What Would You Do?
The nurse is preparing to administer metoprolol to a patient whose blood pressure is 98/60 mm Hg and heart rate is 52 bpm. What should the nurse do?
A. Administer the medication as ordered.
B. Hold the dose and notify the provider.
C. Give the dose and recheck BP in 30 minutes.
D. Document and continue other medications.
B. Hold the dose and notify the provider.
Rationale: Beta-blockers lower heart rate and BP; holding the dose prevents bradycardia and hypotension.
This class prevents the conversion of angiotensin I to angiotensin II, lowering blood pressure and causing vasodilation
ACE inhibitors (e.g., lisinopril, enalapril)
Increased urination and low potassium levels
Thiazide diuretics (like hydrochlorothiazide)
Rationale: Thiazides promote sodium and water loss, which also increases potassium excretion.
This ACE inhibitor commonly causes a dry, persistent cough due to bradykinin buildup.
Lisinopril
This is considered the normal blood pressure for a healthy adult, according to the American Heart Association (and our textbook)
A patient taking losartan reports feeling dizzy when standing up. What should the nurse do?
A. Instruct the patient to rise slowly from sitting or lying positions.
B. Hold the medication and notify the provider.
C. Encourage the patient to drink coffee before standing.
D. Administer IV fluids.
A. Instruct the patient to rise slowly from sitting or lying positions.
Rationale: Orthostatic hypotension is common with ARBs — teach slow position changes.
This class blocks beta-1 receptors in the heart, reducing heart rate and cardiac output.
Beta-blockers (e.g., metoprolol, atenolol)
A dry, persistent cough and high levels of potassium
ACE inhibitors (like lisinopril or enalapril)
Rationale: ACE inhibitors increase bradykinin (causing cough) and decrease aldosterone (raising potassium).
This ARB is often used when patients can’t tolerate an ACE inhibitor’s cough
Losartan
A consistent blood pressure reading of 140/90 mm Hg or higher is typically classified as this condition.
Stage 2 Hypertension
A patient taking hydrochlorothiazide reports muscle weakness and irregular heartbeat. Which action should the nurse take first?
A. Assess the patient’s serum potassium level.
B. Encourage the patient to drink more fluids.
C. Document findings and continue monitoring.
D. Administer an antiarrhythmic medication.
A. Assess the patient’s serum potassium level.
Rationale: Thiazide diuretics can cause hypokalemia, leading to arrhythmias — check potassium levels immediately.
These medications block calcium from entering smooth muscle cells of arteries, causing vasodilation and lowering BP.
Calcium channel blockers (e.g., amlodipine, diltiazem)
Ankle swelling, flushing, and headache due to vasodilation
Calcium channel blockers (like amlodipine or nifedipine)
Rationale: Vasodilation increases capillary pressure and causes edema and headaches
This beta-blocker slows the heart rate and decreases myocardial oxygen demand; always check HR before giving.
Metoprolol
This type of hypertension has no identifiable cause and accounts for about 90–95% of cases.
Primary (essential) hypertension
A diabetic patient taking metoprolol reports not feeling shaky or sweaty when their blood sugar drops. What should the nurse do?
A. Teach that beta-blockers can mask hypoglycemia symptoms.
B. Instruct the patient to double their insulin dose.
C. Encourage taking the beta-blocker with meals.
D. Discontinue metoprolol immediately.
A. Teach that beta-blockers can mask hypoglycemia symptoms.
Rationale: Beta-blockers can hide warning signs of hypoglycemia — patients must monitor glucose closely.
This class blocks angiotensin II receptors to lower BP without increasing bradykinin, so they rarely cause a cough.
ARBs (e.g., losartan, valsartan)
Slow heart rate, fatigue, and cold hands or feet
Beta-blockers (like metoprolol or propranolol)
Rationale: Beta-blockers reduce heart rate and cardiac output, leading to fatigue and poor circulation.
This potassium-sparing diuretic blocks aldosterone, helping lower BP but increasing the risk of hyperkalemia.
Spironolactone
When teaching a patient with hypertension, the nurse explains that this organ’s damage may be detected by elevated BUN and creatinine levels.
The kidneys
A 72-year-old patient with hypertension and heart failure is prescribed carvedilol (Coreg). During the morning assessment, the nurse notes:
What is the nurse’s priority action?
A. Administer the medication and recheck vitals in 1 hour.
B. Encourage ambulation to reduce edema.
C. Hold the carvedilol and notify the healthcare provider immediately.
D. Elevate the legs and continue with the current plan of care.
C. Hold the carvedilol and notify the healthcare provider immediately.
Rationale: Carvedilol, a non-selective beta-blocker, decreases heart rate and contractility. The patient’s bradycardia (HR < 50 bpm) and new signs of heart failure worsening (edema, SOB) indicate possible drug-induced cardiac decompensation.
These drugs inhibit sodium reabsorption in the distal tubule, increasing water excretion and lowering blood pressure.
Thiazide diuretics (e.g., hydrochlorothiazide)
Severe hypotension after the first dose, especially in patients taking diuretics or those with heart failure
ACE inhibitors
Rationale: The “first-dose effect” occurs due to sudden vasodilation and volume depletion.
Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI
Shortest half-life
Must be administered multiple times throughout the day
Captopril
This condition occurs when blood pressure suddenly rises to severe levels (often >180/120 mm Hg) and causes acute organ damage.
Hypertensive emergency