I Tried to Make Categories
Your pt is getting diuretic therapy for HTN. Which finding indicates the medication is working?
Increased HR
Reduced BP
Increased urine out put
Lower leg edema
Reduced BP.
Critical here is to read the question very carefully. It states the pt is getting a diuretic to treat HTN and then asks how do we know that the pt's problem is getting fixed. While increased urine output is a sign we'd expect to see with a diuretic, that doesn't tell us anything about the BP.
Alpha 1 blocking medications end in?
-osin
Explain first dose phenomenon and what pt teaching we would give for it regarding HTN medications.
When a patient has a significant reaction to the first dose of a medication. With HTN meds we would tell our patients to call for help to get out of bed and avoid driving until they know how the med will effect them.
What other type of medication should we ask our male patients about, as it also lowers BP? (Hint; not diuretics and not for women)
Erectile disfunction medications.
Two common ones are sildenafil and tadalafil
Name 3 adverse reactions to monitor for when caring for a pt on reteplase.
hematuria, black/tarry stool, bleeding from IV or other injection sites, altered LOC, dysrhythmias.
Which finding would lead you to withhold administering spirnolactone?
BP of 135/85
K of 3.0
Glucose of 100
K of 5.8
K of 5.8.
Spirnolactone is a potassium sparing diuretic, so if their K is already elevated we would want a potassium wasting diuretic.
A client is started on a diuretic. Which outcomes would indicate the medication is working (select all that apply)?
Increased BUN
HR of 125
Decreased edema
Weight loss
Decreased edema & weight loss
Aside from thiazide diuretics, which class of medication is first line Tx for HTN?
ACE inhibitors
If after providing pt education about hydralazine your pt says "this medication will cure my HTN", what would that indicate?
That clarification/further pt education is needed.
What are 4 assessments should you do before giving nitro to a patient with chest pain?
BP, HR, pain Ax (intensity and location), Hx of ED med use in past 24 hrs, # of nitro doses already been taken.
Spironolactone is often given to treat what?
Heart Failure
Ventricular tachycardia
Hypokalemia
Heart Failure
No we haven't talked the heart failure chapter yet, however in the renal presentation when discussing the common uses for K-sparing diuretics, it was one of the most common uses.
The primary MOA of loop diuretics. **Bonus if you can name where these diuretics work.
Promotes excretion / blocks reabsorption of sodium, water, potassium, calcium and chloride
Bonus: they work in the Loop of Henle/nephron loop.
What is the MOA of alpha 1 adrenergic receptor antagonists?
Block sympathetic stimulation of vascular smooth muscle
Name three important pieces of patient education r/t HTN meds.
-Take at the same time each day
-Take even if your BP is nml
- Keep a log of your BPs to share with your doc
-Monitor your BP with the same machine
-Lifestyle modifications PRN (smoking, exercise, DASH diet)
-Avoid driving until you see how the medication effects you
What is a main difference you'd likely see in dosing frequency for a patient taking sublingual nitroglycerin and a patient prescribed transdermal nitroglycerin?
The sublingual nitro would most likley be PRN, the transdermal would most likely be daily (with breaks to avoid tolerance)
Which labs should a nurse check to monitor for adverse S/E from a pt taking HCTZ? (Hint; remember this med is a potent diuretic)
Uric acid, sodium, potassium and blood glucose.
This med is a potent diuretic; Na+ and water are BFFs so if water goes, as does Na+. When Na+ is away K comes out to play (AKA, body retains K when Na+ is low). We're also concentrating the blood, so uric acid and glucose may both go up and cause problems so would need to monitor that.
What is the MOA of ACE inhibitors?
Angiotensin converting enzyme (ACE) inhibitors inhibit the formation of angiotensin I to angiotensin II, thereby reducing vasoconstriction.
Pt's BP is 133/79. Which AHA hypertension category does this fall under?
Normal
Elevated
HTN Stage 1
HTN Stage 2
This patient is at HTN Stage 1
Nml = less than 120 and less than 80
Elevated is 120-129 and less than 80
HTN Stage 1 = 130 - 139 or 80/89
HTN Stage 2 = 140+ or 90+
Which of the following CCBs affect both the heart and the blood vessels (select all that apply)?
Diltiazem, felodipine, nifedipine, verapamil, amlodipine
Diltiazem and verapamil.
Remember if your heart is fine you get -dipine; meaning the -dipine meds are used when only effecting the blood vessels is needed.
What is the MOA of calcium channel blockers in the management of angina?
Reduction of O2 demand through vasodilation / dilates blood vessels to reduce heart's workload / relaxes arteriolar smooth muscle and reduces cardiac workload.
Your patient is getting IV furosemide. Which finding would most likely indicate dehydration?
Increased urine output
Elevated BUN
Decreased HR
Elevated BP
Elevated BUN
This indicates increased work on the kidneys, often due to dehydration. While the others may be seen with dehydration, they are not the most reliable of the choices given.
Describe the RAAS (5 main parts)
Angiotensinogen is produced by the liver
When BP gets low, renin is produced by the kidneys which turns angiotensinogen into angiotensin I.
ACE is produced by the vessels which turns angiotensin I into angiotensin II. This has two effects:
- Causes vasoconstriction in arterioles which increases blood pressure.
- Aldosterone is produced by the adrenal cortex which increases sodium reabsorption, leads to fluid retention which increases BP.
Your patient was admitted with pneumonia, has HTN and a H/o asthma. Which prescription would you clarify with the provider?
Albuterol
Proranolol
Ceftriaxone
Losartan
Propranolol.
Beta blockers block the beta receptors in the lungs which causes bronchoconstriction which is not good for pt's with asthma or COPD.
Albuterol (commonly used bronchodilator), ceftriaxone (antibiotic) and losartan (an ARB HTN med) have no immediate contraindications for asthmatics.
You tell a patient to take their sublingual nitro before engaging in physical activity to prevent chest pain. Is this appropriate teaching? Why or why not?
No, sublingual nitro is for acute onset angina, NOT meant to be taken as a prophylactic.
If angina starts during physicial activity the pt should sit or lay down, take one SL tab, wait 5 min and if angina is still present, call 911 and take another tablet.
You have a med surg patient admitted for complications from a HTN med. Chart is below; which issue would you address first? Which second?
A: BP 185/90
B: RR 20
C: HR 98
D: Chest pain 3/10
E: Swelling to periorbital area, lips and tongue
F: Hoarse voice
G: Heart sounds are within defined limits
H: Respirations are labored with audible inspiratory stridor
I: Potassium = 4.9
J: Troponin = 0.1
H then, E. (Pt is likely on an ACE inhibitor)
Remember ABC, and then most dangerous to least dangerous. The most immediate risk to the patient is the closing of the airway (starting based on the stridor).