Nokea
An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug?
- A. Dry mouth
- B. Restlessness
- C. Constipation
- D. Hypotension
Correct Answer: D
Rationale: The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experiences more problems with hypotension, dizziness, and syncope. The other options are incorrect.
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A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?
- A. 10 minutes
- B. 30 minutes
- C. 1 hour
- D. 24 hours
Correct Answer: A
Rationale: Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient's blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient's blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect.
A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril. The nurse is aware that the advantage of this drug for this patient is which characteristic?
- A. Captopril rarely causes first-dose hypotensive effects.
- B. Captopril has little effect on electrolyte levels.
- C. Captopril is a prodrug and is metabolized by the liver before becoming active.
- D. Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.
Correct Answer: D
Rationale: A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.
The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?
- A. Calcium channel blockers
- B. Diuretics
- C. Nonsteroidal anti-inflammatory drugs
- D. Nitrates
Correct Answer: C
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response?
- A. This therapy will take about 3 months.
- B. This therapy will take about a year.
- C. This therapy will go on until your symptoms disappear.
- D. Therapy for high blood pressure is usually lifelong.
Correct Answer: D
Rationale: There is no cure for hypertension, and treatment will be lifelong. The other answers are not appropriate.
A patient has a new order for the adrenergic drug doxazosin. When providing education about this drug, the nurse will include which instructions?
- A. Weigh yourself daily, and report any weight loss to your prescriber.
- B. Increase your potassium intake by eating more bananas and apricots.
- C. The impaired taste associated with this medication usually goes away in 2 to 3 weeks.
- D. Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy.
Correct Answer: D
Rationale: A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect.