensin I
4. angiotensin II promotes aldosterone
   secretion
5. Renin is released by the kidneys

Answer 23

angiotensinogen is converted by renin to form angiotensin I
Renin is released by the kidneys
aldosterone causes sodium retention
angiotensin II promotes aldosterone secretion
angiotensin I is converted by angiotensin I-converting enzyme to angiotensin II

Question 24

Cognitive skill: application

The nurse educates the patient in scenario #1 regard-
ing what to do when taking hypertension medica-
tion. Which instructions will be included in the
teaching? (Select all that apply.) (362)

1. “You will need to know the correct dose to take
   for your medication.”
2. “It is important to know when you are to take
   these drugs so you can remember the time to
   take them and how often.”
3. “We will go over the common adverse effects to
   watch for when taking these medications.”
4. “It is important for you to check your tempera-
   ture every day.
5. “I will teach you when you should perform toe
   wiggles and rising up on your toes.

Answer 24

1. “You will need to know the correct dose to take
   for your medication.”
2. “It is important to know when you are to take
   these drugs so you can remember the time to
   take them and how often.”
3. “We will go over the common adverse effects to
   watch for when taking these medications.”
4. “I will teach you when you should perform toe
   wiggles and rising up on your toes.

Question 25

Scenario #2: A patient evaluated in the clinic for ongoing hypertension management also has the diagnosis of diabe- tes and being overweight. The patient mentioned the stress of a job was causing fatigue and sleep was a problem. Objective: Identify recommended lifestvle modifications after a diagnosis of hypertension. NCLEX item type: cloze Cognitive skill: recognize cues Choose the most likely options for the information missing from the statements below by selecting from the list of options provided. The nurse explains to the patient in scenario #2 that Heart failure and Stoke may be the result of uncontrolled hypertension, and it is important to treat hypertension with Lifestyle Modificstions and Anti-Hypertensive medications.

Answer 25

The nurse explains to the patient in scenario #2 that **Heart failure** and **Stoke** may be the result of uncontrolled hypertension, and it is important to treat hypertension with **Lifestyle Modificstions and Anti-Hypertensive medications.**

Question 26

NCLEX item type: multiple response Cognitive skill: evaluate cues The nurse discusses the modifications that are recommended for the patient in scenario #2. Which statements by the nurse are appropriate? (Select all that apply.) (355) 1. Weight reduction 2. Using the DASH diet 3. Stress management training 4. Maintaining usual sodium intake 5. Increase physical activity to moderate exercise

Answer 26

1 Weight reduction 2 Using the DASH diet 3 Stress management training 5 Increase physical activity to moderate exercise

Question 27

NCLEX item type: multiple response Cognitive skill: application The nurse discusses lifestyle modifications for the patient in scenario #2 regarding the treatment of hypertension. Which suggestions are appropri- ate for the nurse to recommend? (Select all that apply.) (356) 1. Eating more fruits and vegetables 2. Consuming more dairy products per day 3. Reducing the amount of dietary sodium intake 4. Limiting consumption of alcohol to no more than two drinks per day 5. Increasing physical activity to 40 minutes, three or four times per week

Answer 27

1 Eating more fruits and vegetables 3 Reducing the amount of dietary sodium intake 4 Limiting consumption of alcohol to no more than two drinks per day 5 Increasing physical activity to 40 minutes, three or four times per week

Question 28

NCLEX item type: multiple choice Cognitive skill: compare A patient asks the nurse how much exercise is con- sidered enough for the control of blood pressure. The nurse knows that a range of 4-9 mm Hg of approximate systolic pressure reduction can occur with engaging in regular physical activity how often? (356) 1. For as little as 30 minutes a week 2. For at least 40 minutes 3-4 days a week 3. For 15-20 minutes a week at the most 4. For as little as 90 minutes a week

Answer 28

For at least 40 minutes 3-4 days a week

Question 29

NCLEX item type: multiple choice Cognitive skill: interpret The nurse was instructing the patient in the scenario regarding lifestyle modification and recognized that further education was needed after the patient made which statement? (355-356) 1. "So my plan is to start losing weight gradually so I can keep it off." 2. "I know that I will have to stop eating tortilla chips since they have a lot of salt." 3. "I understand that I need to walk more than just twice a week, so I think I will walk four times a week." 4. "Since I will be started on drug therapy for my high blood pressure, I do not need to change my habits."

Answer 29

"Since I will be started on drug therapy for my high blood pressure, I do not need to change my habits."

Question 30

NCLEX item type: multiple choice Cognitive skill: knowledge While discussing the best way to change diet habits with a patient who has hypertension, the nurse asks the patient which appropriate question? (360) 1. "Have you ever tried to adjust your portion size and number of servings from refined carbohy- drates and sodium?" 2. "Do you understand what is meant by restrict- ing the amount of dairy products in your diet?" 3. "Do you know how to estimate the percentage of total daily calories from fats?" 4. "How is food prepared in the home? Do you prefer fried or baked foods?"

Answer 30

"Do you know how to estimate the percentage of total daily calories from fats?"

Question 31

NCLEX item type: multiple choice Cognitive skill: explain A patient in scenario #1 was discussing how to man- age his blood pressure with the nurse and men- toned that he likes to smoke an occasional cigar. What is the best response from the nurse? (361) 1. "How often would you say is 'occasional'?" 2. "That should be okay; smoking does not affect your blood pressure." 3. "You will need to stop smoking altogether, since that is very bad for you." 4. "Did you know that smoking will cause the diuretic you are on to be ineffective?"

Answer 31

"How often would you say is 'occasional'?"

Question 32

Objective: Identify initial options and progression of medicines used to treat hypertension. NCLEX item type: multiple response Cognitive skill: classify The nurse expects that the patient in scenario #1 may be started on which drug class? (Select all that apply.) (356) 1. Thiazide diuretics 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Aldosterone receptor antagonists 5. Angiotensin-converting enzyme inhibitors

Answer 32

Thiazide Diuretics Calcium Channel Blockers Angiotensin-Converting Enzyme Inhitbitors

Question 33

NCLEX item type: multiple choice Cognitive skill: compare After being on a thiazide for several months, the patient in scenario #2 being treated for stage 1 hy- pertension will most likely have which medication added because the target blood pressure was not attained? (356) 1. aliskiren (Tekturna) 2. eplerenone (Inspra) 3. nifedipine (Procardia) 4. spironolactone (Aldactone)

Answer 33

nifedipine (Procardia)

Question 34

NCLEX item type: cloze Cognitive skill: recognize cues 34. Choose the most likely options for the information missing from the statements below by selecting from the list of options provided. The nurse recognizes that for patients who have stage 2 hypertension there may be a pro- gression of blood pressure control and a need to be started on two-drug combinations for blood pressure control, the two first line agents could be Thiazaide Diuretics, Angiotensin-Converting enzyme inhibitors and Thiazide Diuretics and Calcium Channel Blockers.

Answer 34

The nurse recognizes that for patients who have stage 2 hypertension there may be a pro- gression of blood pressure control and a need to be started on two-drug combinations for blood pressure control, the two first line agents could be **Thiazaide Diuretics, Angiotensin-Converting enzyme inhibitors and Thiazide Diuretics and Calcium Channel Blockers. **

Question 35

Objective: Identify and summarize the action of five drug classes used to treat hypertension. NCLEX item type: multiple choice Cognitive skill: knowledge The nurse recognizes the class of antihypertensive agents that lower blood pressure by blocking a very potent vasoconstrictor from binding to the receptor sites in vascular smooth muscle, brain, heart, kidneys, and adrenal glands as which class? (367) 1. Beta blockers 2. Angiotensin I receptor blockers 3. Calcium channel blockers 4. Aldosterone receptor antagonists

Answer 35

Angiotensin I Recptor Blockers

Question 36

NCLEX item type: multiple choice Cognitive skill: compare The nurse needs to teach patients who develop a chronic, dry, nonproductive cough and are taking an antihypertensive agent, that they will need to contact their healthcare provider to get a different agent. Which medication would be likely to cause this adverse effect? (365-366) 1. metoprolol 2. hydralazine 3. captopril 4. amlodipine

Answer 36

captopril

Question 37

NCLEX item type: multiple response Cognitive skill: analyze The nurse knows that calcium channel blockers are used for the reduction of blood pressure and have what other effect? (Select all that apply.) (372-373) 1. Reduce the afterload of the heart 2. Peripheral vasodilating effects 3. Increase the sodium excretion in the kidneys 4. Increase the preload of the heart 5. Peripheral vasoconstricting effects

Answer 37

1. Reduce the afterload of the heart 2. Peripheral vasodilating effects 3. Increase the sodium excretion in the kidneys

Question 38

NCLEX item type: multiple response Cognitive skill: application The nurse discusses with a patient starting on the drug prazosin, an alpha-1 adrenergic blocking agent, and explains that the drug has which thera- peutic effects? (Select all that apply.) (375) 1. Improving memory 2. Reducing blood lipids 3. Improving urine flow 4. Reducing blood pressure 5. Reducing gastric acid production

Answer 38

Improving urine flow

Question 39

NCLEX item type: multiple choice Cognitive skill: explain The nurse explains to the patient receiving hydrala- zine the effect the drug will have. Which statement by the nurse needs to be revised? (378-379) 1. "Hydralazine is a direct vasodilator that results in a reduced peripheral vascular resistance." 2. "This drug needs to be given with a beta block- er to prevent the reflex tachycardia that occurs. 3. "Hydralazine is considered a first-line antihy- pertensive agents." 4. "When you are on this drug you need to be aware that it may cause orthostatic hypoten- sion."

Answer 39

"Hydralazine is considered a first-line antihy- pertensive agents."