Chapter 45: Vasodilators

Chapter 45: Vasodilators

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A patient with hypertension and heart failure presents to the emergency department complaining of a headache. The vital signs are: BP 189/112, pulse 92, respiration 20, and temp 99° F. The nurse administers hydralazine (Apresoline) intravenously. Reassessment after administration of the drug reveals these vital signs: BP 135/84, pulse 124, respiration 18, temp 98.8° F. The nurse correctly interprets these results as

a.	rebound hypertension.
b.	reflex tachycardia.
c.	essential hypertension.
d.	postural hypotension.

 

 

ANS:   B

Reflex tachycardia is caused by lowering of the arterial blood pressure. Hydralazine can trigger reflex stimulation of the heart by the sympathetic nervous system, thereby causing cardiac work and myocardial oxygen demand to increase and an increased heart rate.

Rebound hypertension does not occur with vasodilation.

The blood pressure has decreased, therefore essential hypertension is not present.

Postural hypotension results from relaxation in the veins, and hydralazine dilates arterioles.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 489

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A patient is receiving sodium nitroprusside (Nitropress) for hypertensive crisis. To prevent complications of this drug related to fluid retention, the nurse should avoid rapid infusion and be prepared to administer which of the following?

a.	Furosemide (Lasix) to prevent edema
b.	Beta blocker to counteract reflex tachycardia
c.	NSAID to counteract vasodilation
d.	Sodium thiosulfate to prevent cyanide poisoning

 

 

ANS:   A

Sodium nitroprusside can trigger retention of sodium and water. Lasix can help offset this effect.

There is no indication that reflex tachycardia is occurring, therefore administration of a beta blocker is not necessary.

Administration of an NSAID would not counteract vasodilation.

There is no indication the patient has cyanide poisoning.

 

DIF:    Cognitive Level: Application             REF:    pp. 491-492

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

3. A patient is receiving vasodilator therapy for hypertension. To counter the increase in blood volume caused by prolonged vasodilator therapy, the patient should be concurrently receiving what drug?

a.	Intravenous normal saline to increase the fluid volume
b.	A diuretic to prevent sodium and water retention
c.	A beta-adrenergic blocker (if the patient has a history of heart failure)
d.	Nesiritide (Natrecor) to increase preload

 

 

ANS:   B

Vasodilators cause an increase in blood volume secondary to prolonged reduction of blood pressure. The increase in volume represents an attempt by the body to restore blood pressure to pretreatment levels. A diuretic would help reduce fluid retention and, consequently, the blood pressure would not increase.

Intravenous normal saline would further increase the amount of fluid in the body and therefore is contraindicated.

A beta blocker also would contribute to an increase in volume; it would be indicated only if reflex tachycardia were an issue.

Nesiritide reduces preload; it is a vasodilator used in severe heart failure.

 

DIF:    Cognitive Level: Application             REF:    p. 491

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential