Question 1

A patient has an average blood pressure of 135/85 mm Hg based on the average of three separate measurements. The nurse understands that this patient should be treated with which of the following?&#10;A) a beta blocker.&#10;B) a diuretic and a beta blocker.&#10;C) a diuretic.&#10;D) lifestyle changes.

Accepted Answer

The patient's blood pressure falls into the elevated category (systolic 120-139 mm Hg or diastolic 80-89 mm Hg). The initial approach for managing elevated blood pressure typically involves recommending lifestyle changes such as diet modification, increased physical activity, weight loss if overweight, and reducing alcohol intake, rather than immediately starting medication.

Question 2

The nurse is caring for a patient who will begin taking lisinopril (Zestril) for hypertension. The nurse reviews the patient's laboratory test results and notes increased BUN and creatinine. Which action will the nurse take?

A) Administer the captopril and monitor vital signs.
B) Contact the provider to discuss changing to fosinopril (Monopril).
C) Obtain an order for intravenous fluids to improve urine output.
D) Request an order to add hydrochlorothiazide (HydroDIURIL).

Accepted Answer

Increased BUN and creatinine levels can indicate renal impairment, and lisinopril can further decrease renal function. Therefore, it would be appropriate to contact the provider to discuss changing to a different medication that may be better tolerated by the patient's kidneys. Administering captopril or adding hydrochlorothiazide may further exacerbate the patient's renal impairment. Intravenous fluids may be appropriate for some patients, but it is not the best initial intervention without provider input.

Question 3

The nurse is preparing to care for a Native American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient?&#10;A) Acebutolol (Sectral)&#10;B) Captopril (Capoten)&#10;C) Carteolol HCl (Cartrol)&#10;D) Metoprolol (Lopressor)

Accepted Answer

Captopril (Capoten) has been found to be more effective in reducing blood pressure in Native American patients compared to other antihypertensive medications. It is also a good choice for patients with diabetes or kidney disease.

Question 4

The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient?&#10;A) Encouraging increased fluid intake&#10;B) Increasing activity and exercise&#10;C) Initiating a fall risk protocol&#10;D) Providing a low potassium diet

Accepted Answer

Thiazide diuretics can cause orthostatic hypotension and electrolyte imbalances, increasing the risk of falls, especially in elderly patients. Initiating a fall risk protocol is important to ensure patient safety.

Question 5

The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patient's ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and:

A) ask to decrease the dose to 2.5 mg/day.
B) discuss twice daily dosing.
C) request an order for a diuretic.
D) suggest adding propranolol to the regimen.

Accepted Answer

Amlodipine is a calcium channel blocker that can cause peripheral edema as a side effect. The nurse should notify the provider and ask to decrease the dose to 2.5 mg/day.

Question 6

The nurse is preparing to administer an ACE inhibitor to a patient who has hypertension. The patient started the ACE inhibitor the day prior. The nurse notes peripheral edema and swelling of the patient's lips. The patient has a blood pressure of 160/80 mm Hg and a heart rate of 76 beats per minute. What is the nurse's next action?

A) Administer the dose and observe carefully for hypotension.
B) Hold the dose and notify the provider of a hypersensitivity reaction.
C) Notify the provider and request an order for a diuretic medication.
D) Request an order for serum electrolytes and renal function tests.

Accepted Answer

The patient is exhibiting signs of a hypersensitivity reaction to the ACE inhibitor, specifically angioedema. The nurse should hold the dose and notify the provider immediately. Administration of additional doses of the ACE inhibitor could exacerbate the reaction and potentially lead to anaphylaxis. The provider may consider alternative medications or prescribe an antihistamine or corticosteroid to manage the reaction.

Question 7

A 65-year-old patient has a blood pressure of 155/95 mm Hg. The nurse understands that with treatment, the goal for this patient's blood pressure is&#10;A) 120/80 mm Hg&#10;B) 130/89 mm Hg&#10;C) 140/90 mm Hg&#10;D) 150/90 mm Hg

Accepted Answer

The answer of A 65-year-old patient has a blood pressure...

Question 8

The nurse is admitting a patient who has been taking minoxidil (Loniten) to treat resistant hypertension. Prior to beginning therapy with this medication, the patient had a blood pressure of 170/95 mm Hg and a heart rate of 72 beats per minute. The nurse assesses the patient and notes a blood pressure of 130/72 mm Hg and a heart rate of 78 beats per minute, and also notes a 2.2-kg weight gain since the previous hospitalization and edema of the hands and feet. The nurse will contact the provider to discuss which intervention?

A) Adding hydrochlorothiazide to help increase urine output
B) Adding metoprolol (Lopressor) to help decrease the heart rate
C) Increasing the dose of minoxidil to lower the blood pressure
D) Restricting fluids to help with weight reduction

Accepted Answer

The 2.2-kg weight gain and edema indicate fluid retention, which can be managed by adding a diuretic such as hydrochlorothiazide to increase urine output. Increasing the dose of minoxidil could further decrease blood pressure and cause more fluid retention. Adding metoprolol to decrease heart rate may not address the underlying issue of fluid retention. Restricting fluids alone may not be sufficient to manage the edema.

Question 9

A patient who has recently begun taking captopril (Capoten) to treat hypertension calls a clinic to report a persistent cough that started right after starting the captopril. The nurse will perform which action?

A) Instruct the patient to go to an emergency department because this is a hypersensitivity reaction.
B) Reassure the patient that this side effect is nothing to worry about and will diminish over time.
C) Schedule an appointment with the provider to evaluate the cough and discuss changing to an angiotensin II receptor blocker (ARB).
D) Tell the patient to stop taking the drug immediately since this is a serious side effect of this drug.

Accepted Answer

A persistent cough is a common side effect of captopril and other ACE inhibitors. Although it is not a serious side effect, it can be bothersome for the patient. Changing to an ARB may be a reasonable option to manage the patient's hypertension without the cough. Instructing the patient to go to the emergency department or stop taking the drug immediately are not necessary actions in this case. Reassuring the patient that the side effect will diminish over time may be true for some patients, but not all, and should not be the only action taken by the nurse.

Question 10

The nurse is caring for a hospitalized patient who experiences an acute spike in blood pressure. The nurse will expect an order to administer which medication?&#10;A) Amlodipine (Norvasc)&#10;B) Nifedipine (Procardia)&#10;C) Nifedipine extended release (Procardia XL)&#10;D) Verapamil (Calan)

Accepted Answer

Nifedipine (Procardia) is a fast-acting calcium channel blocker that can be used for acute management of high blood pressure. It can quickly lower blood pressure, making it suitable for situations where an immediate effect is desired.

Question 11

The nurse is teaching a patient who has hypertension about long-term management of the disease with alpha blocker therapy. The patient reports typically consuming 1 to 2 glasses of wine each evening with meals. How will the nurse respond?

A) "Alpha blockers and wine cause a reflex hypertension."
B) "Four to 6 ounces of wine is considered safe with these medications."
C) "Wine in moderation helps you relax and get better blood pressure control."
D) "Wine can increases the hypotensive effects of alpha blockers."

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Accepted Answer

The answer of The nurse is teaching a patient who...

Question 12

The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss which of the following?

A) adding a diuretic medication.
B) changing to an angiotensin-converting enzyme (ACE) inhibitor.
C) decreasing the beta blocker dose.
D) doubling the beta blocker dose.

Accepted Answer

The answer of The nurse is caring for an African-American...

Question 13

A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes?&#10;A) Changing from weight bearing exercise to yoga&#10;B) Decreased fluid intake and increased potassium intake&#10;C) Stress reduction and increased protein intake&#10;D) Weight reduction and decreased sodium intake

Accepted Answer

The answer of A patient is diagnosed with borderline hypertension...

Question 14

The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action?

A) Administer the medication and monitor the patient's serum glucose.
B) Contact the provider to discuss another type of antihypertensive medication.
C) Request an order for renal function tests prior to administering this drug.
D) Teach the patient about the risks of combining herbal medications with this drug.

Accepted Answer

The answer of The nurse is performing an assessment on...

Deck 39: Antihypertensives