Ch43 - Focus on Nursing Pharmacology 6e Instructor Test Bank PDF

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Focus on Nursing Pharmacology 6e
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Chapter 43- Drugs Affecting Blood Pressure What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African 1. 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 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. The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. 2. What is the priority nursing assessment related to this drug?

A) Mental illness B) Hepatic disease C) Renal disease D) Peptic ulcer disease 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. A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching 3. 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.

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. 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 4. 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 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. 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 5. 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 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. A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a 6. 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 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. 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) 7. 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 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. What is the nurse’s priority to assess before giving a female patient her prescription for an 8. angiotensin II receptor blocker (ARB)? A)  Do you eat something when you take your medications? B)  How much physical exercise do you get?  When was your last menstrual period (LMP)? C)

D)  Have you always weighed 130 pounds since you grew up? 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. 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 9. of this drug toxicity? A) Intake of alcohol B) The use of eggs in the diet C) The ingestion of grapefruit juice Intake of aged cheese D)

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. An older adult patient is taking a sustained-release antihypertensive drug. What is the 10. 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. 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. 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 11. the losartan regimen for better control of this patient’s hypertension? A) Candesartan (Atacand) B) Hydrochlorothiazide (Hyzaar) C) Captopril (Capoten) D) Antidiuretic hormone (ADH) 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. The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). 12. What drug specific adverse effect will the nurse include in the drug teaching? A) Sedation B) Persistent cough C) Tachycardia D) Rash 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. 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 13. 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. 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. The nurse provides dietary teaching to the patient with hypertension and determines the 14.

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 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). 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 15. what? A) Maintaining compliance B) Maintaining the blood pressure within normal limits

C) Maintaining a fluid volume balance D) Maintaining homeostasis 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. 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 16. apply.) A) Heart rate B) Stroke volume C) Preload D) Total peripheral resistance

E) Pulse pressure 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. 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 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. When a combination of drugs needs to be incorporated into the drug regimen for a 18. hypertensive patient, what type of diuretic would the nurse expect to administer? A) Thiazide B) Loop C) Potassium-sparing D) Osmotic 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. 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? 19. (Select all that apply.) A) Renal disease B) Cerebral infarction C) Heart failure D) Cholecystitis E) Migraine headache 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. The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial hypertension. What single indicator would the nurse use to evaluate the 20. effectiveness of this medication? A) Oxygen saturation B) Resting respiratory rate C) Exercise tolerance D) Breath sounds 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. 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 21. point? Encourage activity and begin weight loss diet. A)

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. Ans:

A

Feedback: Treatment of childhood hypertension should be done very cautiously because the longterm 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. 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 22. return blood pressure to an acceptable limit? Lifestyle changes A)

B) Mild diuretic C) Calcium channel blocker. D) Beta-blocker 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. 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 23. only used in what circumstances? Hypertensive emergencies A)

B) Hypertension in a patient having a myocardial infarction C) Hypertension complicated by symptoms of a stroke D) Hypertension associated with diabetic ketoacidosis 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. 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 24. 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 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 a...