Chapter 47: Drugs for Hypertension

Chapter 47: Drugs for Hypertension

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory setting. The patient’s diagnostic tests are all normal. The nurse will expect this patient’s provider to order:

a.	a beta blocker.
b.	a loop diuretic and spironolactone.
c.	a thiazide diuretic.
d.	counseling on lifestyle changes.

 

 

ANS:  C

This patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as an adjunct to drug therapy but should also begin drug therapy because hypertension already exists.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 499-500 | p. 505

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient with diabetes develops hypertension. The nurse will anticipate administering which type of medication to treat hypertension in this patient?

a.	ACE inhibitors
b.	Beta blockers
c.	Direct-acting vasodilators
d.	Thiazide diuretics

 

 

ANS:  A

ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 507-508 | pp. 510-511

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg, and 126/96 mm Hg. Which category describes this patient’s BP?

a.	Hypertension
b.	Isolated systolic hypertension
c.	Normal
d.	Prehypertension

 

 

ANS:  A

Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg. When systolic and diastolic BP fall into different categories, classification is based on the higher category. This patient has a hypertensive diastolic BP. Isolated systolic hypertension occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg. Because this patient has an elevated diastolic BP, it is not considered normal. Prehypertension occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 499-500

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

4. A nurse checks a patient’s vital signs in the hospital and notes a blood pressure of 146/98 mm Hg. What will the nurse do?

a.	Instruct the patient to consume a low-sodium diet.
b.	Prepare the patient for an electrocardiogram and blood tests.
c.	Recheck the patient’s blood pressure in the other arm.
d.	Request an order for a thiazide diuretic.

 

 

ANS:  C

Diagnosis of hypertension should be based on several blood pressure readings, not just one. High readings should be confirmed in the contralateral arm. Low-sodium diets are indicated for patients with confirmed hypertension. An electrocardiogram and blood tests are indicated for patients with confirmed hypertension to rule out primary causes. Thiazide diuretics are first-line drugs for confirmed hypertension.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 500

TOP:   Nursing Process: Assessment

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