Question 1

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?

Accepted Answer

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.

Question 2

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?

Accepted Answer

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.

Question 3

A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

Accepted Answer

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.

Question 4

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?

Accepted Answer

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.

Question 5

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?

Accepted Answer

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.

Question 6

A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?

Accepted Answer

Current recommendations for African Americans to prevent hypertension include sodium restriction of less than 1500 mg/day,although this is under investigation. The patient has a normal BMI and does not consume alcohol excessively,so weight loss and alcohol cessation are not necessary. Potassium supplements are not indicated; patients should be advised to consume foods high in potassium.

Question 7

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?

Accepted Answer

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.

Question 8

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?

Accepted Answer

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.

Question 9

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

Accepted Answer

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.

Question 10

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:

Accepted Answer

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.

Question 11

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:

Accepted Answer

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.

Question 12

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:

Accepted Answer

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.

Question 13

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?

Accepted Answer

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.

Question 14

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?

Accepted Answer

Diagnosis of hypertension should be based on several blood pressure readings,not just one. High readings should be confirmed in the contralateral arm. Low-sodium diets are indicated for patients with confirmed hypertension. An electrocardiogram and blood tests are indicated for patients with confirmed hypertension to rule out primary causes. Thiazide diuretics are first-line drugs for confirmed hypertension.

Question 15

A patient with hypertension will begin taking an alpha₁ blocker. What will the nurse teach this patient?

Accepted Answer

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.

Question 16

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?

Accepted Answer

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.

Question 17

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

Accepted Answer

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.

Question 18

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:

Accepted Answer

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.

Question 19

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?

Accepted Answer

Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg. When systolic and diastolic BP fall into different categories,classification is based on the higher category. This patient has a hypertensive diastolic BP. Isolated systolic hypertension occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg. Because this patient has an elevated diastolic BP,it is not considered normal. Prehypertension occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg.

Quiz 47: Drugs for Hypertension

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 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 patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

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 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 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?

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?

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?

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

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 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 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 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 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 patient with hypertension will begin taking an alpha₁ blocker. What will the nurse teach this patient?

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

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 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?

Quiz 47: Drugs for Hypertension

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 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 patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

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 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 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?

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?

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?

Which two-drug regimen would be appropriate for a patient with hypertension who does not have other compelling conditions?

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 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 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 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 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 patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this patient?

A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness. What will the nurse tell the patient?

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 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 patient with hypertension will begin taking an alpha₁ blocker. What will the nurse teach this patient?