PrepU Hypertension

Question 1

Why should over-the-counter cold medicines be avoided in ct. taking antihypertensive medication?

Answer 1

Could cause serious hypotension (HTN) if doubling doses. May precipitate HTN.

Question 2

Stopping antihypertensive abruptly can cause what?

Answer 2

A severe hypertensive reaction (not recommended)

Question 3

What is true about differences in blood pressure taken on opposite arms?

Answer 3

Pressure should not differ more than 5 mm Hg between arms

Question 4

Difference between hypertensive emergency and hypertensive urgency?

Answer 4

Emergency involves target organ damage.

Question 5

What types of medications are used to treat hypertension emergency?

Answer 5

IV vasodilators

Question 6

What class of medication is used to treat hypertensive emergencies?

Answer 6

-oral fast-acting agents such as
- beta-adrenergic blocking agents
- angiotensin-converting enzyme inhibitors
- alpha agonists

Question 7

Which diuretic agent may cause gout attacks and sudden joint point.

Answer 7

Thiazide

Question 8

A health care provider has prescribed a loop diuretic for a client with hypertension. The client also has diabetes mellitus. What condition should the nurse monitor for this client after administering the loop diuretic?

Answer 8

Increased blood glucose levels using a blood glucometer test (may be elevated or urine may test positive for glucose)

Question 9

Modifiable risk factors for hypertension:

Answer 9

-high blood cholesterol levels (HDL specifically)
-cigarette smoking
-obesity and visceral fat
-fitness level
-alcohol consumption
-insulin resistance and metabolic abnormalities
-obstructive sleep apnea.

Question 10

How many mg/day is considered a low-sodium diet?

Answer 10

500 mg/day

Question 11

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):
A. indirect vasodilator
B. direct vasoconstrictor
C. direct vasodilator
D. indirect vasoconstrictor

Answer 11

C; most are reserved for use in severe hypertension or hypertensive emergencies:
-diazoxide
-hydralazine (generic)
-minoxidil
-nitroprusside

Question 12

A client receiving an ACE inhibitor reports a problem with coughing. The nurse would ask the client if the client is receiving
A. lisinopril
B. benazepril

Answer 12

B: Benazepril is associated with an unrelenting cough.

Question 13

Alpha1-adrenergic receptor blocker can increase risk for what side-effect, so therefore should be taken at night?

Answer 13

orthostatic hypotension and falls

Question 14

When are direct vasodilators indicated?

Answer 14

When other drug therapies do not achieve the desired reduction

Question 15

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce?
A. Eating extra potassium to make up for lost minerals due to medications
B. walking as far as the ct. can every day
C. Changing positions slowly related to possible hypotension
D. Keeping follow up appointments

Answer 15

C.
Elderly have impaired cardiovascular reflexes and are more sensitive to extracellular volume depletion caused by diuretics and sympathetic inhibition caused by adrenergic antagonists.
-This safety precaution will help prevent falls.
-Eating extra potassium is not a good idea if the ct. is taking a potassium-sparing diuretic.
-Both other points are good for education but are not safety precautions

Question 16

A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
A. Do not smoke for at least 8 hours before a blood pressure reading
B. Sit quietly for 5 minutes prior to taking blood pressure
C. Be sure the forearm is well supported above heart level while taking blood pressure
D. Keep legs crossed while taking BP

Answer 16

B.
Instructions for taking BP at home include:
1- Avoid smoking cigarettes or drinking caffeine for 30 min. before measuring BP
2- Sit quietly for 5 minutes before measurement
3- Have the forearm supported at heart level, with both feet on the ground during the measurement

Question 17

Which finding indicates that hypertension is progressing to target organ damage?
A. Retinal blood vessel damage
B. Urine output of 60 mL over 2 hours
C. A BUN concentration of 12 mg/dL
D. Assess for presence of pneumonia

Answer 17

A: Eye exam with opthalmoscope = evidence of vascular damage = early detection. If there is damage to the eye, there is likely damage occurring in the body.
Both other answers are normal.
Pneumonia does not indicate target organ damage

Question 18

When blood pressure is measured, pressure rises during ventricular contraction, then falls during relaxation. As the pressure falls, there is a brief rise as the aortic valve closes. This rise is known by which terminology?

Answer 18

Dicrotic notch

Question 19

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 may create a risk for:
A. constipation
B. falls
C. xerostomia
D. depression

Answer 19

B:
Angiotensin II receptor blockers are associated with a risk of dizziness and a consequent risk for falls, which is more pronounced among older adults.

Question 20

What is the therapeutic effect of captopril (Capoten), ramipril & quinapril?

Answer 20

Inhibits ACE needed to change inactive angiotensin I to active angiotensin II. = decreases secretion of aldosterone, thus preventing sodium and water retention.
*Decreases peripheral vascular resistance
*lowers blood pressure

Question 21

Therapeutic action of medications such as verapamil?

Answer 21

calcium channel blockers block movement of calcium ions into arterial smooth muscles. They also dilate coronary and peripheral arteries

Question 22

Therapeutic value of eplerenone (Inspra)?

Answer 22

Inhibits aldosterone from binding to mineralocorticoid receptors

Question 23

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help promote compliance?

Answer 23

Cough.

Question 24

Besides cough, what are some other adverse side effects that can be caused by ACE inhibitors?

Answer 24

-GI irritation
-constipation
-photosensitivity

Question 25

Which condition contributes to secondary hypertension?
A. calcium deficiency
B. hepatic function
C. arterial vasoconstriction
d. acid-base imbalance

Answer 25

C. a condition that affects fluid volume or renal function or causes vasoconstriction.
A and D do not contribute to hypertension

Question 26

What BP readings are considered to be a hypertensive emergency?

Answer 26

BP of greater than 180/120, complicated by evidence of acute/worsening target organ damage. * It is critical that emergent interventions be implemented to return blood pressure to safe levels to prevent permanent organ dysfunction or death.

Question 27

If blood pressure is not lowered quickly during a hypertensive emergency, what can occur to other bodily organs?

Answer 27

-stroke
-kidney failure
-retinopathy
*Alarm should be set to alert medical staff if BP continues to rise

Question 28

Therapeutic value of Losartan and Olmesartan?

Answer 28

Angiotensin II receptor antagonists (ARBs); lower blood pressure by blocking the binding of angiotensin II at receptor sites in vascular smooth muscle and adrenal glands.

Question 29

A nurse is teaching a client who is newly diagnosed with HT and diabetes mellitus. What will the nurse specify about this client’s target blood pressure?

Answer 29

130/80: (lower goal pressure for those with diabetes mellitus)

Question 30

Guidelines for Dietary Approaches to Stop Hypertension (DASH) eating plan: (5)

Answer 30

1. Consume diet rich in vegetables, fruits, and low-fat dairy products (reduce sat. and total fat)
2. reduce dietary sodium intake to no more that 100 mmol/day (2.4 g sodium or 5 g sodium chloride)
3. engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week)
4. Moderate alcohol consumption (no more than 2 drinks per day for men and 1 drink per day for women)
5. Tobacco avoided

Question 31

Which hormone is a potent vasoconstricting hormone in the blood stream?

Answer 31

Angiotensin II

Question 32

Beta-blockers block what?

Answer 32

beta-adrenergic receptors = decreases sympathetic nervous system stimulation.

Question 33

What do loop diuretics do?

Answer 33

Excrete water from the loop of Henle, reducing circulating blood volume.

Question 33

What dietary caution needs to be provided to ct. prescribed oral furosemide?

Answer 33

strategies to limit sodium intake.

Question 34

Which pathogenesis is primarily responsible for Raynaud phenomenon?

Answer 34

Vasospasm of small distal arteries caused by excessive vasoconstrictor response to stimuli that normally produces only moderate vasoconstriction.

Question 35

What is the largest single cause of secondary hypertension?

Answer 35

Renal disease

Question 36

A nurse is planning a community education program on hypertension. Which parameter should be included to explain the regulation of arterial blood pressure?

Answer 36

cardiac output and systemic vascular resistance

Question 37

How is the mean arterial blood pressure determined?

Answer 37

cardiac output and peripheral vascular resistance
(mean arterial blood pressure = cardiac output x peripheral vascular resistance)

Question 38

What is the formula for cardiac output?

Answer 38

cardiac output = stroke volume x heart rate

Question 39

What does the peripheral vascular resistance reflect?

Answer 39

changes in the radius of the arterioles and viscosity/thickness of the blood.