Chapter 18
Unfolding Case Study
1.
c.
Based on the American Heart Association Blood Pressure Category criteria, the client has hypertension stage 2 (systolic blood pressure 140 mm Hg or higher and diastolic blood pressure 90 mm Hg or higher).
2.
c.
Renal function tests are likely to be ordered for Hahn to evaluate the function of her kidneys because both hypertension and diabetes can cause kidney damage. Kidney function should also be evaluated before starting pharmacological treatment for hypertension.
3.
c.
ACE inhibitors, such as enalapril, can cause hyperkalemia (an elevated serum potassium level), so the nurse should advise the client not to use potassium-containing salt substitutes.
4.
b.
The client who smokes should be advised to stop smoking to aid in blood pressure control and reduce the risk for coronary artery disease. Other nonpharmacologic treatments for hypertension include weight reduction, salt restriction, exercising 30–40 minutes four times/week, and limiting alcohol intake.
5.
d.
Constipation is an adverse effect of verapamil, so the nurse instructs Hahn to increase her daily fiber intake to help reduce this effect.
6.
a.
In a heart-healthy diet, the client should reduce her intake of red meat. This statement indicates a need for further teaching.
Review Questions
1.
d.
Hypertension stage 2 is classified as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher.
2.
b.
Benazepril is an ACE inhibitor and may be used alone or in combination with other drugs in the management of hypertension and heart failure. A therapeutic effect of the medication is a normal blood pressure reading; 126/76 mm Hg falls within the AHA guidelines for normal blood pressure.
3.
a.
Nadolol is a nonselective beta-adrenergic blocker used to treat hypertension and other cardiac disease processes. Nadolol inhibits beta 1 and beta 2. Blockade of beta 2 receptors in the lungs causes bronchospasm; thus, nadolol is contraindicated in clients with asthma.
5.
d.
Transdermal nitroglycerin is prescribed as a maintenance medication for stable angina, which takes 30–60 minutes for therapeutic effects to begin. The patch should be applied around the same time every day and worn for 12–14 hours and then removed for 10–12 hours to avoid client tolerance.
6.
d.
Verapamil is a calcium channel blocker. Grapefruit juice increases blood levels of verapamil by inhibiting its metabolism. The excess amount of medication can intensify the medication’s hypotensive effect, placing the client at an increased risk for syncopal episodes.
7.
b.
Hydrochlorothiazide is a thiazide diuretic and can deplete potassium levels in the body. Clients should eat foods rich in potassium. Clients should monitor themselves for signs of hypokalemia such as fatigue, tachycardia, muscle weakness, and leg cramps.
9.
d.
Losartan is a selective and competitive angiotensin II receptor blocker (ARB) at the angiotensin I receptor.
10.
a.
Carvedilol is a beta-adrenergic blocker and slows the heart rate. A side effect of carvedilol is bradycardia. The health care provider should be notified of bradycardia in a client before the administration of the drug.