A client is prescribed clonidine as a transdermal patch. After instructing the client about this drug, the nurse determines that the teaching was successful when the client states that the patch should remain in place for how long?
- A. 24 hours
- B. 3 days
- C. 7 days
- D. 2 weeks
Correct Answer: C
Rationale: The nurse should ensure that the transdermal patch is intact for a period of 1 week. A clonidine transdermal patch should be applied to a hairless area over the torso for 1 week. If the patch loosens before 7 days, it has to be reinforced. The nurse has to mark the date of placement and the date of removal of the patch on the surface of the patch.
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A client who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse reactions. The nurse would be alert for which of the following due to abrupt discontinuation?
- A. Breathing difficulty
- B. Rebound hypertension
- C. Orthostatic hypotension
- D. Anginal attacks
Correct Answer: B
Rationale: Rebound hypertension will occur in clients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse reactions associated with antihypertensive drug usage and may not occur on stopping the drug.
A client, aged 60 years, is receiving nitroprusside for hypertensive emergency. The nurse would be alert for the development of which of the following?
- A. Significant hypotension
- B. Rebound hypertension
- C. Blindness
- D. Stroke
Correct Answer: A
Rationale: An older adult client is at risk for significant hypotension when receiving nitroprusside. To prevent this, the dosage should be reduced during the initial period of therapy. Rebound hypertension, stroke, and blindness will not occur during nitroprusside therapy.
A nurse is reviewing the medical records of several clients who have come to the clinic for a visit. The nurse determines that a client with which blood pressure readings would be identified as prehypertensive?
- A. 112 / 72 mm Hg
- B. 128 / 86 mm Hg
- C. 144 / 92 mm Hg
- D. 164 / 102 mm Hg
Correct Answer: B
Rationale: Prehypertension is classified as a systolic blood pressure ranging between 120 and 139 mm Hg or a diastolic pressure ranging between 80 and 89 mm Hg. A systolic pressure below 120 mm Hg and a diastolic pressure below 80 mm Hg is considered normal. Stage 1 hypertension would be characterized by a systolic pressure between 140 and 159 mm Hg or a diastolic pressure between 90 and 99 mm Hg. Stage 2 hypertension would be characterized by a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 100 mm Hg or greater.
When educating a group of nursing students on the mechanism of action of angiotensin-converting enzyme inhibitor (ACEI) drugs, the instructor identifies which of the following as the action brought about by aldosterone?
- A. Inhibits renin secretion
- B. Causes sodium and water retention
- C. Causes excess potassium retention
- D. Promotes angiotensin I conversion
Correct Answer: B
Rationale: Aldosterone causes retention of sodium and water. This in turn causes a rise in blood pressure. ACEIs act by inhibiting the conversion of angiotensin I to angiotensin II. Aldosterone does not inhibit the release of renin and is not involved in the retention of potassium. Angiotensin-converting enzymes, and not aldosterone, are involved in the conversion of angiotensin I to angiotensin II.
The nurse is providing care to a client being treated for a hypertensive emergency. Which of the following would be appropriate for the nurse to do?
- A. Take a blood pressure every 30 minutes.
- B. Alternate the arms for assessing the blood pressure and pulse.
- C. Continuously monitor the client's status.
- D. Measure the pulse rate every hour.
Correct Answer: C
Rationale: When the patient has severe hypertension, does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The blood pressure should be taken in the same arm and same position each time.
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