A
A client receiving hydrochlorothiazide (Microzide) asks the nurse why they are urinating so frequently. Which statement should the nurse provide the client?
1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure."
2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure."
3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases."
4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."
Answer: 2
Explanation:
1. Hydrochlorothiazide (Microzide) does not enhance kidney function.
2. Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (Microzide) decrease blood pressure by decreasing total blood volume.
3. Hydrochlorothiazide (Microzide) does not dilate blood vessels.
4. Hydrochlorothiazide (Microzide) does not increase heart rate.
Which electrolytes should the nurse anticipate monitoring for a client prescribed losartan (Cozaar)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Potassium
2. Sodium
3. Calcium
4. Chloride
5. Magnesium
Answer: 1, 2
Explanation:
1. The electrolytes that will be monitored for a client prescribed losartan include
potassium.
2. The electrolytes that will be monitored for a client prescribed losartan include sodium.
3. The electrolytes that will be monitored for a client prescribed losartan do not include calcium.
4. The electrolytes that will be monitored for a client prescribed losartan do not include chloride.
5. The electrolytes that will be monitored for a client prescribed losartan do not include magnesium.
The nurse has completed the education for a client prescribed hydrochlorothiazide (Microzide). Which statement made by the client indicates an understanding of the teaching?
1. "I really need to avoid grapefruit juice when I take this medication."
2. "I need to avoid salt substitutes and potassium-rich foods."
3. "I take my medication early in the morning."
4. "If I develop a cough, I should call my physician."
Answer: 3
Explanation:
1. Grapefruit juice inhibits the metabolism of the calcium channel blockers.
2. Hydrochlorothiazide (Microzide) is a potassium-excreting diuretic, and potassium supplementation is often necessary.
3. Taking hydrochlorothiazide (Microzide) early in the day will help prevent nocturia.
4. Development of a cough occurs with ACE inhibitors.
The nurse is preparing to administer clevidipine (Cleviprex) to a client experiencing a hypertensive crisis. Which interventions should the nurse implement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Monitor bowel sounds
2. Administer the drug intravenously
3. Continually monitor blood pressure
4. Crush caplets for administration
5. Infuse prescription in normal saline at 125 mL/h
Answer: 2, 3
Explanation:
1. There is no particular reason that bowel sounds should be monitored more frequently than normally done.
2. Clevidipine (Cleviprex) is administered intravenously.
3. Clevidipine (Cleviprex) has an ultrashort half-life so blood pressure will be monitored continuously.
4. This drug is not supplied in caplet form.
5. Infusing normal saline at this rate would be contraindicated in hypertensive emergency.
Which intervention is the highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88?
1. Smoking-cessation program
2. Diuretic therapy
3. Weight-loss program
4. Stress management
Answer: 1
Explanation:
1. Smoking cessation is the priority.
2. The client is in the prehypertensive class and is not a candidate for prescriptive therapy.
3. Although weight management is very important, the client has a normal body mass index of 20.
4. There is no indication the client is experiencing stress.
The nurse is providing education for nonpharmacological interventions to manage
hypertension. Which information should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Increase your dietary intake of fruits and vegetables.
2. Decrease the consumption of alcohol.
3. Reduce the dietary intake of potassium.
4. Increase physical activity.
5. Restrict your intake of sodium.
Answer: 1, 2, 4, 5
Explanation:
1. Increasing the intake of fruits and vegetables is recommended to help manage
hypertension.
2. Decrease the consumption of alcohol.
3. Dietary potassium should be increased to help control hypertension
4. Increased physical activity is recommended to help manage hypertension.
5. Reduction of the intake of sodium is recommended to help manage hypertension
The nurse has prescribed dietary education for a client prescribed nifedipine (Procardia XL). Which dietary choice should the nurse recognize requires further education?
1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice
2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice
3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice
4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice
Answer: 2
Explanation:
1. There is no food-drug interaction with calcium channel blockers and whole-wheat pancakes with syrup and bacon, oatmeal, and orange juice.
2. Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency.
3. There is no food-drug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice.
4. There is no food-drug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.
The nurse has discussed lifestyle modifications to help manage the client's hypertension. Which statement made by the client indicates an understanding of the information?
1. "I need to get started on my medications right away."
2. "My father had hypertension, did nothing, and lived to be 90 years old."
3. "I know I need to give up my cigarettes and alcohol."
4. "I won't be able to run in the marathon race anymore."
Answer: 3
Explanation:
1. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away.
2. The fact that the patient's father had hypertension and lived to be 90 years old does not mean that the patient will have the same experience; the patient is in denial.
3. Limiting intake of alcohol and discontinuing tobacco products are important
nonpharmacological methods for controlling hypertension.
4. Increasing physical activity is an important lifestyle modification for controlling
hypertension.
Which factors are responsible for blood pressure?
1. Blood volume, heart rate, and stroke volume
2. Cardiac output, blood volume, and peripheral vascular resistance
3. Age, weight, and race
4. Body mass index, diet, and genetics
Answer: 2
Explanation:
1. The heart rate is not specifically involved in the blood pressure; however, the blood volume or cardiac output influences the blood pressure.
2. Although many factors can contribute to blood pressure, such as diet and weight, the cardiac output, blood volume, and peripheral vascular resistance are the factors responsible for blood pressure.
3. Age, weight, and race do not specifically control blood pressure.
4. Body mass index, diet, and genetics do not specifically control blood pressure.
Which electrolyte imbalance should the nurse be concerned about for the client who is prescribed a thiazide diuretic?
1. Magnesium
2. Calcium
3. Chloride
4. Potassium
Answer: 4
Explanation:
1. Magnesium is not a concern.
2. Calcium is not a concern.
3. Chloride is not a concern.
4. The client prescribed a thiazide diuretic is at risk for a potassium and sodium imbalance. The client should be monitored for hypokalemia. Magnesium, calcium, and chloride are not a concern.
Which clients should the nurse anticipate will require a pharmacological intervention to manage their blood pressure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy
2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes
3. A 56-year-old woman whose blood pressure is 135/84 mmHg who also has Cushing's disease
4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy
5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy
Answer: 2, 5
Explanation:
1. Hypertension in this age group of healthy adults is considered to be 140/90 mmHg.
2. Since this 61-year-old has both hypertension and diabetes, pharmacotherapy is indicated.
3. This client's blood pressure is not in a hypertensive range.
4. Since there are no other compelling illnesses, this client's hypertension does not require pharmacological intervention.
5. Blood pressure over 150/90 mmHg requires treatment in those over age 60.
Which statement made by a client newly prescribed a beta-adrenergic blocker should the nurse be concerned about?
1. "I don't handle stress well; I have a lot of diarrhea."
2. "When I have a migraine headache, I need to have the room darkened."
3. "My father died of a heart attack when he was 48 years old."
4. "I have always had problems with my asthma."
Answer: 4
Explanation:
1. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.
2. Beta-adrenergic blockers do not affect migraine headaches.
3. Having a father who died of a heart attack when he was young is significant but has no correlation to this client and their use of beta-adrenergic blockers.
4. This prescription should be used with caution in clients with asthma. With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction.
For which assessment findings should the nurse hold enalapril (Vasotec)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Cough
2. Lightheadedness on ambulation
3. Periorbital edema
4. Sneezing
5. Difficulty swallowing
Answer: 3, 5
Explanation:
1. Cough is a common side effect of this drug. The nurse should discuss the finding with the healthcare provider, but there is no need to hold the prescription.
2. Orthostatic hypotension is common at the beginning of therapy. The nurse would manage safety of the patient but would not hold the prescription.
3. Periorbital edema may indicate angioedema, which is a serious adverse effect. Holding the prescription is indicated.
4. Sneezing is not associated with enalapril.
5. Difficulty swallowing may indicate swelling in the throat related to angioedema. Holding the drug is indicated.
The nurse educator is reviewing the physiological regulation blood pressure. Which should the educator identify as initially involved?
1. Production of angiotensin II
2. Action of renin
3. Antidiuretic hormone
4. Production of angiotensin I
Answer: 2
Explanation:
1. Angiotensin I forms angiotensin II which results in vasoconstriction.
2. Renin forms angiotensin I.
3. Antidiuretic hormone does not initially regulate the blood pressure. Antidiuretic
hormone affects the renin which affects angiotensin I, which affects angiotensin II resulting in vasoconstriction.
4. The production of angiotensin I is acted upon in the lung to form angiotensin II.
Which prescription should the nurse be concerned about a pregnant client receiving?
1. Enalapril (Vasotec)
2. Potassium supplement
3. Doxazosin (Cardura)
4. Hydrochlorothiazide (HCTZ)
Answer: 1
Explanation:
1. Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.
2. Potassium supplements are Pregnancy Category A drugs.
3. Doxazosin is a Pregnancy Category B drug.
4. HCTZ is a Pregnancy Category B drug.
For which conditions is a client with hypertension at risk?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Kidney damage
2. Stroke
3. Liver failure
4. Heart failure
5. Blindness
Answer: 1, 2, 4, 5
Explanation:
1. The kidneys are affected by hypertension.
2. Stroke is a common effect of hypertension.
3. Liver failure is not commonly associated with hypertension.
4. The heart is affected by hypertension.
5. The retina is affected by hypertension.
Which is a priority nursing intervention for a client who is newly prescribed enalapril (Vasotec)?
1. Monitor the client for headaches.
2. Take the client's blood pressure.
3. Order a sodium-restricted diet for the client.
4. Review the client's lab results for hypokalemia.
Answer: 2
Explanation:
1. Although headache is a side effect, it is not the priority.
2. Enalapril may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope.
3. Enalapril does not affect sodium levels.
4. Enalapril is more likely to cause hyperkalemia, not hypokalemia
The nurse notes that a client experiencing heart failure has been receiving nifedipine (Procardia). Which is a priority assessment for the nurse?
1. Review recent lab results for hypokalemia.
2. Assess urinary output.
3. Assess level of orientation.
4. Auscultate breath sounds for crackles.
Answer: 4
Explanation:
1. Calcium channel blockers do not cause hypokalemia.
2. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time.
3. Level of orientation may be decreased with heart failure, but it is not a priority
assessment at this time.
4. Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure.
Which changes are sensed by the baroreceptors and relayed to the vasomotor center?
1. Oxygenation
2. Blood pressure
3. Carbon dioxide
4. Blood pH
Answer: 2
Explanation:
1. Chemoreceptors recognize levels of oxygen.
2. Baroreceptors sense and relay changes in blood pressure.
3. Chemoreceptors recognize levels of carbon dioxide.
4. Chemoreceptors recognize pH levels.
The nurse has provided education for a client prescribed nifedipine (Adalat CC). Which statement made by the client indicates an understanding of the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "If I drink alcohol while taking this medication, I will get very sick to my stomach."
2. "I should stop taking my melatonin sleep medication."
3. "I should no longer drink grapefruit juice."
4. "I should no longer drink sports drinks with caffeine in them."
5. "I should stop taking my vitamin C supplement."
Answer: 1
Explanation:
1. Alcohol may potentiate the effects of nifedipine, but this combination does not cause gastric irritation.
2. Concurrent use with melatonin may increase blood pressure and heart rate.
3. Grapefruit juice may enhance absorption of nifedipine.
4. Caffeine is not contraindicated when taking nifedipine.
5. Vitamin C supplements are not contraindicated when taking nifedipine.
The nurse reviewing the records of a client diagnosed with hypertension notes a weight of 200 lbs, height 5' 4", dietary intake includes primarily starches, an alcohol intake of three beers per week, and stressors include 60-hour workweeks. Based on this information, which should the nurse identify as a priority outcome?
1. Patient will eliminate alcohol from the diet.
2. Patient will decrease stress by limiting work to 40 hours/week.
3. Patient will balance diet according to the food pyramid.
4. Patient will achieve and maintain optimum weight.
Answer: 4
Explanation:
1. Eliminating alcohol is important but not the priority outcome.
2. Decreasing stress is important but not the priority outcome.
3. A balanced diet is important but not the priority outcome.
4. Achieving and maintaining optimum weight is of greatest importance when a client has hypertension. For obese patients, a 10- to 20-pound weight loss can produce a measurable change in blood pressure.
Which is the nurse's priority assessment for a client treated with intravenous hydralazine (Apresoline)?
1. Hypotension and bradycardia
2. Hypotension and hyperthermia
3. Hypotension and tachycardia
4. Hypotension and tachypnea
Answer: 3
Explanation:
1. Direct vasodilators do not produce bradycardia.
2. Direct vasodilators do not affect body temperature.
3. Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug.
4. Direct vasodilators do not affect respiratory rate.
A client prescribed doxazosin (Cardura) asks how the medication works. Which information should the nurse provide the client?
1. "Doxazosin causes the kidneys to excrete more urine."
2. "Doxazosin helps the heart work more efficiently."
3. "Doxazosin helps dilate the blood vessels."
4. "Doxazosin decreases the release of the stress hormones."
Answer: 3
Explanation:
1. Excreting more urine is an effect of diuretic medications.
2. Increasing the efficiency of the heart is not an effect of doxazosin.
3. Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins.
4. Decreasing the release of stress hormones is not an effect of doxazosin.
Which statement is accurate in regard to secondary hypertension?
1. There is no known cause.
2. It can result from chronic renal impairment.
3. It is also known as idiopathic.
4. It accounts for 90% of all hypertensive cases
Answer: 2
Explanation:
1. Primary hypertension has no known cause.
2. Secondary hypertension has an identifiable cause.
3. Primary hypertension is known as idiopathic.
4. Secondary hypertension accounts for 10% of all cases.
The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "I have incorporated yoga into my exercise program."
2. "I will monitor my daily sodium intake."
3. "I will drink a glass of red wine daily to help lower my blood pressure."
4. "I am receiving acupuncture to help me stop smoking."
Answer: 1, 2, 4
Explanation:
1. Incorporating yoga into an exercise program will help decrease stress and improve body strength.
2. Restricting sodium intake is a positive lifestyle change.
3. Increasing the intake of alcohol, including wine, is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of alcohol.
4. Eliminating tobacco products is a positive lifestyle change.