Chapter 43 Answer Key

Chapter 43 The client with a 10-year history of hypertension would like to know what effect the condition has on the heart. What is the nurse’s best response? Myocardium hypertrophy After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure? Left ventricle A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate? Risk for injury A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially? 2 A client with a blood pressure of 165/95 mmHg is experiencing which stage of hypertension? Stage 2 A patient newly diagnosed with hypertension has just been given a prescription for medication. What would be the most important outcome for this patient? Having taken the first dose of medication A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? Baseline renal function A patient is admitted to the unit with problems controlling their serum glucose levels. The patient has hypertension as a co-morbidity, and the physician has ordered hydralazine for this patient. The nurse caring for this patient knows that hydralazine is a(n): 1/22 direct vasodilator. A client who is malnourished and hypertensive client is being treated with losartan. Considering the client’s nutritional status, how should the dose of the medication be adjusted in this client? Lowered A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? persistent cough A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: a persistent, dry cough may occur; however, it is not serious. The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? Diastolic blood pressure below 90 mm Hg A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume? Changes in heart contraction The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? Ham sandwich with mustard, carrots and cheesy dip Key behavioral determinants of blood pressure are related to what factor? 2/22 Dietary consumption of calories and salt An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect? Falls The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client’s systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first? Stop the infusion and administer diluted phentolamine. A client who is taking an ACE inhibitor informs the nurse that she is considering having a child. What information should the nurse provide to the client related to this new information? ACE inhibitors are contraindicated during pregnancy because they are teratogenic. A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure? Left ventricle A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate? Risk for injury 3/22 A client develops primary hypertension and asks the nurse, “How long will I need to receive therapy?” The nurse responds based on the understanding that therapy would be required for how long? Lifelong A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially? 2 A client with a blood pressure of 165/95 mmHg is experiencing which stage of hypertension? Stage 2 A client with which diagnosis should be prescribed captopril as the first-line treatment? Diabetes mellitus A client who is malnourished and hypertensive client is being treated with losartan. Considering the client’s nutritional status, how should the dose of the medication be adjusted in this client? Lowered An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for: falls. A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to? Angiotensin II receptor blockers The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? 4/22 It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. Hubert, who is on hydralazine therapy, exhibits the symptoms of fever and arthralgia. Which action would help determine if a serious adverse effect has occurred? Monitoring the CBCs and the antinuclear antibody titer The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." A client is receiving a diuretic as the first-line treatment of mild hypertension. The nurse monitors the client for signs and symptoms of hypokalemia with which agent? Hydrochlorothiazide A client is prescribed phenylephrine intravenously (IV) to treat paroxysmal atrial tachycardia. What effect is the medication producing? Reflex bradycardia A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? pulmonary edema How does captopril contribute to a reduction of a client’s blood pressure? blocking the conversion of angiotensin I to angiotensin II A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client’s most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? elevated potassium levels Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure? 5/22 bronchiole A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? 130/80 mm Hg A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely? Potassium After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker? Valsartan A patient is admitted to the unit with problems controlling their serum glucose levels. The patient has hypertension as a co-morbidity, and the physician has ordered hydralazine for this patient. The nurse caring for this patient knows that hydralazine is a(n): direct vasodilator. A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.) Damage to the heart Damage to the kidneys Damage to the eyes During a routine check up of a 45-year-old patient with renal disease, the nurse observes an increase in the patient's blood pressure. Which is the most likely consequence of renal impairment? Secondary hypertension A client who is malnourished and hypertensive client is being treated with losartan. Considering the client’s nutritional status, how should the dose of the medication be adjusted in this client? Lowered Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? 6/22 “When was your last menstrual period?” A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse? Slow the rate of the infusion The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient? Monitoring for complications and side effects of treatment When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to: Decreased venous return A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? Diastolic blood pressure below 90 mm Hg The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." A male client’s friend tells him to stop taking his metoprolol because he read that it causes cancer. The nurse encourages the client to consult his prescriber because abrupt withdrawal from the drug may cause what effect? Exacerbation of his angina 7/22 Key behavioral determinants of blood pressure are related to what factor? Dietary consumption of calories and salt How can the home care nurse assist the client or the client’s family members who have hypertension? (Select all that apply.) Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate? Midodrine A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Instant bronchodilation The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client’s systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first? Stop the infusion and administer diluted phentolamine. A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? 130/80 mm Hg A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client’s risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? Take the medication at bedtime. A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Cough 8/22 A client develops primary hypertension and asks the nurse, “How long will I need to receive therapy?” The nurse responds based on the understanding that therapy would be required for how long? Lifelong A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex? Aldosterone A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Peripheral vascular resistance A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.) Damage to the heart Damage to the kidneys Damage to the eyes The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching? Hyperkalemia A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe? Hydrochlorothiazide A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Serum potassium levels A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider 9/22 concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? Diastolic blood pressure below 90 mm Hg A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions? Bradycardia The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Clonidine A client, being treated in the hospital for a femoral fracture, is scheduled to receive a daily dose of prescribed metoprolol. Prior to administering this drug, the nurse should assess and document which client data? Select all that apply. Heart rate Blood pressure Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Exacerbation of chronic cardiovascular conditions A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Instant bronchodilation The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and 10/22 edema at the right forearm IV site. The client’s systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first? Stop the infusion and administer diluted phentolamine. A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? pulmonary edema A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client’s most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? elevated potassium levels Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure? bronchiole A client, prescribed amlodipine, asks how this drug works. What is the nurse’s best response? “It dilates peripheral arteries and relaxes vascular smooth muscle.” A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? Cough When describing the adverse effects associated with ACE inhibitors, which would the nurse include? (Select all that apply.) Constipation Proteinuria Photosensitivity Cough A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex? Aldosterone 11/22 The clinic nurse is caring for a 39-year-old black, male client who is 25 pounds overweight and has been newly diagnosed with hypertension after three consecutive blood pressure readings above normal. What will be initial drug therapy for this patient? a diuretic A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Peripheral vascular resistance A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Serum potassium levels A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: a persistent, dry cough may occur; however, it is not serious. The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock? Hypoperfusion of tissues The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient? Monitoring for complications and side effects of treatment A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? 12/22 Hypotensive crisis Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Exacerbation of chronic cardiovascular conditions A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur? Instant bronchodilation A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition? pulmonary edema An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client’s blood pressure be classified? prehypertension A 37-year-old client presents with a blood pressure of 128/78 mm Hg. What lifestyle change should the nurse suggest related to this assessment finding? “Be aware of your salt intake and limit hidden salt.” A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. After reviewing the client’s most recent blood work, the nurse should consider withholding the dose because of what laboratory finding? elevated potassium levels Epinephrine typically demonstrates the potential to promote relaxation of muscles in what structure? bronchiole A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? 13/22 130/80 mm Hg A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation The pharmacology instructor is discussing hypertension in children and adolescents. What should the instructor tell the class is the reason for the cautious management of childhood hypertension? The long-term effects of the antihypertensive agents are not known. The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching? Hyperkalemia A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Serum potassium levels Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? “When was your last menstrual period?” Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect? Mark, who is suffering from impaired renal function Hubert, who is on hydralazine therapy, exhibits the symptoms of fever and arthralgia. Which action would help determine if a serious adverse effect has occurred? Monitoring the CBCs and the antinuclear antibody titer 14/22 The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock? Hypoperfusion of tissues The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient? Monitoring for complications and side effects of treatment When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to: Decreased venous return A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? Hypotensive crisis The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia? Diltiazem The nurse recognizes that which medication may be used to treat a hypertensive crisis? Nitroprusside The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply. 15/22 Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider. The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing? Clonidine Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Exacerbation of chronic cardiovascular conditions An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client’s blood pressure be classified? prehypertension A client with diabetes also has hypertension. The nurse would expect that the blood pressure goal for the client would be which of the following? 130/80 mm Hg A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply. Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse’s best response? “Many clients require two or more drugs for high blood pressure.” 16/22 A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Lisinopril The clinic nurse is caring for a 39-year-old black, male client who is 25 pounds overweight and has been newly diagnosed with hypertension after three consecutive blood pressure readings above normal. What will be initial drug therapy for this patient? a diuretic A nurse is presenting a class for patients newly diagnosed with hypertension. What factor would the nurse tell the class has the greatest effect on diastolic blood pressure? Peripheral vascular resistance The pharmacology instructor is discussing hypertension in children and adolescents. What should the instructor tell the class is the reason for the cautious management of childhood hypertension? The long-term effects of the antihypertensive agents are not known. Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart. A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.) Damage to the heart Damage to the kidneys Damage to the eyes The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching? Hyperkalemia 17/22 A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Serum potassium levels A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action? Frequent assessment of the client's cardiac status Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? Nick, age 35, who is suffering from hepatic impairment The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock? Hypoperfusion of tissues When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to: Decreased venous return A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question? "He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly." A patient admitted to the emergency department receives isoproterenol for treatment of shock. What effect would the nurse expect to observe? Increased heart rate 18/22 The pharmacology instructor is discussing management of hypertension using angiotensin-converting enzyme (ACE) inhibitors. According to the instructor, ACE inhibitors are considered first-line antihypertensive agents for clients with what disease or condition? Diabetes mellitus A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response? "With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease." A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor? Aliskiren Norepinephrine has been prescribed for an older adult client for treatment of shock. The nurse should carefully monitor the client due to the increased risk of which side effect? Exacerbation of chronic cardiovascular conditions An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client’s blood pressure be classified? isolated systolic hypertension The rescue squad brought a 48-year-old client to the ED in the midst of a hypertensive emergency. Blood pressure is 188/112 mm Hg, and the client reports severe headache and drowsiness. The client is disoriented and vomits. What is the nurse’s primary goal in this hypertensive emergency? Lower blood pressure as quickly as possible 19/22 A client is receiving candesartan. The nurse understands that this drug acts in which manner? Selectively binds with angiotensin II receptors in the vascular smooth muscle A nursing instructor determines that a class discussion on antihypertensive drugs was successful when the students identify which medication as lowering blood pressure by blocking the binding of angiotensin II at receptor sites in the vascular smooth muscle and adrenal glands? Losartan Olmesartan A client is receiving lisinopril for the treatment of hypertension. The client began taking ibuprofen (Motrin) over the counter for arthritis pain. Which adverse effect is most likely to occur with this combination of medications? Increased blood pressure A client with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe? Hydrochlorothiazide Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure? Thiazide diuretics A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action? Frequent assessment of the client's cardiac status Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? Nick, age 35, who is suffering from hepatic impairment 20/22 The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock? Hypoperfusion of tissues The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock? Bradycardia A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? A diuretic A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed? Hypotensive crisis Nonpharmacologic management should be tried alone or with drug therapy. What methods of nonpharmacologic management are used in the treatment of hypertension? (Select all that apply.) Weight reduction Limited alcohol intake Moderate sodium restriction When describing the action of calcium channel blockers, which would be an expected effect? Slowed impulse formation A male client who has been receiving verapamil for several months comes to the clinic reporting significant dizziness, light-headedness, and fatigue. He also reports frequent episodes of nausea and swelling of his ankles. Drug toxicity is suspected. Which question would be critical to ask the client? “Have you been drinking any grapefruit juice lately?” Which agent would be used to treat hypertension by blocking the postsynaptic alpha-1 receptor sites? 21/22 Prazosin A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor? Aliskiren A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate? Midodrine An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for additional health education? “I'll only need to take these drugs on days when my blood pressure is particularly high.” An older adult client usually has blood pressure readings of approximately 145/80 mm Hg. How would this client’s blood pressure be classified? isolated systolic hypertension 22/22