Chapter 23 Drugs Used to Treat Hypertension

Chapter 23  Drugs Used to Treat Hypertension

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurse’s best response?
a.
“Stop taking the medication immediately.”
b.
“Rise to a sitting or standing position slowly; your symptoms will resolve.”
c.
“I will schedule you to visit the health care provider today.”
d.
“Cut the pill in half and take a reduced dosage.”

ANS: B
Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the health care provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider.

DIF: Cognitive Level: Application REF: p. 366 | p. 370
OBJ: 6 TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

2. Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?
a.
Weight loss of more than 2 pounds/week
b.
LDL cholesterol levels have decreased.
c.
Urinary output is increased.
d.
Blood pressure has decreased.

ANS: D
The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure–elevating (vasoconstricting) and sodium retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs.

DIF: Cognitive Level: Application REF: p. 373 OBJ: 7
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity

3. How does propranolol (Inderal) control hypertension?
a.
Blocks alpha receptors throughout the body
b.
Increases the diuretic response in the renal tubules
c.
Reduces the sympathetic stimulation in cardiac muscle
d.
Inhibits the conversion of angiotensin I to angiotensin II

ANS: C
The beta adrenergic–blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This results in a decrease in heart rate, cardiac output, and blood pressure. Beta blockers do not affect alpha receptors. Beta blockers do not have a diuretic effect. ACE inhibitors are in the class of drugs that affects angiotensin conversion.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which class of antihypertensive agents should be avoided by patients with asthma?
a.
ACE inhibitors
b.
Diuretics
c.
Aldosterone receptor antagonists
d.
Beta adrenergic blocking agents

ANS: D
Beta adrenergic blocking agents can cause bronchoconstriction, which will aggravate asthmatic conditions. ACE inhibitors do not affect respiratory function. Diuretics have the effect of improving respiratory function in cases of congestive heart failure. Aldosterone receptor antagonists do not affect respiratory function.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 7
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. Which is true about postural hypotension during therapy with direct vasodilators?
a.
It indicates a therapeutic effect.
b.
It gradually resolves with continued medication use.
c.
It is a dose limiting complication of drug therapy.
d.
It is a precursor to hypertensive crisis.

ANS: B
Orthostatic hypotension can occur particularly at the initiation of therapy. Patients should be encouraged to change positions slowly. Symptoms generally will resolve as the patient becomes used to the medication. Postural hypotension is not a therapeutic effect and is not a precursor to a hypertensive crisis. Postural hypotension is an adverse effect with vasodilator therapy.

DIF: Cognitive Level: Comprehension REF: p. 366 | p. 370 | p. 383
OBJ: 7 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity