Chapter 34: Antihypertensive Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client is admitted to the emergency department with a severe headache, nausea, shortness of breath, and blood pressure of 200/120 mm Hg. Which response should the nurse prioritize? 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. Answer: C Rationale: When the client has a severe hypertensive emergency (such as an extremely elevated blood pressure), does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The alarm should be set to alert the medical staff if the blood pressure continues to rise. The client is at risk of developing serious complications such as a stroke, kidney failure, or retinopathy if the blood pressure is not lowered quickly. Question format: Multiple Choice Chapter: 34 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 437, Ongoing Assessment 2. A client presents to the urgent care clinic reporting severe dizziness. On assessment, the nurse learns the client was recently prescribed losartan and quit taking it thinking it was responsible for the dizziness. Which assessment should the nurse prioritize? a. Breathing difficulty b. Rebound hypertension c. Orthostatic hypotension d. Anginal attacks 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. Question format: Multiple Choice Chapter: 34 Learning Objective: 4 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 440, Educating the Client and Family 3. The nurse is teaching a client with hypertension about losartan which the health care provider has prescribed. The nurse can explain that losartan exerts which action on the body? a. Blocks aldosterone receptors b. Prevents conversion of angiotensin I c. Blocks angiotensin II receptors d. Prevents renin secretion 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. A new drug type—direct renin inhibitors—will inhibit renin and subsequently prevent the angiotensin conversion process. A second newer drug type is selective aldosterone receptor antagonists (SARAs), which blocks the angiotensin process by binding with aldosterone. Question format: Multiple Choice Chapter: 34 Learning Objective: 4 Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 434, Action of Angiotensin II Receptor Antagonists 4. The nurse is assessing a client with renal disease and discovers the client's blood pressure has increased since the last visit. The nurse suspects the client has developed which concern? a. Essential hypertension b. Secondary hypertension c. Rebound hypertension d. Hypertensive emergency