Unit6: Chapter 43 (Karch 7th Ed) - Drugs Affecting Blood Pressure

Question 1

1. What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man
   who is 25 pounds overweight and newly diagnosed with hypertension?
   A) An angiotensin-converting enzyme (ACE) inhibitor
   B) A beta-blocker
   C) A calcium channel blocker
   D) A diuretic

Answer 1

Ans: D
Feedback:
African Americans are at highest risk for developing hypertension with men more likely than women to
develop the disease. African Americans have documented differences in response to antihypertensive
therapy. They are most responsive to single-drug therapy and diuretics. The first line use of a diuretic is
in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or
alpha-adrenergic blocker should follow. African Americans are less responsive to ACE inhibitors and
beta-blocker.

Question 2

2. The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the
   priority nursing assessment related to this drug?
   A) Mental illness
   B) Hepatic disease
   C) Renal disease
   D) Peptic ulcer disease

Answer 2

Ans: C
Feedback:
Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the
presence of impaired renal function. Mental illness, hepatic disease, or peptic ulcer disease is not a
contraindication with this drug.

Question 3

3. A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include?
   A) Report onset of a cough or fever to health care provider.
   B) Limit fluid intake to decrease urinary output.
   C) Monitor blood pressure once a week.
   D) Take the drug late in the day to prevent sleepiness

Answer 3

Ans: A
Feedback:
Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle
weakness, and upper respiratory tract infections, so the patient should be taught to report a fever or
cough to his health care provider. Fluid intake should be normal and the drug is best taken in the
morning. Blood pressure should be monitored daily, especially when first starting the drug when
adverse effects are not yet known.

Question 4

4. A patient newly diagnosed with hypertension has just been given a prescription for medication. Along
   with promoting safety, what is the other goal of the nurse’s teaching plan?
   A) A blood pressure of 120/80
   B) Medication compliance
   C) A discussion with his insurance company about the cost of the drug
   D) Verbalization of why drugs should be kept out of the reach of children

Answer 4

Ans: B
Feedback:
The nurse provides thorough patient teaching, including the name of the drug, dosage prescribed,
measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and
evaluation, to enhance patient knowledge about drug therapy and to promote compliance. All of the
options are realistic outcomes for this patient. However, compliance is a great concern for people who
are in need of hypertensive agents. It would be most important for his or her health care provider to
know that he or she has filled the prescription and is taking his or her medication as prescribed.
Keeping the drug out of the reach of children would be a safety measure.

Question 5

5. A stepped care management approach to treating hypertension includes weight loss, smoking cessation,
   decreased use of alcohol, reducing salt in the diet, and increased physical exercise. In which step of a
   stepped-care management approach will the nurse teach about these changes in lifestyle?
   A) Step 1 only
   B) Steps 1 and 2
   C) Steps 1, 2, and 3
   D) Steps 1, 2, 3, and 4

Answer 5

Ans: D
Feedback:
Lifestyle changes are encouraged in all four steps and should be advocated for the maintenance of good
health. These changes are stressed in steps 1 and 2 in the hope that drug therapy will not be necessary.
However, these changes should occur in steps 3 and 4 as well.

Question 6

6. A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up
   appointment. What adverse effects would the nurse assess the patient for?
   A) Chest pain and pale skin
   B) Shortness of breath and wheezing
   C) Peripheral edema and bradycardia
   D) Tachycardia and increased energy level

Answer 6

Ans: C
Feedback:
Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension.
Skin flushing and rash may occur. There should be no effect on the lungs and usually this drug causes
fatigue rather than increased energy levels.

Question 7

7. A patient who works on road construction has been diagnosed with hypertension. After attempting to
   decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need
   to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is
   the nurse’s priority assessment?
   A) Chronic constipation
   B) Excessive sweating on the job
   C) Three large meals a day
   D) One beer every night

Answer 7

Ans: B
Feedback:
A patient taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the
job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or
dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller
meals rather than three larger ones would be better and should be encouraged. However, this could be a
problem with his job. The best treatment for constipation would be to increase fluid and fiber and one
beer a night would be within reason when considering alcohol intake.

Question 8

8. What is the nurse’s priority to assess before giving a female patient her prescription for an angiotensin
   II receptor blocker (ARB)?
   A) Do you eat something when you take your medications?
   B) How much physical exercise do you get?
   C) When was your last menstrual period (LMP)?
   D) Have you always weighed 130 pounds since you grew up?

Answer 8

Ans: C
Feedback:
It would be important to know when the patient’s LMP occurred and that the patient was not pregnant.
These drugs can cause fetal abnormalities and fetal death. The other questions are appropriate and
would help the nurse plan care for the patient; however, it would not be as important as assessing for
the possibility of pregnancy before beginning of therapy. The nurse should teach the patient the need to
avoid pregnancy using a barrier contraceptive.

Question 9

9. A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When
   collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?
   A) Intake of alcohol
   B) The use of eggs in the diet
   C) The ingestion of grapefruit juice
   D) Intake of aged cheese

Answer 9

Ans: C
Feedback:
The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit
juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to
toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a
patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit
juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not
be the most likely cause of drug toxicity. Eggs and cheese should not exert any food drug interaction.

Question 10

10. An older adult patient is taking a sustained-release antihypertensive drug. What is the nurse’s priority
    teaching point about this medication?
    A) Take your blood pressure only at night.
    B) Swallow the drug whole and do not to cut, crush, or chew it.
    C) Take the drug before bedtime.
    D) Use over-the-counter (OTC) drugs to control headache or cold symptoms.

Answer 10

Ans: B
Feedback:
Sustained-release drugs are suspended in a matrix system that allows a steady release of the drug over
time. Sustained-release drugs cannot be cut, crushed, or chewed; it destroys the matrix system and
allows absorption of the complete dose all at once. Older patients should be especially cautioned about
sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for
excessive dosing if these drugs are inappropriately cut. Many OTC drugs contain ingredients that
increase blood pressure and so are not recommended for patients with hypertension. The patient can
take his or her blood pressure any time during the day but should take the drug in the morning.

Question 11

11. A patient has been started on losartan (Cozaar), an angiotensin II receptor blocker (ARB), for
    hypertension. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the
    patient’s hypertension. What does the nurse anticipate will be added to the losartan regimen for better
    control of this patient’s hypertension?
    A) Candesartan (Atacand)
    B) Hydrochlorothiazide (Hyzaar)
    C) Captopril (Capoten)
    D) Antidiuretic hormone (ADH)

Answer 11

Ans: B
Feedback:
When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks.
If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination
product of losartan and hydrochlorothiazide (Hyzaar) is available. Adding a second ARB such as
candesartan or captopril would risk causing toxic adverse effects. ADH causes retention of water in the
nephrons, which would further increase blood pressure.

Question 12

12. The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug
    specific adverse effect will the nurse include in the drug teaching?
    A) Sedation
    B) Persistent cough
    C) Tachycardia
    D) Rash

Answer 12

Ans: B
Feedback:
Benazepril, enalapril, and fosinopril are generally well tolerated but cause an unrelenting cough,
possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited,
which may lead patients to discontinue the drug. This persistent cough develops in approximately 10%
to 20% of patients.

Question 13

13. The nurse provides drug teaching to the patient prescribed captopril (Capoten). What statement made
    by the patient does the nurse interpret to mean teaching has been effective?
    A) I will limit my fluid intake to 1,200 mL daily.
    B) I will call my doctor if I bruise easily or become extremely tired.
    C) I will move from a reclining to a standing position slowly.
    D) I will increase my intake of foods high in potassium.

Answer 13

Ans: B
Feedback: Captopril has been associated with a sometimes-fatal pancytopenia, cough, and unpleasant
gastrointestinal (GI) distress so the patient should be alert to symptoms related to anemia, reduction in
platelets, or infection. There is no need to increase potassium intake because a slight rise in potassium
level is associated with this drug. Orthostatic hypotension is not a listed adverse effect. There is no need
to limit fluid intake for most patients unless they have a comorbid disorder.

Question 14

14. The nurse provides dietary teaching to the patient with hypertension and determines the patient
    understood the information when what meal is selected?
    A) Hot dogs, baked beans, and cole slaw
    B) French fries, grilled hamburger, and cola drink
    C) Grilled chicken, green salad with dressing, and baked apple
    D) Bologna sandwich with mayonnaise, potato chips, and a chocolate-chip cookie

Answer 14

Ans: C
Feedback:
Chicken, salad, and fruit are all low in sodium. The other meal options all contain foods high in sodium
(i.e., hot dogs, French fries, processed meats like bologna, and potato chips).

Question 15

15. The nurse works with the patient, diagnosed with hypertension, and the patient’s family to determine
    the goal of drug therapy for the patient taking an antihypertensive medication is what?
    A) Maintaining compliance
    B) Maintaining the blood pressure within normal limits
    C) Maintaining a fluid volume balance
    D) Maintaining homeostasis

Answer 15

Ans: B
Feedback:
Helping the patient to maintain the blood pressure within normal limits is the goal of drug therapy.
How blood pressure is maintained within normal limits may involve balancing fluid volume and patient
compliance with the plan of care, but these are interventions and not the goal of therapy. Returning the
patient to homeostasis comes before maintaining homeostasis.

Question 16

16. While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Select all that apply.)
A) Heart rate
B) Stroke volume
C) Preload
D) Total peripheral resistance
E) Pulse pressure

Answer 16

Ans: A, B, D
Feedback:
The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume, or
the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by
the volume of blood in the system), and total peripheral resistance, or the resistance of the muscular
arteries to the blood being pumped through. The preload and the pulse pressure are not factors that
regulate pressure in the cardiovascular system.

Question 17

17. The nurse recognizes blood pressure is determined by three elements including what?
A) Peripheral resistance
B) Pulse pressure
C) Renal blood flow
D) Preload

Answer 17

Ans: A
Feedback:
The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume,
and peripheral resistance. The small arterioles are thought to be the most important factors in
determining peripheral resistance. Because they have the smallest diameter, they are able to almost stop
blood flow into capillary beds when they constrict, building up tremendous pressure in the arteries
behind them as they prevent the blood from flowing through.

Question 18

18. When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient,
    what type of diuretic would the nurse expect to administer?
    A) Thiazide
    B) Loop
    C) Potassium-sparing
    D) Osmotic

Answer 18

Ans: A
Feedback:
A somewhat controversial study, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart
Attack Trial (ALLHAT), reported in 2002 that patients taking the less expensive, less toxic diuretics
did better and had better blood pressure control than patients using other antihypertensive agents.
Replications of this study have supported its findings, and the use of a thiazide diuretic is currently
considered the first drug used in the stepped-care management of hypertension.

Question 19

19. The nurse is caring for a patient who has been noncompliant with treatment for hypertension. The nurse
    explains that untreated hypertension increases the risk of what? (Select all that apply.)
    A) Renal disease
    B) Cerebral infarction
    C) Heart failure
    D) Cholecystitis
    E) Migraine headache

Answer 19

Ans: A, B, C
Feedback:
Hypertension is a common chronic disorder. It is estimated that at least 20% of the people in the United
States have hypertension. Hypertension increases risks of myocardial infarction, heart failure, cerebral
infarction and hemorrhage, and renal disease. It does not increase the risk of cholecystitis or migraine
headache.

Question 20

20. The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial
    hypertension. What single indicator would the nurse use to evaluate the effectiveness of this
    medication?
    A) Oxygen saturation
    B) Resting respiratory rate
    C) Exercise tolerance
    D) Breath sounds

Answer 20

Ans: C
Feedback:
Although it is certainly important to assess all aspects of oxygenation and ventilation, the single best
indicator of drug effectiveness is improved exercise tolerance. Many patients can oxygenate at rest and
maintain a normal resting respiration, but activity increases oxygen demand, which is when signs of
pulmonary hypertension are best seen.

Question 21

21. The pediatric nurse examines a child with mildly elevated blood pressure who is 10% above the upper
    weight limits for his or her age. What is the nurse’s priority teaching point?
    A) Encourage activity and begin weight loss diet.
    B) Explain how to administer diuretics to reduce adverse effects.
    C) Involve social services in monitoring this child’s diet.
    D) Explain the most common adverse effects of calcium channel blockers.

Answer 21

Ans: A
Feedback:
Treatment of childhood hypertension should be done very cautiously because the long-term effects of
the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy is
started if at all possible. Weight loss and increased activity may bring an elevated blood pressure back
to normal in many children. As a result, the priority teaching point is to help parents understand how to
adapt the child’s diet to reduce weight and introduce family activities to increase exercise. Drug
teaching would only be required if lifestyle changes is inadequate to lower blood pressure. There is no
need to involve social services.

Question 22

22. The nurse is caring for an obese child with hypertension and slightly elevated serum glucose levels.
    What would the nurse anticipate will be ordered if lifestyle changes do not return blood pressure to an
    acceptable limit?
    A) Lifestyle changes
    B) Mild diuretic
    C) Calcium channel blocker.
    D) Beta-blocker

Answer 22

Ans: B
Feedback:
Lifestyle changes should be instituted before drug therapy if at all possible. If drug therapy is used, a
mild diuretic may be tried first, with monitoring of blood glucose and electrolyte levels on a regular
basis. Calcium channel blockers have been used to treat hypertension in children and may be among the
first considerations if drug therapy other than mild diuretics is needed. Beta-blockers have been used
with success in some children; adverse effects may limit their usefulness in others. The safety and
efficacy of the angiotensin-converting-enzyme (ACE) inhibitors and the angiotensin-receptor blockers
(ARBs) have not been established in children.

Question 23

23. The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient
    being brought to the hospital in an ambulance. The nurse knows this drug is only used in what
    circumstances?
    A) Hypertensive emergencies
    B) Hypertension in a patient having a myocardial infarction
    C) Hypertension complicated by symptoms of a stroke
    D) Hypertension associated with diabetic ketoacidosis

Answer 23

Ans: A
Feedback:
Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies.
These include hydralazine, minoxidil, and nitroprusside. The presence of absence of a comorbidity does
not increase the likelihood of use. These drugs are used when blood pressure is extremely high and
needs to be reduced quickly.

Question 24

24. The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan
    (Cozaar). The health care provider changes this patient’s prescription to losartan with
    hydrochlorothiazide (Hyzaar). What benefits does the nurse anticipate this patient will receive from this
    drug therapy? (Select all that apply.)
    A) Slows progression of diabetic nephropathy in type 2 diabetes
    B) Increases excretion of fluid and sodium resulting in lower blood volume
    C) Alters electrolyte and acid base balance
    D) Improves control of blood pressure due to combination therapy
    E) Produces far fewer adverse effects resulting from the combination

Answer 24

Ans: A, B
Feedback:
Many patients require more than one type of antihypertensive to achieve good control of their blood
pressure. There are now many fixed-combination drugs available for treating hypertension. This allows
for fewer tablets or capsules each day, making it easier for the patient to comply with drug therapy.
Losartan slows the progression of diabetic nephropathy in patients with hypertension and type 2
diabetes. Hydrochlorothiazide is a diuretic that will increase excretion of fluid and sodium resulting in
a lower circulating blood volume that will help to reduce blood pressure, preload, and afterload. The
two drugs will work together to better control the patient’s blood pressure. Alteration in electrolytes
and acid base is a reasonable expectation but it is an adverse effect and not a benefit. There are likely to
be more adverse effects when taking drugs that are not fixed combinations

Question 25

25. The patient is diagnosed with secondary hypertension. What will be the focus of nursing care to treat
this patient?
A) Administering epinephrine
B) Administering antihypertensives
C) Promoting healthy lifestyle
D) Treating the cause

Answer 25

Ans: A
Feedback:
Most people have essential, or primary, hypertension with no known cause that is treated with
medications and lifestyle changes. Patients with secondary hypertension means there is a known cause
of the blood pressure elevation. There are many different things that can result in secondary
hypertension; the focus of care is treating the cause whether that requires surgery, medication, or
discontinuing a medication that is causing hypertension as an adverse effect.

Question 26

26. The patient does not want to take medication to treat his or her hypertension if he or she can avoid it
and asks the nurse if there is anything else he or she can do? What lifestyle changes will the nurse
recommend? (Select all that apply.)
A) Increase time spent exercising.
B) Eliminate all salt from your diet.
C) Reduce intake of fluids.
D) Lose some weight.
E) Try meditation

Answer 26

Ans: A, D, E
Feedback:
Exercising, losing weight, and meditation to reduce stress are all effective changes the patient can make
in her lifestyle. However, if these do not bring blood pressure to within acceptable limits, the next step
in the stepped-care management approach to treat hypertension would be to introduce a diuretic, betablocker,
angiotensin-converting enzyme inhibitor, calcium channel blocker, or angiotensin II receptor
blocker in addition to the lifestyle changes. It is not necessary, or even possible, to eliminate all sodium
from the diet but cutting back will reduce water retention. Reducing intake of fluids is not a healthy
option and would not be suggested unless comorbidities, such as possibility of heart failure, were
present.

Question 27

27. The nurse evaluates the patient’s lifestyle for factors that are contributing to his or her diagnosis of
    hypertension and then addresses the need to change what factor?
    A) Working outdoors in the sun
    B) Weight lifting at the gym
    C) Married with two children
    D) Exposure to high-frequency noise

Answer 27

Ans: D
Feedback:
Factors that are known to increase blood pressure in some people include high levels of psychological
stress, exposure to high-frequency noise, a high-salt diet, lack of rest, and genetic predisposition.
Working outdoors in the sun may increase risk for skin cancer but does not contribute to hypertension.
Weight lifting is good exercise, especially if he uses low weight and frequent repetition. Being married
with two children is not a contributing factor for hypertension.

Question 28

28. A patient is admitted to the intensive care unit in shock with hypotension. What is an appropriate
    nursing diagnosis for this patient?
    A) Impaired gas exchange
    B) Deficient fluid volume
    C) Risk for shock
    D) Ineffective peripheral tissue perfusion

Answer 28

Ans: D
Feedback:
An appropriate nursing diagnosis would be ineffective peripheral tissue perfusion. If blood pressure
becomes too low, the vital centers in the brain, as well as the rest of the tissues of the body, may not
receive enough oxygenated blood to continue functioning. Because the patient is already in shock it
would not be a risk diagnosis. There is no indication of altered gas exchange or deficient fluid volume.

Question 29

29. The nurse is caring for a patient who takes ramipril (Altace) to treat hypertension. What would be an
    appropriate nursing diagnosis to include in this patient’s care plan?
    A) Ineffective tissue perfusion related to changes in cardiac output
    B) Acute pain related to skin effects and headache
    C) Altered gas exchange related to unrelenting cough
    D) Impaired body image

Answer 29

Ans: A
Feedback:
Nursing diagnoses related to drug therapy might include ineffective tissue perfusion (total body) related
to changes in cardiac output because ramipril is associated with adverse effects such as reflex
tachycardia, chest pain, angina, heart failure, and cardiac arrhythmias. Although dermatitis and rash
may occur, headaches are not an associated adverse effect of this drug. Benazepril, enalapril, and
fosinopril can cause an unrelenting cough but ramipril is not associated with this adverse effect.
Impaired body image would not be associated with this drug.

Question 30

30. What drug is a safe and effective calcium channel blocker only if the nurse administers them as
    sustained-release or extended-release preparations to treat hypertension?
    A) Aliskiren (Tekturna)
    B) Diltiazem (Cardizem)
    C) Atenolol (Tenormin)
    D) Metoprolol (Lopressor)

Answer 30

Ans: B
Feedback:
The calcium channel blockers available in immediate-release and sustained-release forms that are used
in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc,
DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and
effective for this use only if they are given as sustained-release or extended-release preparations. These
include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and
verapamil (Calan SR). Aliskiren (Tekturna) is a renin inhibitor. Atenolol (Tenormin) and Metoprolol
(Lopressor) are beta-blockers, not calcium channel blockers.

Question 31

31. The nurse works in a clinic that has many African American patients. What would the nurse need to
    consider when caring for patients with hypertension? (Select all that apply.)
    A) African American men are at highest risk for hypertension.
    B) African Americans respond best to single-drug therapy.
    C) African Americans are most responsive to angiotensin-converting enzyme inhibitors.
    D) Increased adverse effects occur when using thiazide and thiazide-like diuretics.
    E) First-line use of a calcium channel blocker with changes to lifestyle is best in African Americans.

Answer 31

Ans: A, B, D
Feedback:
In the United States, African Americans are at highest risk for developing hypertension, with men more
likely than women to develop the disease. African Americans are most responsive to single-drug
therapy (as opposed to combination drug regimens). African Americans are less responsive to
angiotensin-converting enzyme inhibitors and beta-blockers. Increased adverse effects (e.g., depression,
fatigue, drowsiness) often occur when using thiazide and thiazide-like diuretics. Because African
Americans are more responsive to diuretics, the treatment approach should include the first-line use of
a diuretic in combination with diet and other lifestyle changes.

Question 32

32. The nurse is caring for a patient newly prescribed iloprost (Ventavis). What is the nurse’s priority
    teaching point about this medication?
    A) Inhale this drug six to nine times a day during waking hours.
    B) Men should not touch this pill.
    C) It is safe for use in pregnancy.
    D) The drug causes peripheral dilation of blood vessels

Answer 32

Ans: A
Feedback:
Iloprost is an inhaled synthetic prostacyclin that directly dilates the pulmonary vascular bed, reducing
pressure in the pulmonary vascular system, increasing gas exchange, and easing the signs and
symptoms of pulmonary arterial hypertension. It is inhaled using a special delivery device six to nine
times a day while awake. Patients report dizziness and syncope after using the drug and are therefore
encouraged to change position slowly. Men and women should not ingest the drug or get it on their
skin. It is a pregnancy category C drug and so is not considered safe in pregnancy.

Question 33

33. No antihypertensive medication is safe during pregnancy but if the benefit for the mother outweighs the
    risk to the fetus, what classification of medication can the nurse administer to the hypertensive pregnant
    woman?
    A) Angiotensin-converting enzyme (ACE) inhibitor
    B) Angiotensin-receptor blocker (ARB)
    C) Renin inhibitor
    D) Calcium channel blocker

Answer 33

Ans: D
Feedback:
ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of
childbearing age should be advised to use barrier contraceptives to prevent pregnancy while taking
these drugs. Calcium channel blockers and vasodilators should not be used in pregnancy unless the
benefit to the mother clearly outweighs the potential risk to the fetus.

Question 34

34. The patient was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2
    of the stepped-care management of hypertension plan, an angiotensin-converting enzyme inhibitor was
    ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the
    provider will order what?
    A) A diuretic
    B) A beta-blocker
    C) A calcium channel blocker
    D) A vasodilator

Answer 34

Ans: A
Feedback:
In step 3, another drug will be added for combined effect. However, fixed-combination drugs should
only be used when the patient has been stabilized on each drug separately. A diuretic would be added
before adding another class of medication unless the first drug was a diuretic. Vasodilators are
generally used only in hypertensive emergencies

Question 35

35. The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital
    after suffering a myocardial infarction. What drug might the nurse administer that will both treat his
    hypertension and reduce myocardial oxygen consumption?
    A) Captopril
    B) Losartan
    C) Diltiazem
    D) Nitroprusside

Answer 35

Ans: C
Feedback:
Diltiazem inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle
cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and
dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption.
Captopril, losartan, and nitroprusside do not have actions to reduce myocardial oxygen consumption