week9 Ch19, 22, 23, 24, 25 Flashcards
(11 cards)
What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension?
A) An angiotensin-converting enzyme (ACE) inhibitor
B) A beta-blocker
C) A calcium channel blocker
D) A diuretic
D) A diuretic
The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the priority nursing assessment related to this drug?
A) Mental illness
B) Hepatic disease
C) Renal disease
D) Peptic ulcer disease
C) Renal disease
A patient newly diagnosed with hypertension has just been given a prescription for medication. Along with promoting safety, what is the other goal of the nurse’s teaching plan?
A) A blood pressure of 120/80
B) Medication compliance
C) A discussion with his insurance company about the cost of the drug
D) Verbalization of why drugs should be kept out of the reach of children
B) Medication compliance
The nurse provides thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance. All of the options are realistic outcomes for this patient. However, compliance is a great concern for people who are in need of hypertensive agents. It would be most important for his or her health care provider to know that he or she has filled the prescription and is taking his or her medication as prescribed. Keeping the drug out of the reach of children would be a safety measure.
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?
A) Chest pain and pale skin
B) Shortness of breath and wheezing
C) Peripheral edema and bradycardia
D) Tachycardia and increased energy level
C. Peripheral edema and bradycardia
Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension. Skin flushing and rash may occur. There should be no effect on the lungs and usually this drug causes fatigue rather than increased energy levels.
A patient who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is the nurse’s priority assessment?
A) Chronic constipation
B) Excessive sweating on the job
C) Three large meals a day
D) One beer every night
B) Excessive sweating on the job
A patient taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with his job. The best treatment for constipation would be to increase fluid and fiber and one beer a night would be within reason when considering alcohol intake.
A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?
A. Intake of alcohol
B.The use of eggs in the diet
C.The ingestion of grapefruit juice
D.Intake of aged cheese
C. The ingestion of grapefruit juice
The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Eggs and cheese should not exert any fooddrug interaction.
An older adult patient is taking a sustained-release antihypertensive drug. What is the nurse’s priority teaching point about this medication?
a. Take your blood pressure only at night.
b.Swallow the drug whole and do not to cut, crush, or chew it.
c.Take the drug before bedtime.
d.Use over-the-counter (OTC) drugs to control headache or cold symptoms.
b. Swallow the drug whole and do not to cut, crush, or chew it.
Sustained-release drugs are suspended in a matrix system that allows a steady release of the drug over time. Sustained-release drugs cannot be cut, crushed, or chewed; it destroys the matrix system and allows absorption of the complete dose all at once. Older patients should be especially cautioned about sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for excessive dosing if these drugs are inappropriately cut. Many OTC drugs contain ingredients that increase blood pressure and so are not recommended for patients with hypertension. The patient can take his or her blood pressure any time during the day but should take the drug in the morning.
The nurse works with the patient, diagnosed with hypertension, and the patient’s family to determine the goal of drug therapy for the patient taking an antihypertensive medication is what?
A) Maintaining compliance
B) Maintaining the blood pressure within normal limits
C) Maintaining a fluid volume balance
D) Maintaining homeostasis
B) Maintaining the blood pressure within normal limits
Helping the patient to maintain the blood pressure within normal limits is the goal of drug therapy. How blood pressure is maintained within normal limits may involve balancing fluid volume and patient compliance with the plan of care, but these are interventions and not the goal of therapy. Returning the patient to homeostasis comes before maintaining homeostasis.
When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic would the nurse expect to administer?
A) Thiazide
B) Loop
C) Potassium-sparing
D) Osmotic
a.Thiazide
A somewhat controversial study, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), reported in 2002 that patients taking the less expensive, less toxic diuretics did better and had better blood pressure control than patients using other antihypertensive agents. Replications of this study have supported its findings, and the use of a thiazide diuretic is currently considered the first drug used in the stepped-care management of hypertension.
The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances?
a,Hypertensive emergencies
b.Hypertension in a patient having a myocardial infarction
c.Hypertension complicated by symptoms of a stroke
d.Hypertension associated with diabetic ketoacidosis
a. Hypertensive emergencies
Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence of absence of a comorbidity does not increase the likelihood of use. These drugs are used when blood pressure is extremely high and needs to be reduced quickly.
What drug is a safe and effective calcium channel blocker only if the nurse administers them as sustained-release or extended-release preparations to treat hypertension?
a.Aliskiren (Tekturna)
b.Diltiazem (Cardizem)
c.Atenolol (Tenormin)
d.Metoprolol (Lopressor)
b. Diltiazem (Cardizem)
The calcium channel blockers available in immediate-release and sustained-release forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and verapamil (Calan SR). Aliskiren (Tekturna) is a renin inhibitor. Atenolol (Tenormin) and Metoprolol (Lopressor) are beta-blockers, not calcium channel blockers.
