Question 1

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?

Accepted Answer

Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications.Fall risk also increases with a need for increased trips to the bathroom.A fall risk protocol should be implemented.Increasing fluids and activity and limiting potassium are not indicated.

Question 2

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?

Accepted Answer

Patients with chronic lung disease are at risk for bronchospasm with beta blockers,especially those like propranolol which are non-selective.Beta blockers,with the exception of carvedilol,also decrease the efficacy of many oral antidiabetic medications.The nurse should discuss a change in medications to one that does not carry this risk.

Question 3

The nurse understands that a medication such as carvedilol (Coreg)may not be effective in an African-American patient because of its effects on

Accepted Answer

African Americans are more likely to be susceptible to low-renin hypertension.Beta blockers reduce heart rate,contractility,and renin release,and there is a greater hypotensive response in patients with higher renin levels.Changes in heart rate,contractility,and vascular resistance explain why there is some response in this group.

Question 4

The nurse is caring for a patient who experiences a rapid rise in blood pressure.The nurse will contact the provider to discuss administering which medication?

Accepted Answer

The short-acting nifedipine is used to treat rapid rises in blood pressure but cannot be used for out-patient treatment at high dosages because of an increased risk for sudden cardiac death.The other drugs are not used for rapid rise in BP.

Question 5

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?

Accepted Answer

Captopril is an angiotensin II inhibitor.Native-American patients do not respond well to beta blockers.Acebutolol,carteolol,and metoprolol are all beta blockers.

Question 6

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

Accepted Answer

African Americans do not respond well to beta blockers and ACE inhibitors,but do tend to respond to diuretics and calcium channel blockers.Changing to an ACE inhibitor or altering the beta blocker dose are not indicated.Hypertension in African-American patients can be controlled by combining beta blockers with diuretics.

Question 7

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

Accepted Answer

Patients who have renal insufficiency will not require a decrease in dose with fosinopril,as they would with other angiotensin-converting enzyme (ACE)inhibitors.If captopril is given,it should be given in a reduced dose.Increased IV fluids are not indicated.

Question 8

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

Accepted Answer

An angiotensin-converting enzyme (ACE)inhibitor,such as captopril,can cause a constant,irritated cough.The cough will stop with discontinuation of the drug,and many patients can switch to an ARB medication.It does not indicate a hypersensitivity reaction.The cough will not diminish while still taking the drug.The patient does not need to stop taking the drug immediately.

Question 9

A patient has a blood pressure of 155/95 mm Hg.The nurse understands that this patient's risk of cardiovascular disease is _____ greater than normal.

Accepted Answer

Cardiovascular disease (CVD)risk doubles with each increase of 20/10 mm Hg above normal,starting at 115/75 mm Hg.This patient's blood pressure is 40/20 above normal,which increases the risk four times.A blood pressure of 135/85 would be two times greater.The patient's risk would still be four times greater with a blood pressure of 155/70 or 130/95,since systolic and diastolic blood hypertension are each powerful predictors of CVD.

Question 10

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?

Accepted Answer

Weight loss decreases the stress on the heart and the afterload.Decreasing salt intake decreases the amount of retained fluid.Changing to yoga from weight-bearing exercise,limiting fluids,and increasing potassium are not indicated.Stress reduction is recommended,but increasing protein is not.

Question 11

The nurse is admitting a patient who has been taking minoxidil (Loniten)to treat 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?

Accepted Answer

Minoxidil is a direct-acting vasodilator which can cause sodium and water retention.Combining this drug with a diuretic can help reduce edema by increasing urine output.If the patient were tachycardic,a beta blocker might be added.It is not necessary to increase the minoxidil dose or to restrict fluids.

Question 12

The nurse is preparing to administer an angiotensin-converting enzyme (ACE)inhibitor to a patient who has hypertension.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?

Accepted Answer

The patient has signs of angioedema which indicates a hypersensitivity reaction.The nurse should hold the dose and notify the provider.Giving the dose will make the reaction more serious.These are not signs of edema,so a diuretic is not indicated.Electrolytes and renal function tests are not indicated.

Question 13

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

Accepted Answer

This patient is experiencing side effects of the medication.Elderly patients often require lower doses,so the nurse should ask about a dose reduction.Older adults generally require 2.5 to 5.0 mg/day.Twice daily dosing is not recommended.Unless edema persists,a diuretic is not indicated.

Question 14

A patient has a blood pressure of 135/85 mm Hg on three separate occasions.The nurse understands that this patient should be treated with

Accepted Answer

Prehypertension is defined as a systolic pressure of 120 to 139 and a diastolic pressure between 80 and 89.Drug therapy is recommended if the blood pressure is greater than 20/10 over the goal,which would be140/90.Prehypertension is generally treated first with lifestyle changes.

Question 15

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

Accepted Answer

Patients who take beta blockers should avoid all alcohol because it increases the hypotensive effects.It does not cause reflex hypertension.

Question 16

The nurse teaches a patient about antihypertensive medication.Which statements by the patient indicate understanding of the teaching? (Select all that apply. )

Accepted Answer

The patient receiving an antihypertensive medication should be warned to rise slowly to avoid orthostatic hypotension.Patients should be counseled to continue to make lifestyle changes,including decreasing sodium.Often,more than one medication is required.Patients should not stop taking the drug abruptly to avoid rebound hypertension and will not stop the drug when blood pressure returns to normal.

Quiz 44: Antihypertensives

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?

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?

The nurse understands that a medication such as carvedilol (Coreg) may not be effective in an African-American patient because of its effects on