Nokea
An older adult client is prescribed a diuretic and an antihypertensive drug as treatment for his hypertension. The client tells the nurse that he has been perspiring a lot lately and has had some diarrhea. Which nursing diagnosis would the nurse most likely identify as a priority?
- A. Risk for Deficient Fluid Volume
- B. Ineffective Sexuality Patterns
- C. Activity Intolerance
- D. Acute Pain
Correct Answer: A
Rationale: Risk for Deficient Fluid Volume would be the most likely priority because the client is receiving a diuretic and an antihypertensive drug. The risk increases if the client is older or confused. Ineffective Sexuality Patterns would be appropriate if the client were to experience sexual dysfunction related to drug therapy. Activity Intolerance would be appropriate if the client complained of feeling tired and weak. Acute Pain would be related to the development of a headache that may occur with angiotensin II receptor blockers or antiadrenergics.
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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.
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 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.
A nurse is educating a client with hypertension who is prescribed losartan about the drug's action. Which of the following would the nurse incorporate into the teaching about this drug?
- A. Blocking aldosterone receptors
- B. Preventing conversion of angiotensin I
- C. Blocking angiotensin II receptors
- D. Preventing renin secretion
Correct Answer: C
Rationale: Losartan is an angiotensin II receptor antagonist, acting to block the angiotensin II receptors. By blocking the angiotensin II receptor, the renin-angiotensin system is stopped and consequently blood pressure is reduced. Drugs such as captopril prevent the conversion of angiotensin I. Losartan does not prevent renin secretion. Losartan does not block aldosterone receptors.
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.