Nokea
The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of arterial blood pressure?
- A. Cardiac output and systemic vascular resistance
- B. Heart rate and peripheral resistance
- C. Blood volume and renal blood flow
- D. Myocardial contractility and arteriolar constriction
Correct Answer: A
Rationale: Blood pressure is determined by the product of cardiac output and systemic vascular resistance. The other options are incorrect.
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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.
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.
When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct?
- A. You need to have your blood pressure checked once a week and keep track of the readings.
- B. If you notice that the symptoms have gone away, you should be able to stop taking the drug.
- C. An exercise program may be helpful in treating hypertension, but let's check with your doctor first.
- D. If you experience severe side effects, stop the medicine and let us know at your next office visit.
- E. Most over-the-counter decongestants are compatible with antihypertensive drugs.
- F. Please continue taking the medication, even if you are feeling better.
Correct Answer: A,C,F
Rationale: Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. An exercise program may be beneficial but should be confirmed with the prescriber. Therapy is often lifelong, and patients should continue taking the medication even if feeling better to prevent rebound hypertension. Abruptly stopping medication or assuming over-the-counter decongestants are safe can lead to serious complications.
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.
During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, -Why is he looking at my eyes when I have high blood pressure? It does not make sense to me! What is the best response by the nurse?
- A. We need to monitor for drug toxicity.
- B. We must watch for increased intraocular pressure.
- C. The provider is assessing for visual changes that may occur with drug therapy.
- D. The provider is making sure the treatment is effective over the long term.
Correct Answer: D
Rationale: The physician would examine the fundus of a patient's eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.