Chapter 26: Hypertension

Question 1

Hypertension Teaching

Answer 1

major risk factor for heart attack, stroke, heart failure, and kidney failure
can be controlled by diet or lifestyle changes
It is not recommended to stop abruptly antihypertensive drugs

Question 2

Hypertension Teaching 2

Answer 2

If you are a sexually active woman, use birth control measures when taking
angiotensin-converting enzyme (ACE) inhibitors
Take most other oral antihypertensive agents with or after food intake to decrease gastric irritation
Avoid potassium supplements and salt substitutes containing potassium,
unless directed by the prescriber
AVOID ALCOHOL.

Question 3

When: Captopril for Hypertension

Answer 3

prescribed specifically for patients with heart failure or asymptomatic left ventricular
dysfunction

Question 4

Why: Captopril for Hypertension

Answer 4

Captopril decreases morbidity and mortality, and is effective in patients with renal impairment, and improves post-MI survival when added to the standard therapy of aspirin
Captopril blocks the production of angiotensin II, ACE inhibitors decrease
vasoconstriction (thus having a vasodilating effect) and decrease aldosterone
production (thus reducing retention of sodium and water).

Question 5

Hydrochlorothiazide as an added med when current meds are ineffective

Answer 5

For African Americans, losartan and other ARBs may be ineffective when used alone

Question 6

ACE inhibitors and diuretics

Answer 6

ACE inhibitors may be used alone or in combination such as thiazide diuretics

Question 7

Nutritional teaching for HTN

Answer 7

recommended a diet low in sodium (4-6g / day) and fat along with increased consumption of fruits, vegetables, and grains
excessive sodium intake decreases the antihypertensive actions of all antihypertensive drugs
Patients with unrestricted salt intake who are taking thiazides may lose excessive potassium and become hypokalemia

Question 8

Cultural considerations in the use of beta-blockers

Answer 8

Individuals of African descent are less responsive to beta-blockers (less effective as monotherapy)
Asian Americans with hypertension require much smaller doses of beta-adrenergic blockers because they metabolize and excrete the drugs slowly

Question 9

Routes of administration for HTN medications

Answer 9

Intravenous or Oral (IV/PO)

Question 10

Side effects of hypertension meds by class (ACE inhibitors)

Answer 10

sudden deep swelling or welts under the skin, particularly around the eyes and lips

Question 11

Side effects of hypertension meds by class (ANGIOTENSIN II RECEPTOR BLOCKERS)

Answer 11

dizziness, muscle cramps or weakness, heartburn, diarrhea, and decreased
sensitivity to touch. There are reports of angioedema

Question 12

Side effects of hypertension meds by class (CALCIUM CHANNEL BLOCKERS)

Answer 12

cardiovascular adverse effects occur most frequently and include peripheral edema of the hands,
ankles, and feet and pulmonary edema, particularly in patients with heart failure. Other potential adverse effects include headache, drowsiness

Question 13

Side effects of hypertension meds by class (DIRECT RENIN INHIBITORS)

Answer 13

decrease heart rate [chronotropy], force of myocardial
contraction [inotropy]), cardiac output, and renin release from the kidneys

Question 14

Nursing assessment prior to administration

Answer 14

Assess for the use of oral contraceptives, corticosteroids, appetite suppressants, nasal decongestants, and nonsteroidal anti-inflammatory agents- can increase BP. Assess for S/S of hypertension. Assess BP accurately and repeatedly