Chapter 23: Drugs Used to Treat Hypertension My Nursing Test Banks

Chapter 23: Drugs Used to Treat Hypertension

Test Bank

MULTIPLE CHOICE

1. A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurses best response?

a.

Stop taking the medication immediately.

b.

Rise to a sitting or standing position slowly; your symptoms will resolve.

c.

I will schedule you to visit the health care provider today.

d.

Cut the pill in half and take a reduced dosage.

ANS: B

Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the health care provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider.

DIF: Cognitive Level: Application REF: p. 366 | p. 370

OBJ: 6 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?

a.

Weight loss of more than 2 pounds/week

b.

LDL cholesterol levels have decreased.

c.

Urinary output is increased.

d.

Blood pressure has decreased.

ANS: D

The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressureelevating (vasoconstricting) and sodium retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs.

DIF: Cognitive Level: Application REF: p. 373 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

3. How does propranolol (Inderal) control hypertension?

a.

Blocks alpha receptors throughout the body

b.

Increases the diuretic response in the renal tubules

c.

Reduces the sympathetic stimulation in cardiac muscle

d.

Inhibits the conversion of angiotensin I to angiotensin II

ANS: C

The beta adrenergicblocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This results in a decrease in heart rate, cardiac output, and blood pressure. Beta blockers do not affect alpha receptors. Beta blockers do not have a diuretic effect. ACE inhibitors are in the class of drugs that affects angiotensin conversion.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which class of antihypertensive agents should be avoided by patients with asthma?

a.

ACE inhibitors

b.

Diuretics

c.

Aldosterone receptor antagonists

d.

Beta adrenergic blocking agents

ANS: D

Beta adrenergic blocking agents can cause bronchoconstriction, which will aggravate asthmatic conditions. ACE inhibitors do not affect respiratory function. Diuretics have the effect of improving respiratory function in cases of congestive heart failure. Aldosterone receptor antagonists do not affect respiratory function.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. Which is true about postural hypotension during therapy with direct vasodilators?

a.

It indicates a therapeutic effect.

b.

It gradually resolves with continued medication use.

c.

It is a dose limiting complication of drug therapy.

d.

It is a precursor to hypertensive crisis.

ANS: B

Orthostatic hypotension can occur particularly at the initiation of therapy. Patients should be encouraged to change positions slowly. Symptoms generally will resolve as the patient becomes used to the medication. Postural hypotension is not a therapeutic effect and is not a precursor to a hypertensive crisis. Postural hypotension is an adverse effect with vasodilator therapy.

DIF: Cognitive Level: Comprehension REF: p. 366 | p. 370 | p. 383

OBJ: 7 TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

6. The nurse instructs the patient to avoid the sudden discontinuation of beta adrenergic blockers so as to avoid which symptom?

a.

Postural hypotension

b.

Edema

c.

Increased angina

d.

Confusion

ANS: C

Sudden discontinuation of beta adrenergic therapy has caused an exacerbation of anginal symptoms, resulting in cases of myocardial infarction. Postural hypotension occurs with the onset of treatment. Edema and confusion are not precipitated by cessation of treatment with beta blockers.

DIF: Cognitive Level: Comprehension REF: p. 368 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

7. What is mean arterial pressure (MAP)?

a.

The difference between the systolic and diastolic pressures

b.

An indicator of the tone of the arterial blood vessel walls

c.

The average pressure throughout each cycle of the heartbeat

d.

The product of the cardiac output and the peripheral vascular resistance

ANS: C

The MAP is the average pressure throughout each cycle of the heartbeat and is significant because it is the pressure that actually pushes the blood through the circulatory system. The difference between the systolic and diastolic pressures describes the pulse pressure. An indicator of the tone of the arterial blood vessel walls describes the pulse pressure. The product of the cardiac output and the peripheral vascular resistance describes the arterial blood pressure.

DIF: Cognitive Level: Comprehension REF: p. 357 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Which agents are preferred for the initial treatment of hypertension?

a.

ACE inhibitors and angiotensin receptor antagonists

b.

Calcium ion agonists and central acting alpha agonists

c.

Thiazide diuretics and beta adrenergic blockers

d.

Direct vasodilators and peripherally acting adrenergic antagonists

ANS: C

Preferred agents include diuretics and beta adrenergic blockers. ACE inhibitors, angiotensin receptor antagonists, calcium ion agonists, and central acting alpha agonists are alternative agents. Direct vasodilators and peripherally acting adrenergic antagonists are adjunctive agents.

DIF: Cognitive Level: Comprehension REF: p. 367 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Prior to the administration of a beta adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action?

a.

Administer the medication as ordered.

b.

Re evaluate the patient in 20 minutes.

c.

Obtain a serum blood level.

d.

Withhold the medication and notify the health care provider.

ANS: D

These symptoms warrant the nurses withholding the dose and then notifying the health care provider. The medication should not be administered if the patients heart rate is low or the patient is experiencing symptoms of heart failure and poor perfusion. The patient should be assessed frequently after the medication is held and the health care provider is notified, but action needs to be taken immediately. Therapeutic blood levels for beta adrenergic medications are not typically measured.

DIF: Cognitive Level: Application REF: p. 367 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta adrenergic blocker?

a.

Dizziness

b.

Peripheral edema

c.

Hyperglycemia

d.

Wheezing

ANS: D

Wheezing in a patient taking beta adrenergic blockers could indicate the adverse effect of bronchial constriction. Dizziness may indicate changes in blood pressure and safety precautions should be taken, but the medication does not have to be stopped. Peripheral edema may indicate cardiovascular problems, but the medication may have been prescribed to help these conditions. It would not warrant stopping the medication. Hyperglycemia may indicate a need for other interventions, but would not be a reason to stop the medication.

DIF: Cognitive Level: Application REF: p. 367 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse has provided information to a patient with diabetes who has been prescribed a beta adrenergic blocker. Which statement by the patient indicates a need for further teaching?

a.

If I get dizzy, I will stop taking the medication.

b.

I may not have my usual symptoms of low blood sugars.

c.

My dosage may need adjustment if I start taking any NSAIDs.

d.

I will need to be evaluated in a few weeks to see if my dosage is effective.

ANS: A

Patients should never stop taking beta adrenergic blocking agents suddenly because this can result in exacerbation of angina symptoms. Dizziness should resolve with therapy and patients should be taught how to manage this side effect safely. The patient may not experience the usual symptoms of low blood sugar. The dosage of the beta blocker may need to be increased to compensate for the antihypertensive inhibitory effect of nonsteroidal anti inflammatory drugs (NSAIDs). The patient will need to be evaluated to see if the dosage is effective.

DIF: Cognitive Level: Application REF: p. 367 OBJ: 7

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. The nurse is providing instruction to a patient who was recently prescribed an ACE inhibitor for hypertension. Which is an adverse effect of this medication?

a.

Constipation

b.

Chronic cough

c.

Hypokalemia

d.

Nervousness

ANS: B

Chronic cough may develop in as many as one third of patients receiving ACE inhibitors. Constipation, hypokalemia, and nervousness are not adverse effects of this medication.

DIF: Cognitive Level: Comprehension REF: pp. 368-372 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse is explaining to a patient how ACE inhibitors affect blood pressure. Which statement accurately describes the action of these medications?

a.

They increase aldosterone secretion.

b.

They inhibit vasoconstriction.

c.

They lower heart rate.

d.

They promote sodium retention.

ANS: B

ACE inhibitors decrease vasoconstriction and aldosterone secretion. ACE inhibitors do not increase aldosterone secretion, lower the heart rate, or promote sodium retention.

DIF: Cognitive Level: Comprehension REF: pp. 368-372 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. Which common adverse effect of an angiotensin II receptor antagonist will the nurse expect to assess in a patient?

a.

Bradycardia

b.

Headache

c.

Hypokalemia

d.

Insomnia

ANS: B

Headache is a common adverse effect of angiotensin II receptor antagonists. Bradycardia, hypokalemia, and insomnia are not common adverse effects of angiotensin II receptor antagonists.

DIF: Cognitive Level: Comprehension REF: p. 373 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

15. Which medication lowers blood pressure by directly inhibiting renin?

a.

Aliskiren (Tekturna)

b.

Eplerenone (Inspra)

c.

Diltiazem (Cardizem)

d.

Reserpine

ANS: A

Aliskiren is a renin angiotensin antagonist. Eplerenone blocks the action of aldosterone.

Diltiazem is a calcium channel blocker. Reserpine depletes catecholamines.

DIF: Cognitive Level: Knowledge REF: p. 374 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. A patient asks the nurse how amlodipine (Norvasc) works to reduce the blood pressure. Which response will the nurse provide?

a.

It causes blood vessel dilation.

b.

It helps you get rid of fluid.

c.

It helps your heart beat stronger.

d.

It slows your heart rate.

ANS: A

The dihydropyridine group (amlodipine) are calcium channel blocking medications that work by inhibiting the vasoconstricting effects of calcium to cause vasodilation. Amlodipine does not have a diuretic effect or cause the heart to contract more forcefully. Calcium channel blockers do slow the heart rate; however, the dihydropyridines (amlodipine) have peripheral vasodilating effects.

DIF: Cognitive Level: Comprehension REF: p. 377 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. A patient recently prescribed felodipine (Plendil) for treatment of hypertension is experiencing dizziness when rising to a standing position. Which action will the nurse take?

a.

Encourage the patient to sit down if feeling faint.

b.

Advise the patient to increase dietary sodium.

c.

Inform the patient to discontinue the medication.

d.

Instruct the patient to monitor weight daily.

ANS: A

If faintness or dizziness occurs, the nurse instructs the patient to sit or lie down and to change positions more slowly. Advising the patient to increase dietary sodium, informing the patient to discontinue the medication, and instructing the patient to monitor weight are not accurate interventions.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. Which physiologic response will the nurse expect to assess in patients taking hydralazine (Apresoline)?

a.

Pale skin

b.

Tachycardia

c.

Increased urinary output

d.

Cool extremities

ANS: B

With arteriolar smooth muscle relaxation, there is an increase in heart rate. Pale skin, increased urinary output , and cool extremities are not physiologic responses to hydralazine.

DIF: Cognitive Level: Application REF: p. 383 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

19. Which medication is often administered with hydralazine to reduce reflex physiological responses to the drug?

a.

Beta blockers

b.

Renin inhibitor

c.

ACE inhibitor

d.

Angiotensin II receptor blocker

ANS: A

Beta blockers are administered with hydralazine to reduce the reflex tachycardia caused by arterial vasodilation. Diuretics may also be administered to promote water and sodium excretion. Renin inhibitors, ACE inhibitors, and angiotensin II receptor blockers are not usually administered to reduce the physiologic effects of hydralazine.

DIF: Cognitive Level: Application REF: p. 383 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

20. Hydralazine, a direct vasodilator, is used to treat hypertension associated with which condition?

a.

Stroke

b.

Diabetes mellitus

c.

Myocardial infarction

d.

Renal disease

ANS: D

Hydralazine is used to treat hypertension associated with renal disease. Hydralazine is not used to treat hypertension associated with stroke, diabetes mellitus, or myocardial infarction.

DIF: Cognitive Level: Knowledge REF: p. 383 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

21. A patients blood pressure is 134/78 mm Hg. The nurse records the pulse pressure as:

a.

212.

b.

134.

c.

78.

d.

56.

ANS: D

56 is the difference between the systolic and diastolic pressure and is called the pulse pressure, which is an indicator of the tone of the arterial blood vessel walls. 212 is not the pulse pressure. 134 is the systolic pressure. 78 is the diastolic pressure.

DIF: Cognitive Level: Analysis REF: p. 357 OBJ: 1

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

22. Which complication(s) is/are associated with uncontrolled hypertension? (Select all that apply.)

a.

Angina

b.

Stroke

c.

Hyperglycemia

d.

Renal failure

e.

Heart failure

ANS: A, B, D, E

Angina, stroke, renal failure, and heart failure are complications associated with uncontrolled hypertension. Hyperglycemia is not a complication associated with uncontrolled hypertension.

DIF: Cognitive Level: Comprehension REF: p. 359 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

23. The nurse is finished conducting nutritional education with a patient about the DASH (dietary approaches to stop hypertension) diet. The patient would like to complete the breakfast menu for tomorrow. Which foods offered for breakfast would be most appropriate for the patient to choose? (Select all that apply.)

a.

Grapefruit

b.

Bacon

c.

Whole milk

d.

Orange juice

e.

Eggs

f.

Oatmeal

ANS: A, D, F

The DASH eating plan includes a diet rich in fruits, vegetables, and low fat dairy and other foods. Grapefruit, orange juice, and oatmeal would be appropriate choices. Bacon, whole milk, and eggs would not be appropriate for a person on the DASH diet.

DIF: Cognitive Level: Application REF: p. 359 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

24. Which statement(s) concerning the use of antihypertensive therapy for the treatment of hypertension would be considered true? (Select all that apply.)

a.

Diuretics are the most commonly prescribed antihypertensive agent.

b.

Diuretics are not used for older adult patients.

c.

Diuretics are the most expensive of the antihypertensive agents.

d.

Diuretics are often prescribed in combination therapy with other antihypertensive agents.

e.

Loop diuretics are considered potassium sparing.

ANS: A, D

Diuretics are the most commonly prescribed antihypertensive used to treat all classes of hypertension. They are one of the classes of agents that have been shown to reduce cardiovascular morbidity and mortality associated with hypertension. Diuretics are prescribed in combination therapy to potentiate hypotensive activity. More potent diuretics are used for older adult patients. Diuretics are low in cost. Diuretics often cause excretion of potassium, with the exception of potassium sparing diuretics used in combination with thiazide.

DIF: Cognitive Level: Analysis REF: p. 360 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

25. Which statement(s)

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